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Prognostic factors and combined use of tocilizumab and corticosteroids in a Spanish cohort of elderly COVID-19 patients.
Duarte-Millán, Miguel A; Mesa-Plaza, Nieves; Guerrero-Santillán, Marta; Morales-Ortega, Alejandro; Bernal-Bello, David; Farfán-Sedano, Ana I; García de Viedma-García, Vanessa; Velázquez-Ríos, Laura; Frutos-Pérez, Begoña; De Ancos-Aracil, Cristina L; Soria Fernández-Llamazares, Guillermo; Toledano-Macías, María; Cristóbal-Bilbao, Rafael; Luquín-Ciuro, Nuria; Marrero-Francés, Jorge; Piedrabuena-García, Sara I; Satué-Bartolomé, José A; Gonzalo-Pascua, Sonia; Rivilla-Jiménez, Marta; Carpintero-García, Lorena; Ayala-Larrañaga, Ibone; García-Bermúdez, Virginia; Lara-Montes, Celia; Llerena-Riofrío, Álvaro R; RIvas-Prado, Luis; Walter, Stefan; Escriba-Barcena, Almudena; San Martín López, Juan V; Ruíz-Giardín, José M.
  • Duarte-Millán MA; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • Mesa-Plaza N; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • Guerrero-Santillán M; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • Morales-Ortega A; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • Bernal-Bello D; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • Farfán-Sedano AI; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • García de Viedma-García V; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • Velázquez-Ríos L; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • Frutos-Pérez B; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • De Ancos-Aracil CL; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • Soria Fernández-Llamazares G; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • Toledano-Macías M; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • Cristóbal-Bilbao R; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • Luquín-Ciuro N; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • Marrero-Francés J; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • Piedrabuena-García SI; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • Satué-Bartolomé JA; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • Gonzalo-Pascua S; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • Rivilla-Jiménez M; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • Carpintero-García L; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • Ayala-Larrañaga I; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • García-Bermúdez V; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • Lara-Montes C; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • Llerena-Riofrío ÁR; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • RIvas-Prado L; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • Walter S; Methodological Support Unit, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • Escriba-Barcena A; Intensive Care Unit, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • San Martín López JV; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
  • Ruíz-Giardín JM; Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain.
J Med Virol ; 94(4): 1540-1549, 2022 04.
Article in English | MEDLINE | ID: covidwho-1718400
ABSTRACT
Coronavirus disease 2019 (COVID-19) infection in elderly patients is more aggressive and treatments have shown limited efficacy. Our objective is to describe the clinical course and to analyze the prognostic factors associated with a higher risk of mortality of a cohort of patients older than 80 years. In addition, we assess the efficacy of immunosuppressive treatments in this population. We analyzed the data from 163 patients older than 80 years admitted to our institution for COVID-19, during March and April 2020. A Lasso regression model and subsequent multivariate Cox regression were performed to select variables predictive of death. We evaluated the efficacy of immunomodulatory therapy in three cohorts using adjusted survival analysis. The mortality rate was 43%. The mean age was 85.2 years. The disease was considered severe in 76.1% of the cases. Lasso regression and multivariate Cox regression indicated that factors correlated with hospital mortality were age (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.03-1.22), alcohol consumption (HR 3.15, 95% CI 1.27-7.84), CRP > 10 mg/dL (HR 2.67, 95% CI 1.36-5.24), and oxygen support with Venturi Mask (HR 6.37, 95% CI 2.18-18.62) or reservoir (HR 7.87, 95% CI 3.37-18.38). Previous treatment with antiplatelets was the only protective factor (HR 0.47, 95% CI 0.23-0.96). In the adjusted treatment efficacy analysis, we found benefit in the combined use of tocilizumab (TCZ) and corticosteroids (CS) (HR 0.09, 95% CI 0.01-0.74) compared to standard treatment, with no benefit of CS alone (HR 0.95, 95% CI 0.53-1.71). Hospitalized elderly patients suffer from a severe and often fatal form of COVID-19 disease. In this regard, several parameters might identify high-risk patients upon admission. Combined use of TCZ and CS could improve survival.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Adrenal Cortex Hormones / Antibodies, Monoclonal, Humanized / COVID-19 / COVID-19 Drug Treatment Type of study: Cohort study / Etiology study / Experimental Studies / Observational study / Prognostic study Limits: Female / Humans / Male Country/Region as subject: Europa Language: English Journal: J Med Virol Year: 2022 Document Type: Article Affiliation country: Jmv.27488

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Adrenal Cortex Hormones / Antibodies, Monoclonal, Humanized / COVID-19 / COVID-19 Drug Treatment Type of study: Cohort study / Etiology study / Experimental Studies / Observational study / Prognostic study Limits: Female / Humans / Male Country/Region as subject: Europa Language: English Journal: J Med Virol Year: 2022 Document Type: Article Affiliation country: Jmv.27488