1. Clinical characteristics and outcomes of COVID-19 patients with preexisting dementia: a large multicenter propensity-matched Brazilian cohort study.
- Author
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Bicalho MAC, Aliberti MJR, Delfino-Pereira P, Chagas VS, Rosa PMDS, Pires MC, Ramos LEF, Bezerra AFB, de Castro Feres AB, Dos Reis Gomes AG, Bhering AR, Pessoa BP, Silva CTCAD, Cimini CCR, Suemoto CK, Dias CAC, Carazai DDR, Ponce D, Rios DRA, Manenti E, Anschau F, Batista JDL, Alvarenga JC, Viguini JA, Zanellato JM, Rugolo JM, Ruschel KB, do Nascimento L, Menezes LSM, Oliveira LMC, Castro LC, Nasi LA, Carneiro M, Ferreira MAP, Godoy MF, Guimarães-Júnior MH, Oliveira NR, Ziegelmann PK, Porto PF, Mendes PM, Paraíso PG, Reis PPD, Francisco SC, Araújo SF, Avelino-Silva TJ, and Marcolino MS
- Subjects
- Humans, Aged, Brazil epidemiology, Cohort Studies, SARS-CoV-2, Inpatients, COVID-19 complications, COVID-19 diagnosis, COVID-19 epidemiology, Sepsis, Dementia diagnosis, Dementia epidemiology, Dementia therapy
- Abstract
Background: Although dementia has emerged as an important risk factor for severe SARS-CoV-2 infection, results on COVID-19-related complications and mortality are not consistent. We examined the clinical presentations and outcomes of COVID-19 in a multicentre cohort of in-hospital patients, comparing those with and without dementia., Methods: This retrospective observational study comprises COVID-19 laboratory-confirmed patients aged ≥ 60 years admitted to 38 hospitals from 19 cities in Brazil. Data were obtained from electronic hospital records. A propensity score analysis was used to match patients with and without dementia (up to 3:1) according to age, sex, comorbidities, year, and hospital of admission. Our primary outcome was in-hospital mortality. We also assessed admission to the intensive care unit (ICU), invasive mechanical ventilation (IMV), kidney replacement therapy (KRT), sepsis, nosocomial infection, and thromboembolic events., Results: Among 1,556 patients included in the study, 405 (4.5%) had a diagnosis of dementia and 1,151 were matched controls. When compared to matched controls, patients with dementia had a lower frequency of dyspnoea, cough, myalgia, headache, ageusia, and anosmia; and higher frequency of fever and delirium. They also had a lower frequency of ICU admission (32.7% vs. 47.1%, p < 0.001) and shorter ICU length of stay (7 vs. 9 days, p < 0.026), and a lower frequency of sepsis (17% vs. 24%, p = 0.005), KRT (6.4% vs. 13%, p < 0.001), and IVM (4.6% vs. 9.8%, p = 0.002). There were no differences in hospital mortality between groups., Conclusion: Clinical manifestations of COVID-19 differ between older inpatients with and without dementia. We observed that dementia alone could not explain the higher short-term mortality following severe COVID-19. Therefore, clinicians should consider other risk factors such as acute morbidity severity and baseline frailty when evaluating the prognosis of older adults with dementia hospitalised with COVID-19., (© 2024. The Author(s).)
- Published
- 2024
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