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

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J Med Virol. 2021 Nov 29. doi: 10.1002/jmv.27488. Online ahead of print.

ABSTRACT

BACKGROUND: COVID-19 infection in elderly patients is more aggressive and treatments have shown limited efficacy.

OBJECTIVE: 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. To assess the efficacy of immunosuppressive treatments in this population.

METHODS: 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 was performed in order to select variables predictive of death. We evaluated the efficacy of immunomodulatory therapy in three cohorts using an adjusted survival analysis.

RESULTS: The mortality rate was 43%. 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 (HR 1.12, 95%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).

CONCLUSION: 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. This article is protected by copyright. All rights reserved.

PMID:34845754 | DOI:10.1002/jmv.27488