By Melinda Young
After four years of the COVID-19 pandemic, the pressure on hospitals and the nation’s healthcare system has eased considerably. But there are questions about which patients with COVID-19 are at greatest risk of death and acute respiratory distress syndrome (ARDS).
For instance, are patients hospitalized for COVID-19, who are younger than 65 years of age, at less risk of serious outcomes than are similar patients who are older than 85 years of age? New research provides an answer that may surprise many clinicians: Metabolic syndrome measures are a major predictor of outcomes, but chronological age is not a relevant risk factor for poor outcomes attributed to COVID-19.1
“Basically, you can take age out of the equation,” says Valerie Danesh, PhD, RN, FCCM, FAAN, lead study author and research investigator at Baylor Scott & White Research Institute in Dallas. “Our major finding of this study is when we look at the risk factors of acute respiratory failure and mortality due to COVID, we use all measures available to us, like age [and] metabolic risk factors. What [we find] is metabolic syndrome characteristics are the drivers — the predictive components for predicting the adverse outcomes for moderate or severe COVID.”
But chronological age is not predictive. Rather, clinicians could think of patients’ age in terms of their biological age — how well or unwell the person is before contracting the virus.
Regardless of age, hospitalized COVID-19 patients with diabetes, high cholesterol, hypertension, obesity, and/or pre-diabetes were at significant risk of developing acute respiratory failure and dying during hospitalization. Danesh and colleagues found that the oldest patients — those ages 85 years or older — among a cohort of elderly patients had shorter lengths of stay in the intensive care unit (ICU), similar overall hospitalization duration as younger patients, and higher rates of discharge to home health, skilled nursing facilities, and other post-acute providers.
Metabolic syndrome is a chronic low-grade inflammatory state associated with hypertension, pre-diabetes or diabetes, obesity, and dyslipidemia, Danesh says. Danesh and colleagues evaluated and compared patients with one or more of those metabolic conditions with patients of advanced age regarding the risk of ARDS or death from COVID-19.
“When we looked at risk with or without age, it was the same conclusion that adding age as a risk factor didn’t change the statistical model or the strength of the prediction,” Danesh explains. “We didn’t need age as a risk factor.” For clinicians, case managers, and others working with hospitalized COVID-19 patients, the study’s findings imply that a better way to assess patients for risk is to prioritize the whole person’s health, she says. Providing more resources to a COVID patient based solely on the person’s age is not useful.
“We’re looking at the whole person’s health and other biological components for estimating risk and making decisions,” Danesh adds. “This analysis helps to counterbalance some of the public perception that age is the driver, and it balances it more on the clinician community perspective of looking at the whole person for decision-making.”
Danesh and colleagues wanted to more closely study the oldest patients — an underrepresented part of the population. “Early in the pandemic, there were headlines emphasizing that there was up to 360-fold increase in risk of death from the Centers for Disease Control and Prevention early estimates — which have since been tampered down — specific to age being a risk factor,” she explains.
They chose this population of the oldest patients to see if age is a true risk factor. “Because [the health system] is so large, we were able to have quite a sizable representation within Baylor Scott & White Health,” Danesh says.
What they found is that biological age is what drives ICU admissions among COVID patients — not chronological age. “For the mortality risk from moderate and severe COVID disease, age is much less of a factor than metabolic syndrome risk factors,” Danesh explains. “If you are 45 and have three or four metabolic syndrome factors or characteristics, your likelihood of death or acute respiratory failure when hospitalized with COVID is really quite high — irrespective of your not being in a high-risk basket of older age.”
Biological age can be viewed as the wear and tear on a person’s body, resulting in system inflammation and other health problems associated with metabolic syndrome, COVID-19 mortality, and acute respiratory failure. COVID-19 outcomes are tethered to patients’ other health conditions, Danesh adds.
REFERENCE
- Danesh V, Tellson A, Boehm LM, et al. Exploring the association of metabolic syndrome with in-hospital survival of older patients hospitalized with COVID-19: Beyond chronological age. J Gen Intern Med 2024; Apr 8. doi: 10.1007/s11606-024-08744-4. [Online ahead of print].
Are patients hospitalized for COVID-19, who are younger than 65 years of age, at less risk of serious outcomes than are similar patients who are older than 85 years of age? New research provides an answer that may surprise many clinicians: Metabolic syndrome measures are a major predictor of outcomes, but chronological age is not a relevant risk factor for poor outcomes attributed to COVID-19.
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