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Coronavirus disease 2019 in elderly patients: Characteristics and prognostic factors based on 4-week follow-up
Lang Wang1, Wenbo He1, Xiaomei Yu1
1Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang, Wuhan 430060, People's Republic of China; Cardiovascular Research Institute, Wuhan University, Wuhan, People's Republic of China; Hubei Key Laboratory of Cardiology, Wuhan, People's Republic of China.
Insights
Elderly patients with COVID-19 often present with severe symptoms and have a high fatality rate. Key predictors of poor outcomes include dyspnea, cardiovascular disease, and acute respiratory distress syndrome.
Area of Science:
- Gerontology
- Infectious Diseases
- Critical Care Medicine
Background:
- The COVID-19 pandemic disproportionately affects elderly populations, necessitating a deeper understanding of disease characteristics and risk factors in this demographic.
- Investigating prognostic factors in older adults is crucial for developing targeted interventions and improving clinical management strategies.
Purpose of the Study:
- To characterize the clinical features and identify prognostic factors associated with mortality in elderly patients diagnosed with COVID-19.
- To provide insights into risk stratification and inform clinical decision-making for managing COVID-19 in older individuals.
Main Methods:
- A retrospective analysis of consecutive COVID-19 cases aged over 60 years admitted to Renmin Hospital of Wuhan University between January 1 and February 6, 2020.
- Data collected included demographics, clinical symptoms, comorbidities, laboratory findings, and complications. Cox regression analysis was employed to determine prognostic factors for death.
Main Results:
- Out of 339 elderly COVID-19 patients (mean age 71±8 years), 19.2% died by March 5, 2020. Common comorbidities included hypertension (40.8%) and diabetes (16.0%).
- Symptoms like dyspnea (HR 2.35), cardiovascular disease (HR 1.86), chronic obstructive pulmonary disease (HR 2.24), and acute respiratory distress syndrome (HR 29.33) were significant predictors of mortality.
- Lymphocytopenia was frequent (63.2%), while a high lymphocyte count predicted a better outcome (HR 0.10).
Conclusions:
- Elderly COVID-19 patients exhibit a high proportion of severe to critical cases and a significant fatality rate.
- Dyspnea, specific comorbidities (cardiovascular disease, COPD), and acute respiratory distress syndrome are critical indicators of poor prognosis in this age group.
- Close monitoring and prompt treatment are essential for high-risk elderly patients to mitigate adverse outcomes.
Objective:
To investigate the characteristics and prognostic factors in the elderly patients with COVID-19.
Methods:
Consecutive cases over 60 years old with COVID-19 in Renmin Hospital of Wuhan University from Jan 1 to Feb 6, 2020 were included. The primary outcomes were death and survival till March 5. Data of demographics, clinical features, comorbidities, laboratory tests and complications were collected and compared for different outcomes. Cox regression was performed for prognostic factors.
Results:
339 patients with COVID-19 (aged 71±8 years,173 females (51%)) were enrolled, including 80 (23.6%) critical, 159 severe (46.9%) and 100 moderate (29.5%) cases. Common comorbidities were hypertension (40.8%), diabetes (16.0%) and cardiovascular disease (15.7%). Common symptoms included fever (92.0%), cough (53.0%), dyspnea (40.8%) and fatigue (39.9%). Lymphocytopenia was a common laboratory finding (63.2%). Common complications included bacterial infection (42.8%), liver enzyme abnormalities (28.7%) and acute respiratory distress syndrome (21.0%). Till Mar 5, 2020, 91 cases were discharged (26.8%), 183 cases stayed in hospital (54.0%) and 65 cases (19.2%) were dead. Shorter length of stay was found for the dead compared with the survivors (5 (3-8) vs. 28 (26-29), P < 0.001). Symptoms of dyspnea (HR 2.35, P = 0.001), comorbidities including cardiovascular disease (HR 1.86, P = 0.031) and chronic obstructive pulmonary disease (HR 2.24, P = 0.023), and acute respiratory distress syndrome (HR 29.33, P < 0.001) were strong predictors of death. And a high level of lymphocytes was predictive of better outcome (HR 0.10, P < 0.001).
Conclusions:
High proportion of severe to critical cases and high fatality rate were observed in the elderly COVID-19 patients. Rapid disease progress was noted in the dead with a median survival time of 5 days after admission. Dyspnea, lymphocytopenia, comorbidities including cardiovascular disease and chronic obstructive pulmonary disease, and acute respiratory distress syndrome were predictive of poor outcome. Close monitoring and timely treatment should be performed for the elderly patients at high risk.
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