tetano
Editor, Senior Moderator
BMC Geriatr
. 2024 Jan 5;24(1):25.
doi: 10.1186/s12877-023-04494-w. Clinical characteristics and outcomes of COVID-19 patients with preexisting dementia: a large multicenter propensity-matched Brazilian cohort study
Maria Aparecida Camargos Bicalho[SUP] 1 2 [/SUP], Márlon Juliano Romero Aliberti[SUP] 3 4 [/SUP], Polianna Delfino-Pereira[SUP] 5 6 [/SUP], Victor Schulthais Chagas[SUP] 6 7 8 [/SUP], Patryk Marques da Silva Rosa[SUP] 9 [/SUP], Magda Carvalho Pires[SUP] 10 [/SUP], Lucas Emanuel Ferreira Ramos[SUP] 10 [/SUP], Adriana Falangola Benjamin Bezerra[SUP] 11 [/SUP], Ana Beatriz de Castro Feres[SUP] 12 [/SUP], Angélica Gomides Dos Reis Gomes[SUP] 13 [/SUP], Angelinda Rezende Bhering[SUP] 14 [/SUP], Bruno Porto Pessoa[SUP] 15 [/SUP], Carla Thais Cândida Alves da Silva[SUP] 16 [/SUP], Christiane Corrêa Rodrigues Cimini[SUP] 17 18 [/SUP], Claudia Kimie Suemoto[SUP] 3 [/SUP], Cristiana Andrade Coelho Dias[SUP] 9 [/SUP], Daniela Dos Reis Carazai[SUP] 19 [/SUP], Daniela Ponce[SUP] 20 [/SUP], Danyelle Romana Alves Rios[SUP] 21 [/SUP], Euler Manenti[SUP] 22 [/SUP], Fernando Anschau[SUP] 19 [/SUP], Joanna d'Arc Lyra Batista[SUP] 6 23 24 [/SUP], Joice Coutinho de Alvarenga[SUP] 25 [/SUP], Julia Avancini Viguini[SUP] 18 [/SUP], Julia Mariot Zanellato[SUP] 26 [/SUP], Juliana Machado Rugolo[SUP] 19 [/SUP], Karen Brasil Ruschel[SUP] 6 27 [/SUP], Leticia do Nascimento[SUP] 28 [/SUP], Luanna Silva Monteiro Menezes[SUP] 29 30 [/SUP], Lucas Moyses Carvalho de Oliveira[SUP] 31 [/SUP], Luís César de Castro[SUP] 32 [/SUP], Luiz Antônio Nasi[SUP] 33 [/SUP], Marcelo Carneiro[SUP] 34 [/SUP], Maria Angélica Pires Ferreira[SUP] 35 [/SUP], Mariana Frizzo de Godoy[SUP] 36 [/SUP], Milton Henriques Guimarães-Júnior[SUP] 37 [/SUP], Neimy Ramos de Oliveira[SUP] 38 [/SUP], Patricia Klarmann Ziegelmann[SUP] 39 [/SUP], Paula Fonseca Porto[SUP] 9 [/SUP], Paulo Mascarenhas Mendes[SUP] 13 [/SUP], Pedro Gibson Paraíso[SUP] 40 [/SUP], Priscilla Pereira Dos Reis[SUP] 41 [/SUP], Saionara Cristina Francisco[SUP] 41 [/SUP], Silvia Ferreira Araújo[SUP] 42 [/SUP], Thiago Junqueira Avelino-Silva[SUP] 3 43 44 [/SUP], Milena Soriano Marcolino[SUP] 5 6 8 [/SUP]
Affiliations
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.
Keywords: Brazil; COVID-19; Dementia; Hospital mortality; Hospitalisation; Multicentre study; Prognosis; Retrospective study; Severity.
. 2024 Jan 5;24(1):25.
doi: 10.1186/s12877-023-04494-w. Clinical characteristics and outcomes of COVID-19 patients with preexisting dementia: a large multicenter propensity-matched Brazilian cohort study
Maria Aparecida Camargos Bicalho[SUP] 1 2 [/SUP], Márlon Juliano Romero Aliberti[SUP] 3 4 [/SUP], Polianna Delfino-Pereira[SUP] 5 6 [/SUP], Victor Schulthais Chagas[SUP] 6 7 8 [/SUP], Patryk Marques da Silva Rosa[SUP] 9 [/SUP], Magda Carvalho Pires[SUP] 10 [/SUP], Lucas Emanuel Ferreira Ramos[SUP] 10 [/SUP], Adriana Falangola Benjamin Bezerra[SUP] 11 [/SUP], Ana Beatriz de Castro Feres[SUP] 12 [/SUP], Angélica Gomides Dos Reis Gomes[SUP] 13 [/SUP], Angelinda Rezende Bhering[SUP] 14 [/SUP], Bruno Porto Pessoa[SUP] 15 [/SUP], Carla Thais Cândida Alves da Silva[SUP] 16 [/SUP], Christiane Corrêa Rodrigues Cimini[SUP] 17 18 [/SUP], Claudia Kimie Suemoto[SUP] 3 [/SUP], Cristiana Andrade Coelho Dias[SUP] 9 [/SUP], Daniela Dos Reis Carazai[SUP] 19 [/SUP], Daniela Ponce[SUP] 20 [/SUP], Danyelle Romana Alves Rios[SUP] 21 [/SUP], Euler Manenti[SUP] 22 [/SUP], Fernando Anschau[SUP] 19 [/SUP], Joanna d'Arc Lyra Batista[SUP] 6 23 24 [/SUP], Joice Coutinho de Alvarenga[SUP] 25 [/SUP], Julia Avancini Viguini[SUP] 18 [/SUP], Julia Mariot Zanellato[SUP] 26 [/SUP], Juliana Machado Rugolo[SUP] 19 [/SUP], Karen Brasil Ruschel[SUP] 6 27 [/SUP], Leticia do Nascimento[SUP] 28 [/SUP], Luanna Silva Monteiro Menezes[SUP] 29 30 [/SUP], Lucas Moyses Carvalho de Oliveira[SUP] 31 [/SUP], Luís César de Castro[SUP] 32 [/SUP], Luiz Antônio Nasi[SUP] 33 [/SUP], Marcelo Carneiro[SUP] 34 [/SUP], Maria Angélica Pires Ferreira[SUP] 35 [/SUP], Mariana Frizzo de Godoy[SUP] 36 [/SUP], Milton Henriques Guimarães-Júnior[SUP] 37 [/SUP], Neimy Ramos de Oliveira[SUP] 38 [/SUP], Patricia Klarmann Ziegelmann[SUP] 39 [/SUP], Paula Fonseca Porto[SUP] 9 [/SUP], Paulo Mascarenhas Mendes[SUP] 13 [/SUP], Pedro Gibson Paraíso[SUP] 40 [/SUP], Priscilla Pereira Dos Reis[SUP] 41 [/SUP], Saionara Cristina Francisco[SUP] 41 [/SUP], Silvia Ferreira Araújo[SUP] 42 [/SUP], Thiago Junqueira Avelino-Silva[SUP] 3 43 44 [/SUP], Milena Soriano Marcolino[SUP] 5 6 8 [/SUP]
Affiliations
- PMID: 38182982
- PMCID: PMC10770897
- DOI: 10.1186/s12877-023-04494-w
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.
Keywords: Brazil; COVID-19; Dementia; Hospital mortality; Hospitalisation; Multicentre study; Prognosis; Retrospective study; Severity.