Clinical characteristics and predictors of complications and mortality in hospitalized octogenarian patients with COVID-19: an ambispective study
Authors: Arroyo-Huidobro Marta , Fontanet Natàlia Pallarès , Cordomí Cristian Tebé , Simonetti Antonella F. , Pérez-López Carlos , Abelenda-Alonso Gabriela , Rombauts Alexander , Bermudez Isabel Oriol , Izquierdo Elisenda , Díaz-Brito Vicente , Molist Gemma , Melis Guadalupe Gómez , Videla Sebastian , Soto Alfons López , Carratalà Jordi , Molinero Alejandro Rodriguez ,   On behalf of MetroSud and Divine Study Group, Gudiol Carlota , Aranda-Lobo Judit , Sanmartí Montserrat , Moreno Encarna , Alvarez Maria C. , Faura Ana , González Martha , Cruz Paula , Colom Mireia , Perez Andrea , Serrano Laura , Videla Sebastià , Besalú Mireia , Cobo Erik , Cortés Jordi , Fernández Daniel , Garmendia Leire , Gómez Guadalupe , Hereu Pilar , Langohr Klaus , Pérez-Álvarez Núria , Piulachs Xavier , Pallares Natàlia , Tebé Cristian , Besalú Mireia , Cobo Erik , Cortés Jordi , Fernández Daniel , Langohr Klaus , Pérez-Álvarez Núria , Piulachs Xavier , Gómez Guadalupe 
Published: October 2024

Abstract
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 identified as risk factors for complications, 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.

Conclusions
This study demonstrates the clinical presentation of COVID-19 (fever, cough, dyspnea, and asthenia) and the different risk factors for mortality and complications in octogenarian hospitalized patients throughout the pandemic. These findings could be highly valuable for managing future virus pandemics.