In-hospital mortality of older patients with COVID-19 throughout the epidemic waves in the great Paris area: a multicenter cohort study
Abstract Background Mortality 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 patien...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12877-023-04236-y |
| _version_ | 1797451520164233216 |
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| author | Sara Thietart Antoine Rozes Florence Tubach Stéphane Marot Anne-Geneviève Marcelin Mathieu Raux Hélène Vallet Bruno Riou Jacques Boddaert Lorène Zerah |
| author_facet | Sara Thietart Antoine Rozes Florence Tubach Stéphane Marot Anne-Geneviève Marcelin Mathieu Raux Hélène Vallet Bruno Riou Jacques Boddaert Lorène Zerah |
| author_sort | Sara Thietart |
| collection | DOAJ |
| description | Abstract Background Mortality 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. Methods This 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. Results Of 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. Conclusions Mortality 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. |
| first_indexed | 2024-03-09T14:55:49Z |
| format | Article |
| id | doaj.art-199b51eca44b49d3b1bc36009e0baf89 |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-03-09T14:55:49Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-199b51eca44b49d3b1bc36009e0baf892023-11-26T14:10:13ZengBMCBMC Geriatrics1471-23182023-09-0123111010.1186/s12877-023-04236-yIn-hospital mortality of older patients with COVID-19 throughout the epidemic waves in the great Paris area: a multicenter cohort studySara Thietart0Antoine Rozes1Florence Tubach2Stéphane Marot3Anne-Geneviève Marcelin4Mathieu Raux5Hélène Vallet6Bruno Riou7Jacques Boddaert8Lorène Zerah9Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié- Salpêtrière, Département de GériatrieAssistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié Salpêtrière, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, CIC-1901Sorbonne 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-1901Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Département de VirologieSorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Département de VirologieSorbonne Université, INSERM, UMRS1158, AP-HP, Hôpital Pitié-Salpêtrière, Département d’Anesthésie RéanimationSorbonne Université, INSERM, Centre d’Immunologie et des Maladies Infectieuses (Cimi-Paris), AP-HP, Hôpital Saint Antoine, Département de GériatrieSorbonne Université, UMRS INSERM 1166, IHU ICAN, AP-HP, Hôpital Pitié- Salpêtrière, Département des UrgencesSorbonne Université, INSERM, Centre d’Immunologie et des Maladies Infectieuses (Cimi-Paris), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Département de GériatrieSorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Département de GériatrieAbstract Background Mortality 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. Methods This 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. Results Of 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. Conclusions Mortality 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.https://doi.org/10.1186/s12877-023-04236-yCOVID-19In-hospital mortalityGeriatricWavesOmicron |
| spellingShingle | Sara Thietart Antoine Rozes Florence Tubach Stéphane Marot Anne-Geneviève Marcelin Mathieu Raux Hélène Vallet Bruno Riou Jacques Boddaert Lorène Zerah In-hospital mortality of older patients with COVID-19 throughout the epidemic waves in the great Paris area: a multicenter cohort study BMC Geriatrics COVID-19 In-hospital mortality Geriatric Waves Omicron |
| title | In-hospital mortality of older patients with COVID-19 throughout the epidemic waves in the great Paris area: a multicenter cohort study |
| title_full | In-hospital mortality of older patients with COVID-19 throughout the epidemic waves in the great Paris area: a multicenter cohort study |
| title_fullStr | In-hospital mortality of older patients with COVID-19 throughout the epidemic waves in the great Paris area: a multicenter cohort study |
| title_full_unstemmed | In-hospital mortality of older patients with COVID-19 throughout the epidemic waves in the great Paris area: a multicenter cohort study |
| title_short | In-hospital mortality of older patients with COVID-19 throughout the epidemic waves in the great Paris area: a multicenter cohort study |
| title_sort | in hospital mortality of older patients with covid 19 throughout the epidemic waves in the great paris area a multicenter cohort study |
| topic | COVID-19 In-hospital mortality Geriatric Waves Omicron |
| url | https://doi.org/10.1186/s12877-023-04236-y |
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