Pratikkumar Vekaria, MD
Attending Physician
Prisma Health Upstate
Greenville, SC
Disclosure information not submitted.
Areej Syed, MD
Resident Physician
Redmond Regional Medical Center, United States
Disclosure information not submitted.
Brendon Cornett, MPH
Biostatistician and Research Analyst
HCA Healthcare, United States
Disclosure information not submitted.
Amine Bourbia, MD
Physician
Redmond Regional Medical Center, United States
Disclosure information not submitted.
Michael Flynn, Ph.D.
Division Director of Research
HCA -South Atlantic Division, United States
Disclosure information not submitted.
Rahul Kashyap, MD, MBA,
Medical Director Research
Wellspan Health-York Hospital
York, Pennsylvania
Disclosure information not submitted.
Asif Shah, MD, FACP
Physician
Redmond Regional Medical Center, United States
Disclosure information not submitted.
Title: Association of Dementia and Outcomes Among Hospitalized COVID-19 Patients
Introduction:
There are several management and preventative options, including vaccines, available for coronavirus disease-2019 (COVID-19). However, patients' baseline characteristics may play a role in determining overall health outcomes. Dementia is one of these unexplored characteristics, and there is a paucity of data denoting the association between dementia and outcomes among COVID-19 patients.
Methods:
We conducted a retrospective cohort study by extracting data from the HCA Healthcare Enterprise Data Warehouse data, consisting of 160 hospitals, between January-September 2020. We grouped in-patients who had ICD-10 codes (F03.90/F01/G31.09) for dementia with age and gender (1:2) matched patients without a dementia diagnosis. Our primary outcome variables were in-hospital mortality, ICU admissions rate, ICU-free days, mechanical ventilation (MV) use, MV-free days, and 90 days re-admissions. An institutional IRB-exempt determination was made for this study.
Results:
Out of total of 27,930 COVID-19 positive patients, we included 10,473 patients with (n=3491) and without dementia (N=6982) after matching. Patients demographics were similar in dementia and non-dementia groups: age: median (IQR): 79 (73-82) vs. 79 (73-83), sex (F:M -50.1% vs. 49.9%). The BMI (25.8 vs. 27.6) and smoking exposure (23.3% vs. 31.3%) were lower in dementia vs. non-dementia patients. The median (IQR) Elixhauser Comorbidity Index was higher in dementia patients 6 (4-9) vs. 5 (3-7), p < 0.01. Higher mortality was observed in dementia group (30.8%) vs. non-dementia (26.4%), p < 0.01 as unadjusted univariate analysis. However, the rate of ICU admission (30.6% vs. 34%) and MV use (9.5% vs. 14.5%) were lower, but ICU-free days (6 vs. 5), and MV-free days (8 vs. 6) were significantly higher in dementia patients. The 90-day readmission was not different (32.1% vs. 31.8%), p=0.8. In logistic regression analysis, dementia patients had no difference in mortality- OR= 1.0 (95% CI 0.86-1.17), but ICU admissions were significantly lower, OR= 0.58 (95% CI 0.51-0.66).
Conclusions:
Based on our findings, though dementia patients have higher unadjusted hospital mortality compared to non-dementia patients, in logistic regression analysis, there was no difference in hospital mortality. The ICU admissions were significantly lower in dementia patients.