Autor(es):
Custodero, C ; Veronese, N ; Topinkova, E ; Michalkova, H ; Polidori, MC ; Cella, A ; Cruz-Jentoft, AJ ; von Arnim, CAF ; Azzini, M ; Gruner, H ; Castagna, A ; Cenderello, G ; Custureri, R ; Zieschang, T ; Padovani, A ; Sanchez-Garcia, E ; Pilotto, A ; Barbagallo, M ; Dini, S ; Diesner, NM ; Fernandes, M ; Gandolfo, F ; Garaboldi, S ; Musacchio, C ; Pilotto, A ; Pickert, L ; Podestà, S ; Ruotolo, G ; Sciolè, K ; Schlotmann, J
Data: 2023
Identificador Persistente: http://hdl.handle.net/10400.17/4853
Origem: Repositório do Centro Hospitalar de Lisboa Central, EPE
Assunto(s): Aged; Aged, 80 and over; COVID-19 Drug Treatment; COVID-19*; Female; Frailty* / drug therapy; Geriatric Assessment / methods; Humans; Prognosis; Prospective Studies; HCC MED
Descrição
Background: Data regarding the importance of multidimensional frailty to guide clinical decision making for remdesivir use in older patients with coronavirus disease 2019 (COVID-19) are largely unexplored. Objective: The aim of this research was to evaluate if the Multidimensional Prognostic Index (MPI), a multidimensional frailty tool based on the Comprehensive Geriatric Assessment (CGA), may help physicians in identifying older hospitalized patients affected by COVID-19 who might benefit from the use of remdesivir. Methods: This was a multicenter, prospective study of older adults hospitalized for COVID-19 in 10 European hospitals, followed-up for 90 days after hospital discharge. A standardized CGA was performed at hospital admission and the MPI was calculated, with a final score ranging between 0 (lowest mortality risk) and 1 (highest mortality risk). We assessed survival with Cox regression, and the impact of remdesivir on mortality (overall and in hospital) with propensity score analysis, stratified by MPI = 0.50. Results: Among 496 older adults hospitalized for COVID-19 (mean age 80 years, female 59.9%), 140 (28.2% of patients) were treated with remdesivir. During the 90 days of follow-up, 175 deaths were reported, 115 in hospital. Remdesivir treatment significantly reduced the risk of overall mortality (hazard ratio [HR] 0.54, 95% confidence interval CI 0.35-0.83 in the propensity score analysis) in the sample as whole. Stratifying the population, based on MPI score, the effect was observed only in less frail participants (HR 0.47, 95% CI 0.22-0.96 in propensity score analysis), but not in frailer subjects. In-hospital mortality was not influenced by remdesivir use. Conclusions: MPI could help to identify less frail older adults hospitalized for COVID-19 who could benefit more from remdesivir treatment in terms of long-term survival.
