Scientific Bibliography - 20. Observational Study - Rejuvenation Res -. 2022 Jun;25

20. Observational Study - Rejuvenation Res -. 2022 Jun;25(3):129-140. doi: 10.1089/rej.2021.0063. Epub 2022 Jun 6.

COVID-19 as a Paradigmatic Model of the Heterogeneous Disease Presentation in Older People: Data from the GeroCovid Observational Study

Caterina Trevisan  1   2 , Francesca Remelli  1 , Stefano Fumagalli  3   4 , Enrico Mossello  3   4 , Chukwuma Okoye  5 , Giuseppe Bellelli  6   7 , Alessandra Coin  2 , Alba Malara  8 , Pietro Gareri  9 , Fabio Monzani  5 , Susanna Del Signore  10 , Gianluca Zia  10 , Raffaele Antonelli Incalzi  11 , Stefano Volpato  1 , GeroCovid Acute Ward Working Group

Affiliations

  • 1 Department of Medical Science, University of Ferrara, Ferrara, Italy.
  • 2 Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy.
  • 3 Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy.
  • 4 Division of Geriatric and Intensive Care Medicine, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
  • 5 Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
  • 6 School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
  • 7 Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy.
  • 8 ANASTE-Humanitas Foundation, Rome, Italy.
  • 9 CDCD Catanzaro Lido-ASP Catanzaro, Catanzaro, Italy.
  • 10 Bluecompanion Ltd, London, United Kingdom.
  • 11 Unit of Geriatrics, Department of Medicine, Campus Bio-Medico University and Teaching Hospital, Rome, Italy.

Collaborators

  • GeroCovid Acute Ward Working Group:

Rachele Antognoli, Maria Paola Antonietti, Viviana Bagalà, Giulia Bandini, Enrico Benvenuti, Marina Bergamin, Marco Bertolotti, Carlo Adriano Biagini, Angelo Bianchetti, Alessandra Bianchi, Mariangela Bianchi, Silvia Bignamini, Damiano Blandini, Stefano Boffelli, Maura Bugada, Valeria Calsolaro, Donatella Calvani, Elisiana Carpagnano, Barbara Carrieri, Viviana Castaldo, Alessandro Cavarape, Ilaria Cazzulani, Carilia Celesti, Chiara Ceolin, Maria Giorgia Ceresini, Antonio Cherubini, Anita Chizzoli, Erika Ciarrocchi, Paola Cicciomessere, Annalisa Corsi, Carlo Custodero, Federica D'Agostino, Maria Maddalena D'Errico, Aurelio De Iorio, Alessandro De Marchi, Giovambattista Desideri, Evelyn Di Matteo, Emma Espinosa, Luigi Esposito, Chiara Fazio, Chiara Filippini, Lucia Fiore, Caterina Fontana, Lina Forte, Riccardo Franci Montorzi, Carlo Fumagalli, Antonella Giordano, Evelina Giuliani, Antonio Greco, Andrea Herbst, Giuseppe Ielo, Antonella La Marca, Umberto La Porta, Ilaria Lazzari, Diana Lelli, Yari Longobucco, Flaminia Lucchini, Daniela Lucente, Lorenzo Maestri, Marcello Maggio, Paola Mainquà, Alessandra Marengoni, Benedetta Martin, Valentina Massa, Liliana Mazza, Carmela Mazzoccoli, Federica Morellini, Chiara Mussi, Giuseppe Orio, Annalisa Paglia, Giulia Pelagalli, Laura Pelizzoni, Alessandro Picci, Anette Hylen Ranhoff, Onofrio Resta, Antonella Riccardi, Daniela Rinaldi, Renzo Rozzini, Carlo Sabbà, Leonardo Sacco, Mariateresa Santoliquido, Mariella Savino, Francesco Scarso, Giuseppe Sergi, Gaetano Serviddio, Chiara Sidoli, Vincenzo Solfrizzi, Benedetta Soli, Laura Tafaro, Andrea Tedde, Giuseppe Dario Testa, Maria Giulia Tinti, Francesco Tonarelli, Elisabetta Tonon, Aurora Vitali, Francesca Zoccarato, Sonia Zotti

 

Abstract

COVID-19 may have a heterogeneous onset, especially in older age. However, whether and how COVID-19 signs and symptoms may present and aggregate together according to sociodemographic and health factors is unclear, as well as their prognostic value. This study included 981 COVID-19 inpatients who participated in the GeroCovid Observational study. Signs/symptoms at disease onset, sociodemographic, health, cognitive status, and mobility were systematically recorded. Clusters of signs/symptoms were identified through agglomerative hierarchical clustering. The associations of single signs/symptoms and symptom clusters with longer hospitalization (≥16 days) and in-hospital mortality were explored through logistic and Cox regressions. The signs/symptoms most reported in our sample (age 78.3 ± 9.39 years; 49.4% women) were fever (62.5%), cough (45.5%), and dyspnea (62.7%). Atypical symptoms were reported by up to one-third of patients, and delirium by 9.1%. Atypical symptoms were more frequent with advancing age and with lower pre-COVID-19 cognitive and mobility levels. Older men more likely reported respiratory symptoms than women. Dyspnea (hazard ratio [HR] = 1.47, 95% confidence interval [CI]: 1.02-2.12), tachypnea (HR = 1.53, 95% CI: 1.14-2.07), low oxygen saturation (HR = 1.95, 95% CI: 1.32-2.88) and delirium (HR = 1.60, 95% CI: 1.13-2.28) were associated with higher in-hospital mortality. Four symptom clusters were identified. Compared with the mild respiratory symptoms cluster, the severe clinical impairment cluster was associated with higher mortality (HR = 2.57, 95% CI: 1.58-4.18). The severe clinical impairment and aspecific symptoms clusters were associated with longer hospitalization (odds ratio [OR] = 2.38, 95% CI: 1.56-3.63, and OR = 1.75, 95% CI: 1.08-2.83, respectively). Multiple health aspects influence COVID-19 clinical presentation. A symptom clusters approach may help predict adverse health outcomes in older patients. In addition to respiratory symptoms, delirium is independently associated with mortality risk. ClinicalTrials.gov (NCT04379440).

Keywords: COVID-19; aged; cluster analysis; mortality; signs and symptoms.

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