MARLON JULIANO ROMERO ALIBERTI

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/66, Hospital das Clínicas, Faculdade de Medicina

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Assunto: COVID-19 ×

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  • article 5 Citação(ões) na Scopus
    Dissipating the fog: Cognitive trajectories and risk factors 1 year after COVID-19 hospitalization
    (2023) GONCALVES, Natalia Gomes; ALIBERTI, Marlon Juliano Romero; BERTOLA, Laiss; AVELINO-SILVA, Thiago; DIAS, Murilo Bacchini; APOLINARIO, Daniel; BUSATTO, Geraldo; FORLENZA, Orestes; NITRINI, Ricardo; BRUCKI, Sonia Maria Dozzi; BRUNONI, Andre Russowsky; VIDAL, Kallene Summer Moreira; JACOB-FILHO, Wilson; SUEMOTO, Claudia Kimie
    Introduction: Cognitive impairment is common after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, associations between post-hospital discharge risk factors and cognitive trajectories have not been explored. Methods: A total of 1105 adults (mean age SD 64.9 9.9 years, 44% women, 63% White) with severe coronavirus disease 2019 (COVID-19) were evaluated for cognitive function 1 year after hospital discharge. Scores from cognitive tests were harmonized, and clusters of cognitive impairment were defined using sequential analysis. Results: Three groups of cognitive trajectories we re observed during the follow-up: no cognitive impairment, initial short-term cognitive impairment, and long-term cognitive impairment. Predictors of cognitive decline after COVID-19 were older age (beta = -0.013, 95% CI = -0.023;-0.003), female sex (beta = -0.230, 95% CI = -0.413;-0.047), previous dementia diagnosis or substantial memory complaints (beta = -0.606, 95% CI = -0.877;-0.335), frailty before hospitalization (beta = -0.191, 95% CI = -0.264;-0.119), higher platelet count (beta = -0.101, 95% CI = -0.185;-0.018), and delirium (beta = -0.483, 95% CI = -0.724;-0.244). Post-discharge predictors included hospital readmissions and frailty. Discussion: Cognitive impairment was common and the patterns of cognitive trajectories depended on sociodemographic, in-hospital, and post-hospitalization predictors. Highlights Cognitive impairment after coronavirus disease 2019 (COVID-19) hospital discharge was associated with higher age, less education, delirium during hospitalization, a higher number of hospitalizations post discharge, and frailty before and after hospitalization. Frequent cognitive evaluations for 12-month post-COVID-19 hospitalization showed three possible cognitive trajectories: no cognitive impairment, initial short-term impairment, and long-term impairment. This study highlights the importance of frequent cognitive testing to determine patterns of COVID-19 cognitive impairment, given the high frequency of incident cognitive impairment 1 year after hospitalization.
  • article 2 Citação(ões) na Scopus
    Prediction of intensive care admission and hospital mortality in COVID-19 patients using demographics and baseline laboratory data
    (2023) AVELINO-SILVA, Vivian I.; AVELINO-SILVA, Thiago J.; ALIBERTI, Marlon J. R.; FERREIRA, Juliana C.; COBELLO JUNIOR, Vilson; SILVA, Katia R.; POMPEU, Jose E.; ANTONANGELO, Leila; MAGRI, Marcello M.; BARROS FILHO, Tarcisio E. P.; SOUZA, Heraldo P.; KALLAS, Esper G.
    Introduction: Optimized allocation of medical resources to patients with COVID-19 has been a critical concern since the onset of the pandemic.Methods: In this retrospective cohort study, the authors used data from a Brazilian tertiary university hospital to explore predictors of Intensive Care Unit (ICU) admission and hospital mortality in patients admitted for COVID19. Our primary aim was to create and validate prediction scores for use in hospitals and emergency departments to aid clinical decisions and resource allocation. Results: The study cohort included 3,022 participants, of whom 2,485 were admitted to the ICU; 1968 survived, and 1054 died in the hospital. From the complete cohort, 1,496 patients were randomly assigned to the derivation sample and 1,526 to the validation sample. The final scores included age, comorbidities, and baseline laboratory data. The areas under the receiver operating characteristic curves were very similar for the derivation and validation samples. Scores for ICU admission had a 75% accuracy in the validation sample, whereas scores for death had a 77% accuracy in the validation sample. The authors found that including baseline flu-like symptoms in the scores added no significant benefit to their accuracy. Furthermore, our scores were more accurate than the previously published NEWS-2 and 4C Mortality Scores.Discussion and conclusions: The authors developed and validated prognostic scores that use readily available clinical and laboratory information to predict ICU admission and mortality in COVID-19. These scores can become valuable tools to support clinical decisions and improve the allocation of limited health resources.
  • article 6 Citação(ões) na Scopus
    Twelve Months and Counting: Following Clinical Outcomes in Critical COVID-19 Survivors
    (2023) TANIGUCHI, Leandro U.; ALIBERTI, Marlon J. R.; DIAS, Murilo B.; JACOB-FILHO, Wilson; AVELINO-SILVA, Thiago J.
    Rationale: Recent reports suggest that patients with severe coronavirus disease (COVID-19) often experience long-term consequences of the infection. However, studies on intensive care unit (ICU) survivors are underrepresented. Objectives: We aimed to explore 12-month clinical outcomes after critical COVID-19, describing the longitudinal progress of disabilities, frailty status, frequency of cognitive impairment, and clinical events (rehospitalization, institutionalization, and falls). Methods: We performed a prospective cohort study of survivors of COVID-19 ICU admissions in Sao Paulo, Brazil. We assessed patients every 3 months for 1 year after hospital discharge and obtained information on 15 activities of daily living (basic, instrumental, and mobility activities), frailty, cognition, and clinical events. Results: We included 428 patients (mean age of 64 yr, 61% required invasive mechanical ventilation during ICU stay). The number of disabilities peaked at 3 months compared with the pre-COVID-19 period (mean difference, 2.46; 99% confidence interval, 1.94-2.99) and then decreased at 12 months (mean difference, 0.67; 99% confidence interval, 0.28-1.07). At 12-month follow-up, 12% of patients were frail, but half of them presented frailty only after COVID-19. The prevalence of cognitive symptoms was 17% at 3 months and progressively decreased to 12.1% (P = 0.012 for trend) at the end of 1 year. Clinical events occurred in all assessments. Conclusions: Although a higher burden of disabilities and cognitive symptoms occurred 3 months after hospital discharge of critical COVID-19 survivors, a significant improvement occurred during the 1-year follow-up. However, one-third of the patients remained in worse conditions than their pre-COVID-19 status.
  • article 45 Citação(ões) na Scopus
    The Impact of Frailty on the Relationship between Life-Space Mobility and Quality of Life in Older Adults During the COVID-19 Pandemic
    (2021) SARAIVA, M. D.; APOLINARIO, D.; AVELINO-SILVA, T. J.; TAVARES, C. De Assis Moura; GATTAS-VERNAGLIA, I. F.; FERNANDES, C. Marques; RABELO, L. M.; YAMAGUTI, S. Tavares Fernandes; KARNAKIS, T.; KALIL-FILHO, R.; JACOB-FILHO, W.; ALIBERTI, Marlon Juliano Romero
    Background The COVID-19 pandemic has led to abrupt restrictions of lile-space mobility. The impact of shelter-in-place orders on older adults' health and well-being is still unclear. Objective To investigate the relationship between life-space mobility and quality of life (QoL) in older adults with and without frailty during the COVID-19 pandemic. Design Multicenter prospective cohort study based on structured telephone interviews. Setting Four geriatric outpatient clinics in the metropolitan area of Sao Paulo, Brazil. Participants 557 community-dwelling adults aged 60 years and older. Measurements The Life-Space Assessment was used to measure community mobility before and during the COVID-19 pandemic, and a previously validated decrease of >= 5 points defined restricted life-space mobility. Frailty was assessed through the FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale. The impact of shelter-in-place orders on QoL was evaluated with the question << How is the COVID-19 pandemic affecting your QoL?>>, to which participants could respond << not at all >>, << to some extent >>, or << to a great extent >>. We used ordinal logistic regressions to investigate the relationship between restricted life-space mobility and impact on QoL, adjusting our analyses for demographics, frailty, comorbidities, cognition, functionality, loneliness, depression, and anxiety. We explored whether frailty modified the association between life-space mobility and impact on QoL. Results Participants were on average 80 +/- 8 years old, 65% were women, and 33% were frail. The COVID-19 quarantine led to a restriction of community mobility in 79% of participants and affected the QoL for 77% of participants. We found that restricted life-space mobility was associated with impact on QoL in older adults during the pandemic, although frailty modified the magnitude of the association (P-value for interaction=0.03). Frail participants who experienced restricted life-space mobility had twice the odds of reporting an impact on QoL when compared with non-frail individuals, with respective adjusted odds ratios of 4.20 (95% CI=2.36-7.50) and 2.18 (95% CI=1.33-3.58). Conclusion Older adults experienced substantial decreases in life-space mobility during the COVID-19 pandemic, and this unexpected change impacted their QoL. Providers should be particularly watchful for the consequences of abrupt life-space restrictions on frail individuals.
  • article 25 Citação(ões) na Scopus
    Patient-Centered Outcomes Following COVID-19: Frailty and Disability Transitions in Critical Care Survivors*
    (2022) TANIGUCHI, Leandro Utino; AVELINO-SILVA, Thiago Junqueira; DIAS, Murilo Bacchini; JACOB-FILHO, Wilson; ALIBERTI, Marlon Juliano Romero
    OBJECTIVES: As the pandemic advances, the interest in the long-lasting consequences of COVID-19 increases. However, a few studies have explored patient-centered outcomes in critical care survivors. We aimed to investigate frailty and disability transitions in COVID-19 patients admitted to ICUs. DESIGN: Prospective cohort study. SETTING: University hospital in Sao Paulo. PATIENTS: Survivors of COVID-19 ICU admissions. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We assessed frailty using the Clinical Frailty Scale (CFS). We also evaluated 15 basic, instrumental, and mobility activities. Baseline frailty and disability were defined by clinical conditions 2-4 weeks before COVID-19, and post-COVID-19 was characterized 90 days (day 90) after hospital discharge. We used alluvial flow diagrams to visualize transitions in frailty status, Venn diagrams to describe the overlap between frailty and disabilities in activities of daily living, and linear mixed models to explore the occurrence of new disabilities following critical care in COVID-19. We included 428 participants with a mean age of 64 years, 57% males, and a median Simplified Acute Physiology Score-3 score of 59. Overall, 14% were frail at baseline. We found that 124/394 participants (31%) were frail at day 90, 70% of whom were previously non-frail. The number of disabilities also increased (mean difference, 2.46; 95% CI, 2.06-2.86), mainly in participants who were non-frail before COVID-19. Higher pre-COVID-19 CFS scores were independently associated with new-onset disabilities. At day 90, 135 patients (34%) were either frail or disabled. CONCLUSIONS: Frailty and disability were more frequent 90 days after hospital discharge compared with baseline in COVID-19 patients admitted to the ICU. Our results show that most COVID-19 critical care survivors transition to poorer health status, highlighting the importance of long-term medical follow-up for this population.
  • article 101 Citação(ões) na Scopus
    Delirium and Adverse Outcomes in Hospitalized Patients withCOVID-19
    (2020) GARCEZ, Flavia B.; ALIBERTI, Marlon J. R.; POCO, Paula C. E.; HIRATSUKA, Marcel; TAKAHASHI, Silvia de F.; COELHO, Venceslau A.; SALOTTO, Danute B.; V, Marlos L. Moreira; JACOB-FILHO, Wilson; AVELINO-SILVA, Thiago J.
    BACKGROUND Little is known about the association between acute mental changes and adverse outcomes in hospitalized adults with COVID-19. OBJECTIVES To investigate the occurrence of delirium in hospitalized patients with COVID-19 and explore its association with adverse outcomes. DESIGN Longitudinal observational study. SETTING Tertiary university hospital dedicated to the care of severe cases of COVID-19 in Sao Paulo, Brazil. PARTICIPANTS A total of 707 patients, aged 50 years or older, consecutively admitted to the hospital between March and May 2020. MEASUREMENTS We completed detailed reviews of electronic medical records to collect our data. We identified delirium occurrence using the Chart-Based Delirium Identification Instrument (CHART-DEL). Trained physicians with a background in geriatric medicine completed all CHART-DEL assessments. We complemented our baseline clinical information using telephone interviews with participants or their proxy. Our outcomes of interest were in-hospital death, length of stay, admission to intensive care, and ventilator utilization. We adjusted all multivariable analyses for age, sex, clinical history, vital signs, and relevant laboratory biomarkers (lymphocyte count, C-reactive protein, glomerular filtration rate, D-dimer, and albumin). RESULTS Overall, we identified delirium in 234 participants (33%). On admission, 86 (12%) were delirious. We observed 273 deaths (39%) in our sample, and in-hospital mortality reached 55% in patients who experienced delirium. Delirium was associated with in-hospital death, with an adjusted odds ratio of 1.75 (95% confidence interval = 1.15-2.66); the association held both in middle-aged and older adults. Delirium was also associated with increased length of stay, admission to intensive care, and ventilator utilization. CONCLUSION Delirium was independently associated with in-hospital death in adults aged 50 years and older with COVID-19. Despite the difficulties for patient care during the pandemic, clinicians should routinely monitor delirium when assessing severity and prognosis of COVID-19 patients.
  • article 1 Citação(ões) na Scopus
    COVID-19 outcomes in people living with HIV: Peering through the waves
    (2023) SALES, Thais Lorenna Souza; SOUZA-SILVA, Maira Viana Rego; DELFINO-PEREIRA, Polianna; NEVES, Joao Victor Baroni; SACIOTO, Manuela Furtado; ASSIS, Vivian Costa Morais de; DUANI, Helena; OLIVEIRA, Neimy Ramos de; SAMPAIO, Natalia da Cunha Severino; RAMOS, Lucas Emanuel Ferreira; SCHWARZBOLD, Alexandre Vargas; JORGE, Alzira de Oliveira; SCOTTON, Ana Luiza Bahia Alves; CASTRO, Bruno Mateus de; SILVA, Carla Thais Candida Alves da; RAMOS, Carolina Marques; ANSCHAU, Fernando; BOTONI, Fernando Antonio; GRIZENDE, Genna Maira Santos; NASCIMENTO, Guilherme Fagundes; RUSCHEL, Karen Brasil; MENEZES, Luanna Silva Monteiro; CASTRO, Luis Cesar de; NASI, Luiz Antonio; CARNEIRO, Marcelo; GODOY, Mariana Frizzo de; NOGUEIRA, Matheus Carvalho Alves; JR, Milton Henriques Guimaraes; ZIEGELMANN, Patricia Klarmann; ALMEIDA, Rafaela Charao de; FRANCISCO, Saionara Cristina; NETO, Sidney Teodoro Silveira; ARAUJO, Silvia Ferreira; AVELINO-SILVA, Thiago Junqueira; ALIBERTI, Marlon Juliano Romero; PIRES, Magda Carvalho; SILVA, Eduardo Sergio da; MARCOLINO, Milena Soriano
    Objective: To evaluate clinical characteristics and outcomes of COVID-19 patients infected with HIV, and to compare with a paired sample without HIV infection. Methods: This is a substudy of a Brazilian multicentric cohort that comprised two periods (2020 and 2021). Data was obtained through the retrospective review of medical records. Primary outcomes were admission to the intensive care unit, invasive mechanical ventilation, and death. Patients with HIV and controls were matched for age, sex, number of comorbidities, and hospital of origin using the technique of propensity score matching (up to 4:1). They were compared using the Chi-Square or Fisher's Exact tests for categorical variables and the Wilcoxon for numerical variables. Results: Throughout the study, 17,101 COVID-19 patients were hospitalized, and 130 (0.76%) of those were infected with HIV. The median age was 54 (IQR: 43.0;64.0) years in 2020 and 53 (IQR: 46.0;63.5) years in 2021, with a predominance of females in both periods. People Living with HIV (PLHIV) and their controls showed similar prevalence for admission to the ICU and invasive mechanical ventilation requirement in the two periods, with no significant differences. In 2020, in-hospital mortality was higher in the PLHIV compared to the controls (27.9% vs. 17.7%; p = 0.049), but there was no difference in mortality between groups in 2021 (25.0% vs. 25.1%; p > 0.999). Conclusions: Our results reiterate that PLHIV were at higher risk of COVID-19 mortality in the early stages of the pandemic, however, this finding did not sustain in 2021, when the mortality rate is similar to the control group.
  • article 2 Citação(ões) na Scopus
    Palliative care in Hospitalized Middle-Aged and Older Adults With COVID-19
    (2022) ALMEIDA, Lyna Kyria Rodrigues; AVELINO-SILVA, Thiago J.; SILVA, Debora Carneiro de Lima e; CAMPOS, Bruna A.; VARELA, Gabriela; FONSECA, Cristina Mara Baghelli; AMORIM, Victor Lp; PIZA, Felipe Maia de Toledo; ALIBERTI JR., Marlon; DEGANI-COSTA, Luiza Helena
    Context. As COVID-19 overwhelms health systems worldwide, palliative care strategies may ensure rational use of resources while safeguarding patient comfort and dignity. Objective. To describe palliative care practices in hospitalized middle-aged and older adults in two of the largest COVID-19 treatment centers in Sao Paulo, Brazil. Methods. Retrospective cohort. Eligible patients were those aged 50 years or older hospitalized between March and May 2020 with a laboratory confirmation of SARS-CoV-2 infection. Palliative care implementation was defined as present if medical notes indicated a decision to limit escalation of life support measures, or when opioids or sedatives were prescribed for palliative management of symptoms. Results. We included 1162 participants (57% male, median 65 years). Overall, 21% were frail and 54% were treated in intensive care units, but only 17% received palliative care. Stepwise logistic regression demonstrated that age >= 80 years, dementia, history of stroke or cancer, frailty, having a PaO2/FiO(2)<200 or a C-reactive protein >= 150mg/dL at admission predicted palliative care implementation. Patients placed under palliative care stayed longer (13 vs.11 days) and were more likely to die in hospital (86 vs.27%). They also spent more days in ICU and received vasoactive drugs, hemodialysis, and invasive ventilation more frequently. Conclusions. One in five middle-aged and older adults hospitalized with COVID-19 received palliative care in our cohort. Patients who were very old, multimorbid, frail, and had severe COVID-19 were more likely to receive palliative care. However, it was often delayed until advanced and invasive life support measures had already been implemented.
  • article 5 Citação(ões) na Scopus
    Development and validation of the MMCD score to predict kidney replacement therapy in COVID-19 patients
    (2022) FIGUEIREDO, Flavio de Azevedo; RAMOS, Lucas Emanuel Ferreira; SILVA, Rafael Tavares; PONCE, Daniela; CARVALHO, Rafael Lima Rodrigues de; SCHWARZBOLD, Alexandre Vargas; MAURILIO, Amanda de Oliveira; SCOTTON, Ana Luiza Bahia Alves; GARBINI, Andresa Fontoura; FARACE, Barbara Lopes; GARCIA, Barbara Machado; SILVA, Carla Thais Candida Alves da; CIMINI, Christiane Correa Rodrigues; CARVALHO, Cintia Alcantara de; DIAS, Cristiane dos Santos; SILVEIRA, Daniel Vitorio; MANENTI, Euler Roberto Fernandes; CENCI, Evelin Paola de Almeida; ANSCHAU, Fernando; ARANHA, Fernando Graca; AGUIAR, Filipe Carrilho de; BARTOLAZZI, Frederico; VIETTA, Giovanna Grunewald; NASCIMENTO, Guilherme Fagundes; NOAL, Helena Carolina; DUANI, Helena; VIANNA, Heloisa Reniers; GUIMARAES, Henrique Cerqueira; ALVARENGA, Joice Coutinho de; CHATKIN, Jose Miguel; MORAIS, Julia Drumond Parreiras de; MACHADO-RUGOLO, Juliana; RUSCHEL, Karen Brasil; MARTINS, Karina Paula Medeiros Prado; MENEZES, Luanna Silva Monteiro; COUTO, Luciana Siuves Ferreira; CASTRO, Luis Cesar de; NASI, Luiz Antonio; CABRAL, Maderson Alvares de Souza; FLORIANI, Maiara Anschau; SOUZA, Maira Dias; SOUZA-SILVA, Maira Viana Rego; CARNEIRO, Marcelo; GODOY, Mariana Frizzo de; BICALHO, Maria Aparecida Camargos; LIMA, Maria Clara Pontello Barbosa; ALIBERTI, Marlon Juliano Romero; NOGUEIRA, Matheus Carvalho Alves; MARTINS, Matheus Fernandes Lopes; GUIMARAES-JUNIOR, Milton Henriques; SAMPAIO, Natalia da Cunha Severino; OLIVEIRA, Neimy Ramos de; ZIEGELMANN, Patricia Klarmann; ANDRADE, Pedro Guido Soares; ASSAF, Pedro Ledic; MARTELLI, Petronio Jose de Lima; DELFINO-PEREIRA, Polianna; MARTINS, Raphael Castro; MENEZES, Rochele Mosmann; FRANCISCO, Saionara Cristina; ARAUJO, Silvia Ferreira; OLIVEIRA, Talita Fischer; OLIVEIRA, Thainara Conceicao de; SALES, Thais Lorenna Souza; AVELINO-SILVA, Thiago Junqueira; RAMIRES, Yuri Carlotto; PIRES, Magda Carvalho; MARCOLINO, Milena Soriano
    Background: Acute kidney injury (AKI) is frequently associated with COVID-19, and the need for kidney replacement therapy (KRT) is considered an indicator of disease severity. This study aimed to develop a prognostic score for predicting the need for KRT in hospitalised COVID-19 patients, and to assess the incidence of AKI and KRT requirement. Methods: This study is part of a multicentre cohort, the Brazilian COVID-19 Registry. A total of 5212 adult COVID-19 patients were included between March/2020 and September/2020. Variable selection was performed using generalised additive models (GAM), and least absolute shrinkage and selection operator (LASSO) regression was used for score derivation. Accuracy was assessed using the area under the receiver operating characteristic curve (AUC-ROC). Results: The median age of the model-derivation cohort was 59 (IQR 47-70) years, 54.5% were men, 34.3% required ICU admission, 20.9% evolved with AKI, 9.3% required KRT, and 15.1% died during hospitalisation. The temporal validation cohort had similar age, sex, ICU admission, AKI, required KRT distribution and in-hospital mortality. The geographic validation cohort had similar age and sex; however, this cohort had higher rates of ICU admission, AKI, need for KRT and in-hospital mortality. Four predictors of the need for KRT were identified using GAM: need for mechanical ventilation, male sex, higher creatinine at hospital presentation and diabetes. The MMCD score had excellent discrimination in derivation (AUROC 0.929, 95% CI 0.918-0.939) and validation (temporal AUROC 0.927, 95% CI 0.911-0.941; geographic AUROC 0.819, 95% CI 0.792-0.845) cohorts and good overall performance (Brier score: 0.057, 0.056 and 0.122, respectively). The score is implemented in a freely available online risk calculator (https://www.mmcdscore.com/). Conclusions: The use of the MMCD score to predict the need for KRT may assist healthcare workers in identifying hospitalised COVID-19 patients who may require more intensive monitoring, and can be useful for resource allocation.
  • article 39 Citação(ões) na Scopus
    Divergent: Age, Frailty, and Atypical Presentations of COVID-19 in Hospitalized Patients
    (2021) POCO, Paula Cristina Eiras; ALIBERTI, Marlon Juliano Romero; DIAS, Murilo Bacchini; TAKAHASHI, Silvia de Fatima; LEONEL, Fabio Campos; ALTONA, Marcelo; VENYS, Amanda Lagreca; SHIN-IKE, Isabela Akie; GARCIA, Bianca Aparecida; SUMITA, Leticia Harumi; LIMA, Lara Mune de Oliveira; GARCEZ, Flavia Barreto; AVELINO-SILVA, Thiago Junqueira
    Background: Although frailty has been associated with atypical manifestations of infections, little is known about COVID-19 presentations in hospitalized frail patients. We aimed to investigate the association between age, frailty, and clinical characteristics of COVID-19 in hospitalized middle-aged and older adults. Method: Longitudinal observational study comprising 711 patients aged >= 50 years consecutively admitted to a university hospital dedicated to COVID-19 severe cases, between March and May 2020. We reviewed electronic medical records to collect data on demographics, comorbidities, COVID-19 signs/symptoms, and laboratory findings on admission. We defined frailty using the Clinical Frailty Scale (CFS = 1-9; frail >= 5). We also documented in-hospital mortality. We used logistic regressions to explore associations between age, frailty, and COVID-19 signs/symptoms; and between typical symptoms (fever, cough, dyspnea) and mortality. Results: Participants had a mean age of 66 +/- 11 years, and 43% were female. Overall, 25% were frail, and 37% died. The most common COVID-19 presentations were dyspnea (79%), cough (74%), and fever (62%), but patients aged >= 65 years were less likely to have a co-occurrence of typical symptoms, both in the absence (OR = 0.56; 95% CI = 0.39-0.79) and in the presence of frailty (OR = 0.52; 95% CI = 0.34-0.81). In contrast, older age and frailty were associated with unspecific presentations, including functional decline, acute mental change, and hypotension. After adjusting for age, sex, and frailty, reporting fever was associated with lower odds of mortality (OR = 0.70; 95% CI = 0.50-0.97). Conclusions: Atypical COVID-19 presentations are common in frail and older hospitalized patients. Providers should be aware of unspecific disease manifestations during the management and follow-up of this population.