ABSTRACT
COVID-19 hospital mortality is higher among older patients through as yet little-known factors. We aimed to assess the effect of frailty (FR), oropharyngeal dysphagia (OD) and malnutrition (MN) on mortality in hospitalized COVID-19 older patients. Prospective cohort study of older patients (>70 years) with COVID-19 admitted to a general hospital from April 2020 to January 2021. Patients were evaluated on admission, discharge and at 1- and 3-months follow up. FR was assessed with FRAIL-VIG, OD with Volume-Viscosity Swallowing Test and MN with GLIM criteria. Clinical characteristics and outcomes, including intra-hospital, 1- and 3-month mortality, were analyzed. 258 patients were included (82.5±7.6 years; 58.9% women); 66.7% had FR (mild 28.7%, moderate 27.1% and severe 10.9%); 65.4%, OD and 50.6%, MN. OD prevalence increased from non-FR patients through the severity levels of FR: mild, moderate and severe (29.8%, 71.6%, 90.0%, 96.2%; p<0.0001, respectively), but not that of MN (50.6%, 47.1%, 52.5%, 56.0%). Mortality over the whole study significantly increased across FR categories (9.3% non-FR; 23.0% mild; 35.7% moderate; 75.0% severe; p<.001). Functionality (Barthel pre-admission, HR=0.983, CI-95%:0.973-0.993; p=0.001), OD (HR=2.953, CI-95%:0.970-8.989; p=0.057) and MN (HR=4.279, CI-95%:1.658-11.049; p=0.003) were independent risk factors for intra-hospital mortality. FR, OD and MN are highly prevalent conditions in older patients hospitalized with COVID-19. Functionality, OD and MN were independent risk factors for intra-hospital mortality.
Subject(s)
COVID-19 , Deglutition Disorders , Frailty , Malnutrition , Humans , Female , Aged , Male , Deglutition Disorders/complications , Frailty/complications , Prospective Studies , COVID-19/complications , Malnutrition/complicationsABSTRACT
La fiebre de origen desconocido (FOD) constituye unos de los problemas de difícil resolución en la práctica clínica habitual y puede llegar a consumir recursos y esfuerzos diagnósticos considerables. El diagnóstico diferencial se hace especialmente más complejo en el caso de las personas ancianas, fundamentalmente porque con frecuencia manifiestan síntomas inespecíficos o de difícil interpretación. A su vez, el retraso en el diagnóstico comporta un deterioro funcional progresivo, que puede tener consecuencias fatales. La FOD en el anciano difiere de la FOD del adulto joven porque su etiología es diferente. Por tanto, es importante ser exhaustivo a la hora de diagnosticarla en nuestra población, porque a menudo estratable. Las enfermedades sistémicas, han ido ganando preponderancia como una de las causas más frecuentesde FOD en el anciano, y en concreto el diagnóstico de arteritis de células gigantes es el más prevalente entre ellas. Las infecciones y en concreto la tuberculosis, siguen teniendo especial peso cuantitativo en la etiologíade la misma. Por tanto, la rapidez en el diagnóstico y el inicio precoz de una terapia, que en ocasiones será empíricaante la sospecha diagnóstica, han de formar parte de nuestro manejo terapéutico. La FOD en el anciano es un buen ejemplo de síndrome clínico clásico que precisa de un abordaje específico(AU)
Fever of Unknown Origin (FUO) is one of the problems which is difficult to solve in the usual clinic practice, it can also waste diagnosis sources and efforts. The differential diagnosis get seven more complex in old people, basically because frequently they manifest unspecific symptoms or with a difficult interpretation. At the same time, the lateness in the diagnosis means a progressive functional impairment, which could have horrible consequences.The FUO in old people it is different from young people because of the different aetiology. Therefore, it is important to be exhaustive when diagnosing it in the population, because sometimes may be tractable. The systematic diseases, have been getting more preponderance as one of the most frequent FUO inold people, in concrete in the diagnose of giant cell arthritis is one of the most prevalent of them. Infections and specifically tuberculosis continue to have importance in its aetiology.Therefore, swiftness in the diagnose and a precocious starting in a therapy, which sometimes will be empirical beyond the diagnose hunch, have to take part in our therapeutic approach. FUO in old people its a good example of a classic clinical syndrome which needs a specific approach (AU)
