Clinical characteristics and predictors of complications and mortality in hospitalized octogenarian patients with COVID-19: an ambispective study

Key summary points Aim This the study describes the clinical presentation of COVID-19 and the risk factors for complications and death in octogenarian hospitalized patients across the different waves of the disease. Findings The most frequently reported symptoms in hospitalized octogenarian patients were fever, cough, dyspnea, and asthenia with acute respiratory distress syndrome, renal failure, and delirium being the most frequent complications. Regarding complications, diabetes mellitus, heart failure, dyspnea, and higher baseline levels of creatinine were identified as risk factors, while a higher Barthel index and presence of cough were found to be protective. Age, dyspnea, abnormal bilateral chest x-ray, CRP, and sodium were identified as risk factors for death. Message These findings could be valuable for managing future pandemics by contributing to tailored interventions and strategies to reduce COVID-19 mortality and complications in this patient group. Objective This study aimed to describe the clinical presentation of COVID-19 in hospitalized patients aged 80 or above and to identify predictors for death and complications throughout the epidemic waves of the disease. Methods This was an observational, multicenter, ambispective study conducted between March 2020 and August 2021 using data collected in five centers from southern metropolitan area of Barcelona (COVID-MetroSud cohort). Patients were grouped based on the pandemic waves of inclusion in the registry. We conducted a descriptive analysis, followed by bivariate and multivariate analyses (binary logistic regression) to identify predictors of risk for death or complications. Results A total of 1192 patients (mean [SD] age 85.7 [4.22] years and 46.8% female) were included. The most frequently reported symptoms in all waves were fever (63.1%), cough (56.5%), dyspnea (48.2%), and asthenia (27.5%). Laboratory and radiological findings consistently showed abnormal bilateral chest X-ray results (72.5% of patients) and elevated inflammatory markers such as lactate dehydrogenase (mean [SD] 335 [188] U/L), C-reactive protein (CRP) (mean [SD] 110 [88.4] U/L), and ferritin (mean [SD] 842 [1561] U/L). Acute respiratory distress syndrome (43.7%), renal failure (19.2%), and delirium (17.5%) were the most frequent complications. The overall mortality rate was 41.4% and declined across the epidemic waves. Age, diabetes mellitus, heart failure, dyspnea, and higher baseline levels of creatinine were identifie