Risk factors for adverse outcomes in elderly patients with asthma and severe COVID-19 at the hospital and early post-hospital stages
- 作者: Avdeev S.1,2, Gaynitdinova V.1, Pozdniakova A.3, Vlasenko A.4, Gneusheva T.1, Baytemerova I.5
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隶属关系:
- Sechenov First Moscow State Medical University (Sechenov University)
- Pulmonology Research Institute
- University Clinical Hospital № 4 of Sechenov First Moscow State Medical University (Sechenov University)
- Novokuznetsk State Institute Doctors’ Improvements – branch of Russian Medical Academy of Continuous Professional Education
- City Clinical Hospital №5
- 期: 卷 95, 编号 1 (2023)
- 页面: 57-65
- 栏目: Original articles
- URL: https://journals.rcsi.science/0040-3660/article/view/133011
- DOI: https://doi.org/10.26442/00403660.2023.01.202049
- ID: 133011
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Background. Mortality and COVID-19 related factors are thoroughly analyzed. Given the large number of hospitalized patients, the potential short- and long-term COVID-19 related complications, further research is needed on the possible consequences of hospitalization, especially in higher-risk patients, after prolonged hospitalization and intensive care admission.
Aim. To study the clinical course and outcomes of severe COVID-19 in elderly patients with asthma at the hospital and early post-hospital stages.
Materials and methods. The study included 131 elderly patients (WHO, 2020) >60 years old, n=131 with asthma, hospitalized for severe COVID-19. Of these, 86 (65.6%) patients survived, 30 (22.9%) died in the hospital, and 15 (14.9%) patients died after discharge from the hospital (in the 90-day post-hospital period). COVID-19 was confirmed by laboratory tests (SARS-CoV-2 PCR RNA test) and/or clinically and radiologically. All patients had a documented history of asthma. Patients were followed up during the hospital stay and for 90 days after discharge.
Results. Comparison of outcomes showed that in the groups of patients with a fatal outcome (regardless of the stage), the Charlson comorbidity index, respiratory rate, extent of lung damage assessed by computed tomography, the absolute leukocyte and neutrophil number and the ratio of neutrophils to lymphocytes were statistically significantly higher. The absolute number of eosinophils was lower in these groups. In the group of patients who died during hospitalization, severe (IV–V) asthma (p=0.03), steroid use during the previous year (p=0.02), chronic heart failure with a reduced ejection fraction (p=0.009) were more common, and atopic asthma phenotype was less common (p=0.02). In those who died after discharge, more common were non-invasive ventilation and diabetes mellitus (p<0.001). The multivariate regression analysis model revealed the most significant predictors of mortality at the hospital and early post-hospital stages.
Conclusion. Adverse outcomes of severe COVID-19 in elderly patients with asthma include hospital and post-hospital mortality. The most significant predictors of mortality are the comorbidity index and low eosinophil count. Hospital mortality is associated with a higher ratio of neutrophils to lymphocytes and lower total protein levels; early (90-day) post-hospital mortality is associated with extensive lung damage shown by computed tomography and diabetes mellitus.
作者简介
Sergey Avdeev
Sechenov First Moscow State Medical University (Sechenov University); Pulmonology Research Institute
Email: ivv_08@mail.ru
ORCID iD: 0000-0002-5999-2150
акад. РАН, д-р мед. наук, проф., зав. каф. пульмонологии Института клинической медицины им. Н.В. Склифосовского; рук. клинического отд.
俄罗斯联邦, Moscow; MoscowViliya Gaynitdinova
Sechenov First Moscow State Medical University (Sechenov University)
编辑信件的主要联系方式.
Email: ivv_08@mail.ru
ORCID iD: 0000-0001-9928-926X
д-р мед. наук, проф. каф. пульмонологии Института клинической медицины им. Н.В. Склифосовского
俄罗斯联邦, MoscowAnna Pozdniakova
University Clinical Hospital № 4 of Sechenov First Moscow State Medical University (Sechenov University)
Email: ivv_08@mail.ru
ORCID iD: 0000-0001-9125-1873
врач-терапевт приемного отд-ния
俄罗斯联邦, MoscowAnna Vlasenko
Novokuznetsk State Institute Doctors’ Improvements – branch of Russian Medical Academy of Continuous Professional Education
Email: ivv_08@mail.ru
ORCID iD: 0000-0001-6454-4216
канд. техн. наук, преподаватель каф. медицинской кибернетики и информатики
俄罗斯联邦, NovokuznetskTatiana Gneusheva
Sechenov First Moscow State Medical University (Sechenov University)
Email: ivv_08@mail.ru
ORCID iD: 0000-0002-6757-8961
канд. мед. наук, ассистент каф. пульмонологии Института клинической медицины им. Н.В. Склифосовского
俄罗斯联邦, MoscowIrina Baytemerova
City Clinical Hospital №5
Email: ivv_08@mail.ru
ORCID iD: 0000-0001-7277-5284
врач-пульмонолог
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