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Open Access 01-12-2022 | Tocilizumab | Research

Differences in clinical features and mortality in very old unvaccinated patients (≥ 80 years) hospitalized with COVID-19 during the first and successive waves from the multicenter SEMI-COVID-19 Registry (Spain)

Authors: Jose-Manuel Ramos-Rincon, Lidia Cobos-Palacios, Almudena López-Sampalo, Michele Ricci, Manel Rubio-Rivas, Maria-Victoria Nuñez-Rodriguez, Rodrigo Miranda-Godoy, Maria-Eugenia García-Leoni, Rosa Fernández-Madera-Martínez, Gema-María García-García, Jose-Luis Beato-Perez, Daniel Monge-Monge, Uxua Asín-Samper, Marta Bustamante-Vega, Isabel Rábago-Lorite, Santiago-Jesús Freire-Castro, Jose-Pablo Miramontes-González, Jeffrey-Oskar Magallanes-Gamboa, José-Nicolás Alcalá-Pedrajas, Miriam García-Gómez, Verónica Cano-Llorente, Francisco-Javier Carrasco-Sánchez, Jesús Martinez-Carrilero, Juan-Miguel Antón-Santos, Ricardo Gómez-Huelgas, the SEMI-COVID-19 Network

Published in: BMC Geriatrics | Issue 1/2022

Abstract

Background

Old age is one of the most important risk factors for severe COVID-19. Few studies have analyzed changes in the clinical characteristics and prognosis of COVID-19 among older adults before the availability of vaccines. This work analyzes differences in clinical features and mortality in unvaccinated very old adults during the first and successive COVID-19 waves in Spain.

Methods

This nationwide, multicenter, retrospective cohort study analyzes unvaccinated patients ≥ 80 years hospitalized for COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry). Patients were classified according to whether they were admitted in the first wave (March 1-June 30, 2020) or successive waves (July 1-December 31, 2020). The endpoint was all-cause in-hospital mortality, expressed as the case fatality rate (CFR).

Results

Of the 21,461 patients hospitalized with COVID-19, 5,953 (27.7%) were ≥ 80 years (mean age [IQR]: 85.6 [82.3–89.2] years). Of them, 4,545 (76.3%) were admitted during the first wave and 1,408 (23.7%) during successive waves. Patients hospitalized in successive waves were older, had a greater Charlson Comorbidity Index and dependency, less cough and fever, and met fewer severity criteria at admission (qSOFA index, PO2/FiO2 ratio, inflammatory parameters). Significant differences were observed in treatments used in the first (greater use of antimalarials, lopinavir, and macrolides) and successive waves (greater use of corticosteroids, tocilizumab and remdesivir). In-hospital complications, especially acute respiratory distress syndrome and pneumonia, were less frequent in patients hospitalized in successive waves, except for heart failure. The CFR was significantly higher in the first wave (44.1% vs. 33.3%; -10.8%; p < 0.001) and was higher among patients ≥ 95 years (54.4% vs. 38.5%; -15.9%; p < 0.001). After adjustments to the model, the probability of death was 33% lower in successive waves (OR: 0.67; 95% CI: 0.57–0.79).

Conclusions

Mortality declined significantly between the first and successive waves in very old unvaccinated patients hospitalized with COVID-19 in Spain. This decline could be explained by a greater availability of hospital resources and more effective treatments as the pandemic progressed, although other factors such as changes in SARS-CoV-2 virulence cannot be ruled out.

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Title: Differences in clinical features and mortality in very old unvaccinated patients (≥ 80 years) hospitalized with COVID-19 during the first and successive waves from the multicenter SEMI-COVID-19 Registry (Spain)
Authors: Jose-Manuel Ramos-Rincon
Lidia Cobos-Palacios
Almudena López-Sampalo
Michele Ricci
Manel Rubio-Rivas
Maria-Victoria Nuñez-Rodriguez
Rodrigo Miranda-Godoy
Maria-Eugenia García-Leoni
Rosa Fernández-Madera-Martínez
Gema-María García-García
Jose-Luis Beato-Perez
Daniel Monge-Monge
Uxua Asín-Samper
Marta Bustamante-Vega
Isabel Rábago-Lorite
Santiago-Jesús Freire-Castro
Jose-Pablo Miramontes-González
Jeffrey-Oskar Magallanes-Gamboa
José-Nicolás Alcalá-Pedrajas
Miriam García-Gómez
Verónica Cano-Llorente
Francisco-Javier Carrasco-Sánchez
Jesús Martinez-Carrilero
Juan-Miguel Antón-Santos
Ricardo Gómez-Huelgas
the SEMI-COVID-19 Network
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Tocilizumab
SARS-CoV-2
COVID-19
Published in: BMC Geriatrics / Issue 1/2022
Electronic ISSN: 1471-2318
DOI: https://doi.org/10.1186/s12877-022-03191-4

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