학술논문
Clinical characteristics and outcomes of COVID-19 patients with preexisting dementia: a large multicenter propensity-matched Brazilian cohort study.
Document Type
Academic Journal
Author
Bicalho MAC; Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Sala 246, Santa Efigênia, Belo Horizonte, Brazil. macbicalho@gmail.com.; Cologne University, Albertus-Magnus-Platz, Cologne, 50923, Allemagne. macbicalho@gmail.com.; Aliberti MJR; Laboratório de Investigação Médica Em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.; Research Institute, Hospital Sírio-Libanês, São Paulo, Brazil.; Delfino-Pereira P; Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Sala 246, Santa Efigênia, Belo Horizonte, Brazil.; Institute for Health Technology Assessment (IATS), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil.; Chagas VS; Institute for Health Technology Assessment (IATS), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil.; Medical School, Universidade Federal de Viçosa, Av. Peter Henry Rolfs, S/N, Viçosa, Brazil.; Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 110, Belo Horizonte, Brazil.; Rosa PMDS; Medical School, Centro Universitário de Belo Horizonte, Av. Professor Mário Werneck, 1685, Belo Horizonte, Brazil.; Pires MC; Department of Statistics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil.; Ramos LEF; Department of Statistics, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil.; Bezerra AFB; Hospital das Clínicas da Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235, Recife, Brazil.; de Castro Feres AB; Medical School, Faculdade Ciências Médicas de Minas Gerais, Al. Ezequiel Dias, 275, Belo Horizonte, Brazil.; Dos Reis Gomes AG; Hospitais da Rede Mater Dei, Av. do Contorno, 9000, Belo Horizonte, Brazil.; Bhering AR; Hospital UNIMED BH, Av. do Contorno, 3097, Belo Horizonte, Brazil.; Pessoa BP; Hospital Júlia Kubitschek, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil.; Silva CTCAD; Hospital Santo Antônio, Pç. Dr. Márcio Carvalho Lopes Filho, 501, Curvelo, Brazil.; Cimini CCR; Hospital Santa Rosália, R. Do Cruzeiro, 01, Teófilo Otoni, Brazil.; Mucuri Medical School, Universidade Federal dos Vales do Jequitinhonha e Mucuri, R. Cruzeiro, 01, Teófilo Otoni, Brazil.; Suemoto CK; Laboratório de Investigação Médica Em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.; Dias CAC; Medical School, Centro Universitário de Belo Horizonte, Av. Professor Mário Werneck, 1685, Belo Horizonte, Brazil.; Carazai DDR; Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil.; Ponce D; Botucatu Medical School, Universidade Estadual Paulista 'Júlio de Mesquita Filho', Av. Prof. Mário Rubens Guimarães Montenegro, Botucatu, Brazil.; Rios DRA; Universidade Federal de São João del-Rei, R. Sebastião Gonçalves Coelho, 400, Divinópolis, Brazil.; Manenti E; Hospital Mãe de Deus, R. José de Alencar, 286, Porto Alegre, Brazil.; Anschau F; Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil.; Batista JDL; Institute for Health Technology Assessment (IATS), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil.; Universidade Federal da Fronteira Sul, Rod. SC-459, Km 02, Fronteira Sul, Chapecó, Brazil.; Hospital Regional do Oeste, Hospital Regional do Oeste, Florianópolis street, Brazil.; Alvarenga JC; Hospital João XXIII, Av. Professor Alfredo Balena, 400, Belo Horizonte, Brazil.; Viguini JA; Mucuri Medical School, Universidade Federal dos Vales do Jequitinhonha e Mucuri, R. Cruzeiro, 01, Teófilo Otoni, Brazil.; Zanellato JM; Hospital SOS Cárdio, Rod. SC-401, 121, Florianópolis, Brazil.; Rugolo JM; Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil.; Ruschel KB; Institute for Health Technology Assessment (IATS), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil.; Hospital Universitário Canoas, Av. Farroupilha, 8001, Canoas, Brazil.; do Nascimento L; Hospital Universitário de Santa Maria, Av. Roraima, 1000, Santa Maria, Brazil.; Menezes LSM; Hospital Metropolitano Odilon Behrens, R. Formiga, 50, Belo Horizonte, Brazil.; Hospital Luxemburgo, R. Gentios, 1350, Belo Horizonte, Brazil.; Oliveira LMC; Hospital Universitário Ciências Médicas, R. dos Aimorés, 2896, Belo Horizonte, Brazil.; Castro LC; Hospital Bruno Born, Av. Benjamin Constant, 881, Lajeado, Brazil.; Nasi LA; Hospital Moinhos de Vento, R. Ramiro Barcelos, 910, Porto Alegre, Brazil.; Carneiro M; Hospital Santa Cruz, R. Fernando Abott, 174, Santa Cruz Do Sul, Brazil.; Ferreira MAP; Hospital de Clínicas de Porto Alegre, R. Ramiro Barcelos, 2350, Porto Alegre, Brazil.; Godoy MF; Hospital São Lucas da PUCRS, Av. Ipiranga, 6690, Porto Alegre, Brazil.; Guimarães-Júnior MH; Hospital Márcio Cunha, Av. Kiyoshi Tsunawaki, 48, Ipatinga, Brazil.; Oliveira NR; Hospital Eduardo de Menezes, R. Dr. Cristiano Rezende, 2213, Belo Horizonte, Brazil.; Ziegelmann PK; Hospital Tacchini, R. Dr. José Mário Mônaco, 358, Bento Gonçalves, Brazil.; Porto PF; Medical School, Centro Universitário de Belo Horizonte, Av. Professor Mário Werneck, 1685, Belo Horizonte, Brazil.; Mendes PM; Hospitais da Rede Mater Dei, Av. do Contorno, 9000, Belo Horizonte, Brazil.; Paraíso PG; Orizonti - Instituto Oncomed de Saúde e Longevidade, Av. José Do Patrocínio Pontes, 1355, Belo Horizonte, Brazil.; Reis PPD; Hospital Metropolitano Doutor Célio de Castro, R. Dona Luiza, 311, Belo Horizonte, Brazil.; Francisco SC; Hospital Metropolitano Doutor Célio de Castro, R. Dona Luiza, 311, Belo Horizonte, Brazil.; Araújo SF; Hospital Semper, Al. Ezequiel Dias, 389, Belo Horizonte, Brazil.; Avelino-Silva TJ; Laboratório de Investigação Médica Em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil.; Global Brain Health Institute, University of California, Av, Raja Gabaglia, San Francisco, Estoril, USA.; Marcolino MS; Medical School, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Sala 246, Santa Efigênia, Belo Horizonte, Brazil.; Institute for Health Technology Assessment (IATS), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil.; Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 110, Belo Horizonte, Brazil.
Source
Publisher: BioMed Central Country of Publication: England NLM ID: 100968548 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2318 (Electronic) Linking ISSN: 14712318 NLM ISO Abbreviation: BMC Geriatr Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Although dementia has emerged as an important risk factor for severe SARS-CoV-2 infection, results on COVID-19-related complications and mortality are not consistent. We examined the clinical presentations and outcomes of COVID-19 in a multicentre cohort of in-hospital patients, comparing those with and without dementia.
Methods: This retrospective observational study comprises COVID-19 laboratory-confirmed patients aged ≥ 60 years admitted to 38 hospitals from 19 cities in Brazil. Data were obtained from electronic hospital records. A propensity score analysis was used to match patients with and without dementia (up to 3:1) according to age, sex, comorbidities, year, and hospital of admission. Our primary outcome was in-hospital mortality. We also assessed admission to the intensive care unit (ICU), invasive mechanical ventilation (IMV), kidney replacement therapy (KRT), sepsis, nosocomial infection, and thromboembolic events.
Results: Among 1,556 patients included in the study, 405 (4.5%) had a diagnosis of dementia and 1,151 were matched controls. When compared to matched controls, patients with dementia had a lower frequency of dyspnoea, cough, myalgia, headache, ageusia, and anosmia; and higher frequency of fever and delirium. They also had a lower frequency of ICU admission (32.7% vs. 47.1%, p < 0.001) and shorter ICU length of stay (7 vs. 9 days, p < 0.026), and a lower frequency of sepsis (17% vs. 24%, p = 0.005), KRT (6.4% vs. 13%, p < 0.001), and IVM (4.6% vs. 9.8%, p = 0.002). There were no differences in hospital mortality between groups.
Conclusion: Clinical manifestations of COVID-19 differ between older inpatients with and without dementia. We observed that dementia alone could not explain the higher short-term mortality following severe COVID-19. Therefore, clinicians should consider other risk factors such as acute morbidity severity and baseline frailty when evaluating the prognosis of older adults with dementia hospitalised with COVID-19.
(© 2024. The Author(s).)
Methods: This retrospective observational study comprises COVID-19 laboratory-confirmed patients aged ≥ 60 years admitted to 38 hospitals from 19 cities in Brazil. Data were obtained from electronic hospital records. A propensity score analysis was used to match patients with and without dementia (up to 3:1) according to age, sex, comorbidities, year, and hospital of admission. Our primary outcome was in-hospital mortality. We also assessed admission to the intensive care unit (ICU), invasive mechanical ventilation (IMV), kidney replacement therapy (KRT), sepsis, nosocomial infection, and thromboembolic events.
Results: Among 1,556 patients included in the study, 405 (4.5%) had a diagnosis of dementia and 1,151 were matched controls. When compared to matched controls, patients with dementia had a lower frequency of dyspnoea, cough, myalgia, headache, ageusia, and anosmia; and higher frequency of fever and delirium. They also had a lower frequency of ICU admission (32.7% vs. 47.1%, p < 0.001) and shorter ICU length of stay (7 vs. 9 days, p < 0.026), and a lower frequency of sepsis (17% vs. 24%, p = 0.005), KRT (6.4% vs. 13%, p < 0.001), and IVM (4.6% vs. 9.8%, p = 0.002). There were no differences in hospital mortality between groups.
Conclusion: Clinical manifestations of COVID-19 differ between older inpatients with and without dementia. We observed that dementia alone could not explain the higher short-term mortality following severe COVID-19. Therefore, clinicians should consider other risk factors such as acute morbidity severity and baseline frailty when evaluating the prognosis of older adults with dementia hospitalised with COVID-19.
(© 2024. The Author(s).)