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Clinical characteristics and prognostic factors in COVID-19 patients aged ≥80 years
Marcello Covino1, Giuseppe De Matteis2, Michele Santoro1
1Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
Insights
In elderly patients (≥80 years) with coronavirus disease 2019 (COVID-19), severe dementia is a significant risk factor for death. Severe COVID-19 symptoms like low oxygen saturation and high lactate dehydrogenase indicate rapid progression to mortality.
Area of Science:
- Geriatric Medicine
- Infectious Diseases
- Epidemiology
Background:
- Coronavirus disease 2019 (COVID-19) disproportionately affects elderly individuals.
- Understanding prognostic factors in patients aged 80 years and older is crucial for risk stratification and management.
Purpose of the Study:
- To describe the clinical presentation of COVID-19 in patients aged 80 years and older.
- To identify prognostic factors and stratify risk in this vulnerable population.
Main Methods:
- A single-center, retrospective observational study of 69 patients (aged 80-98 years) admitted for confirmed COVID-19.
- Exclusion of asymptomatic patients; analysis of clinical records from March 2020.
- Uni- and multivariate Cox regression analysis to identify risk factors for death.
Main Results:
- The study cohort included 69 patients, with a median age of 84 years; 53.6% were male.
- 20.3% had mild, 43.5% severe, and 36.2% critical COVID-19 disease.
- At 30-day follow-up, 33.3% of patients had died. Independent risk factors for death included severe dementia, low oxygen saturation (pO2 ≤90), and elevated lactate dehydrogenase (>464 U/L).
Conclusions:
- Age alone may not be the primary determinant of mortality risk in patients aged 80 years and older with COVID-19.
- Severe dementia emerged as a significant risk factor.
- Severe COVID-19 presentation, indicated by low oxygen saturation and high lactate dehydrogenase upon admission, is linked to rapid disease progression and mortality in this age group.
Aim:
The aim of the present study was to describe the clinical presentation of patients aged ≥80 years with coronavirus disease 2019 (COVID-19), and provide insights regarding the prognostic factors and the risk stratification in this population.
Methods:
This was a single-center, retrospective, observational study, carried out in a referral center for COVID-19 in central Italy. We reviewed the clinical records of patients consecutively admitted for confirmed COVID-19 over a 1-month period (1-31 March 2020). We excluded asymptomatic discharged patients. We identified risk factors for death, by a uni- and multivariate Cox regression analysis. To improve model fitting and hazard estimation, continuous parameters where dichotomized by using Youden's index.
Results:
Overall, 69 patients, aged 80-98 years, met the inclusion criteria and were included in the study cohort. The median age was 84 years (82-89 years is interquartile range); 37 patients (53.6%) were men. Globally, 14 patients (20.3%) presented a mild, 30 (43.5%) a severe and 25 (36.2%) a critical COVID-19 disease. A total of 23 (33.3%) patients had died at 30 days' follow up. Multivariate Cox regression analysis showed that severe dementia, pO2 ≤90 at admission and lactate dehydrogenase >464 U/L were independent risk factors for death.
Conclusions:
The present data suggest that risk of death could be not age dependent in patients aged ≥80 years, whereas severe dementia emerged is a relevant risk factor in this population. Severe COVID-19, as expressed by elevated lactate dehydrogenase and low oxygen saturation at emergency department admission, is associated with a rapid progression to death in these patients. Geriatr Gerontol Int 2020; ••: ••-••.
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