Abstract: (2022) 22:132 Junior et al. BMC Geriatrics https://doi.org/10.1186/s12877-022-02776-3 Open Access RESEARCH Chronic diseases, chest computed tomography, and laboratory tests as predictors of severe respiratory failure and death in elderly Brazilian patients hospitalized with COVID-19: a prospective cohort study Alberto Frisoli Junior1,2*, Elaine Azevedo1,3, Angela Tavares Paes1,4, Eliene Lima2, João Carlos  Campos Guerra1 and Sheila Jean Mc Neill Ingham2 Abstract Background: The primary risk factors for severe respiratory failure and death in the elderly hospitalized with COVID19 remain unclear. Objective: To determine the association of chronic diseases, chest computed tomography (CT), and laboratory tests with severe respiratory failure and mortality in older adults hospitalized with COVID-19. Method: This was a prospective cohort with 201 hospitalized older adults with COVID-19. Chronic diseases, chest CT, laboratory tests, and other data were collected within the first 48 h of hospitalization. Outcomes were progression to severe respiratory failure with the need of mechanical ventilation (SRF/MV) and death. Results: The mean age was 72.7 ± 9.2 years, and 63.2% were men. SRF/MV occurred in 16.9% (p < 0.001), and death occurred in 8%. In the adjusted regression analyses, lung involvement over 50% [odds ratio (OR): 3.09 (1.03–9.28; 0.043)], C-reactive protein (CRP) > 80 ng/mL [OR: 2.97 (0.99–8.93; 0.052)], Vitamin D < 40 ng/mL [OR: 6.41 (1.21–33.88; 0.029)], and hemoglobin < 12 g/mL [OR: 3.32 (1.20–9.20; 0.020)] were independent predictors for SFR/MV, while chronic atrial fibrillation [OR: 26.72 (3.87–184.11; 0.001)], cancer history [OR:8.32 (1.28–53.91; 0.026)] and IL-6 > 40 pg/ mL [OR:10.01 (1.66–60.13; 0.012)] were independent predictors of death. Conclusion: In hospitalized older adults with COVID-19, tomographic pulmonary involvement > 50%, anemia, vitamin D below 40 ng/mL, and CRP above 80 mg/L were independent risk factors for progression to SRF/MV. The presence of chronic atrial fibrillation, previous cancer, IL-6 > 40 pg/mL, and anemia were independent predictors of death. Keywords: COVID-19, Respiratory failure, Elderly, Mortality, Vitamin D, Anemia *Correspondence: frisoli@uol.com.br 2 Elderly Vulnerability Disease Research Group Unit, Cardiology Division, Federal University of São Paulo, Rua Napoleão de Barros, 715 – Térreo‑ Vila Clementino, São Paulo, SP Zip code: 04024‑002, Brazil Full list of author information is available at the end of the article