Regular Use of VKA Prior to COVID-19 Associated with Lower 7-Day Survival in Hospitalized Frail Elderly COVID-19 Patients: The GERIA-COVID Cohort Study

Nutrients. 2020 Dec 24;13(1):39. doi: 10.3390/nu13010039.

Abstract

Background: Vitamin K concentrations are inversely associated with the clinical severity of COVID-19. The objective of this cohort study was to determine whether the regular use of vitamin K antagonist (VKA) prior to COVID-19 was associated with short-term mortality in frail older adults hospitalized for COVID-19.

Methods: Eighty-two patients consecutively hospitalized for COVID-19 in a geriatric acute care unit were included. The association of the regular use of VKA prior to COVID-19 with survival after 7 days of COVID-19 was examined using a propensity-score-weighted Cox proportional-hazards model accounting for age, sex, severe undernutrition, diabetes mellitus, hypertension, prior myocardial infarction, congestive heart failure, prior stroke and/or transient ischemic attack, CHA2DS2-VASc score, HAS-BLED score, and eGFR.

Results: Among 82 patients (mean ± SD age 88.8 ± 4.5 years; 48% women), 73 survived COVID-19 at day 7 while 9 died. There was no between-group difference at baseline, despite a trend for more frequent use of VKA in those who did not survive on day 7 (33.3% versus 8.2%, p = 0.056). While considering "using no VKA" as the reference (hazard ratio (HR) = 1), the HR for 7-day mortality in those regularly using VKA was 5.68 [95% CI: 1.17; 27.53]. Consistently, COVID-19 patients using VKA on a regular basis had shorter survival times than the others (p = 0.031).

Conclusions: Regular use of VKA was associated with increased mortality at day 7 in hospitalized frail elderly patients with COVID-19.

Keywords: COVID-19; SARS-CoV-2; anticoagulation; older adults; survival; vitamin K antagonist.

Publication types

  • Clinical Trial
  • Observational Study

MeSH terms

  • Age Factors
  • Aged, 80 and over
  • Anticoagulants* / administration & dosage
  • Anticoagulants* / adverse effects
  • COVID-19* / blood
  • COVID-19* / drug therapy
  • COVID-19* / mortality
  • Disease-Free Survival
  • Female
  • Frail Elderly*
  • Humans
  • Longitudinal Studies
  • Male
  • Risk Factors
  • SARS-CoV-2 / metabolism*
  • Severity of Illness Index
  • Sex Factors
  • Survival Rate
  • Vitamin K* / antagonists & inhibitors
  • Vitamin K* / blood

Substances

  • Anticoagulants
  • Vitamin K