Comorbidities predict 30-day hospital mortality of older adults with COVID-19.
Henrique Pott Junior, Marcia Regina Cominetti
PMID 34256151WHAT IT FOUND
In 147 older adults hospitalized with COVID-19, 30-day mortality was higher with greater comorbidity burden: 7.3% with a Charlson score of 3 or less, 22.5% with 4 to 5, and 28.8% with 6 or more.
Key findings
01In 147 adults aged 60 years and older hospitalized with COVID-19, 30-day mortality was 7.3% in the Charlson Comorbidity Index group with score 3 or less, 22.5% in the score 4 to 5 group, and 28.8% in the score 6 or more group.
02After adjustment for sex, National Early Warning Score 2 at admission, and need for ICU admission, the Charlson Comorbidity Index remained associated with 30-day mortality (adjusted hazard ratio 1.33, 95% confidence interval 1.04 to 1.70).
03Survival analysis showed lower survival for the middle and highest comorbidity groups than the lowest group (overall log-rank p = 0.009).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Single-center study of 147 older adults, so results may not apply to other hospitals or populations. Observational and retrospective design cannot show that comorbidities caused higher mortality. Age was higher in the higher comorbidity groups (66.4, 74.1, and 80.7 years), so comorbidity burden and age are entangled. The Cox model reported in Table 3 adjusted for sex, National Early Warning Score 2, and ICU need, but age was not listed among those adjusted variables. The pairwise comparison between the lowest and middle comorbidity groups was p = 0.06, so it did not reach the stated significance threshold. Medical history, symptom onset, comorbidity severity, socioeconomic status, and pre-admission treatment were susceptible to bias, as the authors state. Patients with missing values were list-wise deleted, but the number deleted is not reported.
Declared interests
Funded by CAPES; the sponsor had no role in the design, methods, data collection, analysis, or preparation of the article. Authors declared no competing interests.
The easy way to misread this
Do not conclude that comorbidities caused higher mortality or that the Charlson Comorbidity Index should guide triage. This was an observational single-center study, age differed between comorbidity groups, and no triage rule was tested.