In-hospital mortality of older patients with COVID-19 throughout the epidemic waves in the great Paris area: a multicenter cohort study

BMC Geriatrics

Research

Antoine Rozes¹  Sara Thietart²  Hélène Vallet³  Jacques Boddaert⁴  Lorène Zerah⁵  Florence Tubach⁶  Stéphane Marot⁷  Anne-Geneviève Marcelin⁷  Mathieu Raux⁸  Bruno Riou⁹ 

[1] Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié Salpêtrière, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, F75013, Paris, France;Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié- Salpêtrière, Département de Gériatrie, Paris, France;Sorbonne Université, INSERM, Centre d’Immunologie et des Maladies Infectieuses (Cimi-Paris), AP-HP, Hôpital Saint Antoine, Département de Gériatrie, Paris, France;Sorbonne Université, INSERM, Centre d’Immunologie et des Maladies Infectieuses (Cimi-Paris), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Département de Gériatrie, Paris, France;Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Département de Gériatrie, Paris, France;Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901, F75013, Paris, France;Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Département de Virologie, Paris, France;Sorbonne Université, INSERM, UMRS1158, AP-HP, Hôpital Pitié-Salpêtrière, Département d’Anesthésie Réanimation, Paris, France;Sorbonne Université, UMRS INSERM 1166, IHU ICAN, AP-HP, Hôpital Pitié- Salpêtrière, Département des Urgences, Paris, France;

关键词: COVID-19;    In-hospital mortality;    Geriatric;    Waves;    Omicron;   

DOI  :  10.1186/s12877-023-04236-y

 received in 2022-11-27, accepted in 2023-08-16,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundMortality is high in older patients hospitalized with COVID-19. Previous studies observed lower mortality during the Omicron wave, yet no data is available on older patients. The objective was to compare in-hospital mortality between the Omicron and previous waves in older patients hospitalized with COVID-19.MethodsThis retrospective observational multicenter cohort study used the Greater Paris University Hospitals Group’s data warehouse (38 hospitals). Patients aged ≥ 75 years with a confirmed COVID-19 diagnosis and hospitalized from March 2020 to January 2022 were included. The study period was divided into five waves. The fifth wave (January 1st to 31st 2022) was considered as the Omicron wave as it was the predominant variant (≥ 50%), and was compared with waves 1 (March-July 2020), 2 (August-December 2020), 3 (January-June 2021) and 4 (July-December 2021). Primary outcome was in-hospital mortality. Secondary outcome was occurrence of ICU admission or in-hospital death. Multivariate logistic regression was performed, with a sensitivity analysis according to variant type.ResultsOf the 195,084 patients hospitalized with COVID-19, 19,909 patients aged ≥ 75 years were included (median age 85 [IQR 79–90] years, 53% women). Overall in-hospital mortality was 4,337 (22%), reaching 345 (17%) during wave 5. Waves 1 and 3 were significantly associated with increased in-hospital mortality in comparison with wave 5 (adjusted Odds Ratios aOR 1.42 [95%CI 1.21–1.66] and 1.56 [95%CI 1.33–1.83] respectively). Waves 1 to 3 were associated with an increased risk of occurrence of ICU admission or in-hospital death in comparison with wave 5: aOR 1.29 [95% CI 1.12 to 1.49] for wave 1, aOR 1.25 [95% CI 1.08 to 1.45] for wave 2 and aOR 1.56 [95% CI 1.36 to 1.79] for wave 3. Sensitivity analysis found that Omicron variant was associated with decreased mortality, in comparison with previous variants.ConclusionsMortality was lower during the 5th Omicron wave in the older population, but remained high, implying that this variant could be considered as “milder” but not “mild”. This persistently high mortality during the 5th Omicron wave highlights the importance of including older patients in clinical trials to confirm the benefit/risk balance of COVID-19 treatments in this fragile population.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

Fig. 1