Prognostic factors and combined use of tocilizumab and corticosteroids in a Spanish cohort of elderly COVID‐19 patients

Coronavirus disease 2019 (COVID‐19) infection in elderly patients is more aggressive and treatments have shown limited efficacy. Our objective is to describe the clinical course and to analyze the prognostic factors associated with a higher risk of mortality of a cohort of patients older than 80 yea...

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Published in:	Journal of medical virology Vol. 94; no. 4; pp. 1540 - 1549
Main Authors:	Duarte‐Millán, Miguel A., Mesa‐Plaza, Nieves, Guerrero‐Santillán, Marta, Morales‐Ortega, Alejandro, Bernal‐Bello, David, Farfán‐Sedano, Ana I., García de Viedma‐García, Vanessa, Velázquez‐Ríos, Laura, Frutos‐Pérez, Begoña, De Ancos‐Aracil, Cristina L., Soria Fernández‐Llamazares, Guillermo, Toledano‐Macías, María, Cristóbal‐Bilbao, Rafael, Luquín‐Ciuro, Nuria, Marrero‐Francés, Jorge, Piedrabuena‐García, Sara I., Satué‐Bartolomé, José A., Gonzalo‐Pascua, Sonia, Rivilla‐Jiménez, Marta, Carpintero‐García, Lorena, Ayala‐Larrañaga, Ibone, García‐Bermúdez, Virginia, Lara‐Montes, Celia, Llerena‐Riofrío, Álvaro R., RIvas‐Prado, Luis, Walter, Stefan, Escriba‐Barcena, Almudena, San Martín López, Juan V., Ruíz‐Giardín, José M.
Format:	Journal Article
Language:	English
Published:	United States Wiley Subscription Services, Inc 01-04-2022 John Wiley and Sons Inc
Subjects:	Adrenal Cortex Hormones - administration & dosage Aged, 80 and over Antibodies, Monoclonal, Humanized - administration & dosage Comorbidity Confidence intervals Coronaviruses Corticoids Corticosteroids COVID-19 COVID-19 - mortality COVID-19 - virology COVID-19 Drug Treatment Drug Therapy, Combination elderly Female Health services Hospital Mortality Hospitalization Humans Immunomodulation Male Medical prognosis Monoclonal antibodies Mortality Multivariate analysis Older people Oxygen Oxygen demand Parameter identification Patients Prognosis Regression models Retrospective Studies Risk SARS-CoV-2 - drug effects SARS-CoV-2 - physiology Spain - epidemiology Statistical analysis Steroids Survival Survival Analysis tocilizumab Viral diseases Virology Spain COVID-19 tocilizumab corticosteroids prognosis elderly
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Summary:	Coronavirus disease 2019 (COVID‐19) infection in elderly patients is more aggressive and treatments have shown limited efficacy. Our objective is to describe the clinical course and to analyze the prognostic factors associated with a higher risk of mortality of a cohort of patients older than 80 years. In addition, we assess the efficacy of immunosuppressive treatments in this population. We analyzed the data from 163 patients older than 80 years admitted to our institution for COVID‐19, during March and April 2020. A Lasso regression model and subsequent multivariate Cox regression were performed to select variables predictive of death. We evaluated the efficacy of immunomodulatory therapy in three cohorts using adjusted survival analysis. The mortality rate was 43%. The mean age was 85.2 years. The disease was considered severe in 76.1% of the cases. Lasso regression and multivariate Cox regression indicated that factors correlated with hospital mortality were: age (hazard ratio [HR] 1.12, 95% confidence interval [CI]: 1.03–1.22), alcohol consumption (HR 3.15, 95% CI: 1.27–7.84), CRP > 10 mg/dL (HR 2.67, 95% CI: 1.36–5.24), and oxygen support with Venturi Mask (HR 6.37, 95% CI: 2.18–18.62) or reservoir (HR 7.87, 95% CI: 3.37–18.38). Previous treatment with antiplatelets was the only protective factor (HR 0.47, 95% CI: 0.23–0.96). In the adjusted treatment efficacy analysis, we found benefit in the combined use of tocilizumab (TCZ) and corticosteroids (CS) (HR 0.09, 95% CI: 0.01–0.74) compared to standard treatment, with no benefit of CS alone (HR 0.95, 95% CI: 0.53–1.71). Hospitalized elderly patients suffer from a severe and often fatal form of COVID‐19 disease. In this regard, several parameters might identify high‐risk patients upon admission. Combined use of TCZ and CS could improve survival. Highlights The COVID‐19 disease in the elderly population (> 80 years) is severe in most cases. We analyze which parameters at admission may be useful to better stratify the risk of mortality. Oxygen demand on admission is the most accurate parameter to determine prognosis. A combined use of corticosteroids and tocilizumab may improve overall survival versus corticosteroids alone or standard of care.
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ISSN:	0146-6615 1096-9071 1096-9071
DOI:	10.1002/jmv.27488