Vulnerabilidade em saúde (VES-13) como preditor de mortalidade e ventilação mecânica invasiva em pacientes idosos hospitalizados com COVID-19: um estudo de corte prospectivo

Abstract

Introduction: Many studies have demonstrated the role of the Vulnerable Elders Survey (VES-13) in identifying vulnerable older adults in the community at higher risk of death and functional dependence. However, there are few studies have evaluated the role of VES-13 in hospitalized elderly. Some focused on VES-13 in specific clinical contexts such as, postoperative, trauma, acute coronary syndrome or decompensated heart failure. To date, none of them have evaluated the role of VES-13 in elderly patients hospitalized with COVID- 19. Therefore, in the present study, we tested the ability of VES-13 to predict mortality and the need for invasive mechanical ventilation in elderly patients hospitalized with COVID-19. Methods: This is a single-center, prospective cohort study carried out at Hospital das Clínicas, Faculty of Medicine, University of São Paulo (HCFMUSP) involving 91 participants aged ≥ 60 years and confirmed infection by COVID-19. The VES-13 was applied and demographic, clinical and laboratory variables were collected within 72 hours of hospital admission. The participants were classified as non-vulnerable (0 ≤ VES-13 ≤ 2), vulnerable (3 ≤ VES-13 ≤ 7) and extremely vulnerable (8 ≤ VES-13 ≤ 10). All patients were followed until death or hospital discharge. Results: Systemic arterial hypertension was present in 71 (78%) and obesity in 11 (12%) participants. Regarding health vulnerability, 54 (59.4%) participants were classified as nonvulnerable, 30 (33%) as vulnerable and 7 (7.6%) as super vulnerable. Of the total number of patients, 19 (21%) died and 15 (16%) required invasive mechanical ventilation. After analysis using a generalized linear regression model and adjustments for demographic, clinical, laboratory and qSOFA variables, the patients classified as extremely vulnerable were strongly and independently related to hospital mortality (RR= 9.2; 95% CI 1.1 - 73.9; p< 0.04) and need for invasive mechanical ventilation (RR=45; 95% CI 2.2 – 933; p< 0.02). Conclusion: Elderly patients hospitalized with COVID-19 classified as extremely vulnerable had more unfavorable outcomes. These data highlight the importance of identifying health vulnerability in this population group.