In-hospital mortality of older patients with COVID-19 throughout the epidemic waves in the great Paris area: a multicenter cohort study

• Published in: BMC geriatrics 2023-09, Vol.23 (1), p.1-573, Article 573
• Main Authors: Thietart, Sara, Rozes, Antoine, Tubach, Florence, Marot, Stéphane, Marcelin, Anne-Geneviève, Raux, Mathieu, Vallet, Hélène, Riou, Bruno, Boddaert, Jacques, Zerah, Lorène
• Format: Article
• Language: English
• Subjects: Age; Aged patients; Analysis; Cardiovascular disease; Clinical trials; Codes; Cohort analysis; COVID-19; Data warehouses; France; Geriatric; Geriatrics; Hospitalization; Hospitals; In-hospital mortality; Intensive care; Medical records; Mortality; Multivariate analysis; Older people; Omicron; Patient outcomes; Patients; Population; Regression analysis; Sensitivity analysis; Severe acute respiratory syndrome coronavirus 2; Warehouse stores; Waves
• ISSN: 1471-2318; 1471-2318
• DOI: 10.1186/s12877-023-04236-y

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 [greater than or equal to] 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 ([greater than or equal to] 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 [greater than or equal to] 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. Keywords: COVID-19, In-hospital mortality, Geriatric, Waves, Omicron