Role of Cardio-Renal Dysfunction, Inflammation Markers, and Frailty on In-Hospital Mortality in Older COVID-19 Patients: A Cluster Analysis

• Published in: Biomedicines Vol. 11; no. 9; p. 2473
• Main Authors: Spannella, Francesco, Giulietti, Federico, Laureti, Giorgia, Di Rosa, Mirko, Di Pentima, Chiara, Allevi, Massimiliano, Garbuglia, Caterina, Giordano, Piero, Landolfo, Matteo, Ferrara, Letizia, Fumagalli, Alessia, Lattanzio, Fabrizia, Bonfigli, Anna Rita, Sarzani, Riccardo
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 01.09.2023; MDPI
• Subjects: Atrial fibrillation; Bacterial infections; C-reactive protein; Canada; cluster; Cluster analysis; Comorbidity; COVID-19; Development and progression; Glomerular filtration rate; in-hospital mortality; Inflammation; Medical research; Medicine, Experimental; Mortality; NT-proBNP; older adults; Patient outcomes; Patients; Renal function; SARS-CoV-2; Canada
• ISSN: 2227-9059; 2227-9059
• DOI: 10.3390/biomedicines11092473

Our study aimed to identify clusters of hospitalized older COVID-19 patients according to their main comorbidities and routine laboratory parameters to evaluate their association with in-hospital mortality. We performed an observational study on 485 hospitalized older COVID-19 adults (aged 80+ years). Patients were aggregated in clusters by a K-medians cluster analysis. The primary outcome was in-hospital mortality. Medical history and laboratory parameters were collected on admission. Frailty, defined by the Clinical Frailty Scale (CFS), referred to the two weeks before hospitalization and was used as a covariate. The median age was 87 (83–91) years, with a female prevalence (59.2%). Three different clusters were identified: cluster 1 (337), cluster 2 (118), and cluster 3 (30). In-hospital mortality was 28.5%, increasing from cluster 1 to cluster 3: cluster 1 = 21.1%, cluster 2 = 40.7%, and cluster 3 = 63.3% (p < 0.001). The risk for in-hospital mortality was higher in clusters 2 [HR 1.96 (95% CI: 1.28–3.01)] and 3 [HR 2.87 (95% CI: 1.62–5.07)] compared to cluster 1, even after adjusting for age, sex, and frailty. Patients in cluster 3 were older and had a higher prevalence of atrial fibrillation, higher admission NT-proBNP and C-reactive protein levels, higher prevalence of concurrent bacterial infections, and lower estimated glomerular filtration rates. The addition of CFS significantly improved the predictive ability of the clusters for in-hospital mortality. Our cluster analysis on older COVID-19 patients provides a characterization of those subjects at higher risk for in-hospital mortality, highlighting the role played by cardio-renal impairment, higher inflammation markers, and frailty, often simultaneously present in the same patient.