Role of Cardio-Renal Dysfunction, Inflammation Markers, and Frailty on In-Hospital Mortality in Older COVID-19 Patients: A Cluster Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Ethics Statement
2.3. Clinical Parameters
2.4. Statistical Analysis
3. Results
3.1. General Characteristics and Cluster Characterization
3.2. In-Hospital Mortality
4. Discussion
Study Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Total | Cluster 1 | Cluster 2 | Cluster 3 | p | |
---|---|---|---|---|---|
N = 485 | N = 337 | N = 118 | N = 30 | ||
Female sex | 287 (59.2%) | 205 (60.8%) | 64 (54.2%) | 18 (60.0%) | 0.453 |
Age | 87 (83–91) | 86 (82–90) | 89 (84–94) | 88 (84–91) | <0.001 |
CFS | 6 (4–8) | 6 (4–8) | 7 (4–8) | 7 (6–8) | 0.025 |
Comorbidities | |||||
Diabetes Mellitus | 100 (20.6%) | 63 (18.7%) | 33 (28%) | 4 (13.3%) | 0.060 |
Hypertension | 318 (65.6%) | 211 (62.6%) | 90 (76.3%) | 17 (56.7%) | 0.015 |
Atrial Fibrillation | 130 (26.8%) | 64 (19%) | 52 (44.1%) | 14 (46.7%) | <0.001 |
Dementia | 168 (34.6%) | 111 (32.9%) | 45 (38.1%) | 12 (40%) | 0.485 |
Chronic Lung Diseases | 70 (14.4%) | 44 (13.1%) | 22 (18.6%) | 4 (13.3%) | 0.326 |
Myocardial Infarction | 7 (1.4%) | 2 (0.6%) | 4 (3.4%) | 1 (3.3%) | 0.061 |
Concurrent Bacterial Infection | 25 (5.2%) | 13 (3.9%) | 8 (6.8%) | 4 (13.3%) | 0.052 |
Stroke | 33 (6.8%) | 21 (6.2%) | 9 (7.6%) | 3 (10%) | 0.676 |
Dyslipidemia | 160 (33%) | 114 (33.8%) | 35 (29.7%) | 11 (36.7%) | 0.643 |
Charlson Index (points) | 1 (0–2) | 1 (0–1) | 1 (0–2) | 1 (0–2) | 0.032 |
Lab Parameters | |||||
NT-proBNP (pg/mL) | 1541 (569–4174) | 830 (376–1627) | 5302.5 (4260–8512) | 29,480.5 (21,250–40,161) | <0.001 |
Creatinine (mg/dL) | 1.03 (0.66–1.45) | 1.08 (0.72–1.5) | 0.92 (0.58–1.29) | 0.91 (0.57–1.2) | 0.008 |
eGFR (ml/min/1.73 m2) | 69 (45–84) | 79 (56–86) | 47 (30–74) | 33.5 (18–49) | <0.001 |
Neutrophil count (n/microl) | 6.14 (4.35–9.4) | 5.92 (4.28–8.67) | 6.665 (4.53–10.61) | 6.88 (4.56–11.31) | 0.095 |
CRP (mg/dL) | 3.65 (1.31–8.44) | 3.06 (1.17–7.54) | 4.31 (1.89–10.01) | 6.66 (2.19–13.07) | 0.003 |
Systolic BP (mmHg) | 135.5 ± 21.5 | 136.9 ± 20.5 | 134.9 ± 22.7 | 122.2 ± 24.5 | 0.203 |
End-points | |||||
Length of stay (days) | 14 (9–22) | 14 (9–22) | 13.5 (9–21) | 10.5 (5–25) | 0.437 |
In-hospital mortality | 138 (28.5%) | 71 (21.1%) | 48 (40.7%) | 19 (63.3%) | <0.001 |
HR (95%CI) | |
---|---|
Comorbidities | |
Diabetes Mellitus | 0.86 (0.54–1.37) |
Hypertension | 0.82 (0.54–1.24) |
Atrial Fibrillation | 1.34 (0.90–1.99) |
Dementia | 1.01 (0.68–1.50) |
Chronic Lung Diseases | 1.43 (0.91–2.23) |
Myocardial Infarction | 1.49 (0.37–6.08) |
Concurrent Bacterial Infection | 0.77 (0.37–1.59) |
Stroke | 0.68 (0.32–1.48) |
Dyslipidemia | 0.64 (0.41–0.99) |
Lab Parameters | |
NT-proBNP (pg/mL) | 1.000028 (1.000015–1.000041) |
Creatinine (mg/dL) | 1.11 (1.04–1.19) |
Neutrophil count (n/microl) | 1.10 (1.07–1.13) |
eGFR (ml/min/1.73 m2) | 0.98 (0.97–0.99) |
CRP (mg/dL) | 1.07 (1.05–1.10) |
Systolic BP (mmHg) | 0.99 (0.98–1.00) |
Cluster (ref. 1) | |
2 | 1.96 (1.28–3.01) |
3 | 2.87 (1.62–5.07) |
Outcome | Addition | AUC (95% CI) | Overall NRI (95%CI) | ΔAUC (95%CI) | p |
---|---|---|---|---|---|
Death (n = 138) | 0.60 (0.54–0.66) | ||||
CFS | 0.57 (0.24–0.76) | 0.12 (0.07–0.17) | <0.001 |
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Spannella, F.; Giulietti, F.; Laureti, G.; Di Rosa, M.; Di Pentima, C.; Allevi, M.; Garbuglia, C.; Giordano, P.; Landolfo, M.; Ferrara, L.; et al. Role of Cardio-Renal Dysfunction, Inflammation Markers, and Frailty on In-Hospital Mortality in Older COVID-19 Patients: A Cluster Analysis. Biomedicines 2023, 11, 2473. https://doi.org/10.3390/biomedicines11092473
Spannella F, Giulietti F, Laureti G, Di Rosa M, Di Pentima C, Allevi M, Garbuglia C, Giordano P, Landolfo M, Ferrara L, et al. Role of Cardio-Renal Dysfunction, Inflammation Markers, and Frailty on In-Hospital Mortality in Older COVID-19 Patients: A Cluster Analysis. Biomedicines. 2023; 11(9):2473. https://doi.org/10.3390/biomedicines11092473
Chicago/Turabian StyleSpannella, Francesco, Federico Giulietti, Giorgia Laureti, Mirko Di Rosa, Chiara Di Pentima, Massimiliano Allevi, Caterina Garbuglia, Piero Giordano, Matteo Landolfo, Letizia Ferrara, and et al. 2023. "Role of Cardio-Renal Dysfunction, Inflammation Markers, and Frailty on In-Hospital Mortality in Older COVID-19 Patients: A Cluster Analysis" Biomedicines 11, no. 9: 2473. https://doi.org/10.3390/biomedicines11092473