Data regarding demographics, comorbidities, clinical symptoms, and laboratory analyses were retrospectively collected by one research nurse. In general, all information was obtained within the first 24 h of hospitalization in an acute ward. The geriatric hospital’s wards are managed by medical staff trained in internal medicine and geriatrics and can provide general medical care, such as intravenous pharmacotherapy and non-invasive oxygen support (by nasal cannula and face mask, allowing an increase of the fraction of inspired oxygen from 24 to 65%). Discharge criteria were an improvement of acute illness with subsequent transfer to a rehabilitation ward, or discharge to home or to a nursing home. For patients presenting worsening symptoms and unfavorable evolution, end-of-life care was implemented on the ward with consultation of palliative mobile teams. The diagnosis of COVID-19 was defined as a positive reverse transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2 on a nasopharyngeal swab. Patients with negative virus detection by RT-PCR (18/265; 6.8%) but a high clinical suspicion of disease were also diagnosed with COVID-19 [11].

The Functional Independence Measure (FIM) was performed by a nurse, based on observation during the first 24 h after hospital admission. It reflects functional status and physical function, with a point score ranging from 18 to 126, higher scores corresponding to better functionality [12]. The Clinical Frailty Score (CFS) was calculated by the physician in charge, reflecting the condition of older patients before hospitalization [13]. Higher CFS scores (from 5 to 8) correspond to more severe degrees of frailty, with a terminally ill patient assigned the highest score of 8. The Cumulative Illness Rating Scale-Geriatric (CIRS-G) was performed at admission, measuring a patient’s comorbidity burden by taking into account chronic diseases as well as the severity of acute illnesses, with higher scores representing a higher overall disease burden [14]. The severity of respiratory symptoms was assessed using the Pneumonia Severity Index (PSI) [15] and the abovementioned CURB-65 [16], which varies from 0 to 5, with higher scores being associated with higher mortality. For patients diagnosed with stroke, we computed the Modified Ranking Score (MRS) [17], which assesses functional recovery after a stroke event, as well as the CHA2DS2-VASc [18] and HAS-BLED [19] scores for thromboembolic and bleeding risks, respectively.

Cerebrovascular complications were defined as a diagnosis of stroke with neuroimaging confirmation by CT or MRI, including both ischemic stroke and intracranial hemorrhage. We included all cases of stroke having occurred during hospitalization, between the moment of COVID-19 diagnosis and hospital discharge or death. Hence, stroke diagnoses documented during acute and rehabilitation hospital stays were included in the analysis. For all stroke cases identified, an extensive review of the electronic medical record and imaging results was performed by a geriatrician and, for the purpose of this study, all images were reviewed by the same neuroradiologist.. Stroke cases were classified with respect to their localization, extent of ischemia or hemorrhage, and vascular territory [20]. In general, all patients that were suspected to present a stroke underwent standardized neuroimaging by CT or MRI, routinely performed according to in-house protocols.

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