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Published on: December 19, 2020
Pulmonary thromboembolic disease associated with COVID-19 infection: a comparison between geriatric and non-geriatric
T L Tan1, N E Illa2, S Y Ting3
1Hospital Tengku Ampuan Rahimah, Internal Medicine Department, Selangor, Malaysia. tanthailun@gmail.com.
Insights
Elderly patients with Coronavirus Disease 2019 (COVID-19) and pulmonary thromboembolic disease face higher mortality risks. This study found older adults had more severe disease and worse outcomes despite earlier presentation.
Area of Science:
- Medicine
- Gerontology
- Radiology
Background:
- Coronavirus Disease 2019 (COVID-19) infection is increasing among the elderly.
- Pulmonary thromboembolic (PTE) disease is a known complication of COVID-19.
- Understanding differences in COVID-19 associated PTE between geriatric and non-geriatric patients is crucial.
Purpose of the Study:
- To compare clinical and computed tomographical (CT) features of PTE in COVID-19 patients.
- To explore the 60-day mortality rate in geriatric versus non-geriatric COVID-19 patients with PTE.
- To identify risk factors and outcomes associated with PTE in elderly COVID-19 patients.
Main Methods:
- Retrospective cross-sectional study.
- Inclusion of patients with concomitant COVID-19 and PTE disease admitted in April-May 2021.
- Analysis of demographic, clinical, laboratory, and CT pulmonary angiography (CTPA) data.
Main Results:
- Higher prevalence of hypertension, diabetes, and dyslipidaemia in the geriatric cohort.
- Geriatric patients had lower lymphocyte and albumin levels, and more severe disease despite earlier presentation.
- Pulmonary thrombosis was predominantly in segmental/subsegmental arteries in both groups, with significantly higher in-hospital mortality in the elderly.
Conclusions:
- Elderly patients with COVID-19 and PTE exhibit a higher mortality rate and poorer survival probability.
- Typical COVID-19 symptoms may be masked in the elderly, potentially delaying diagnosis and increasing adverse outcomes.
- Prompt recognition and management of PTE in geriatric COVID-19 patients are essential to improve outcomes.
Introduction:
The magnitude of Coronavirus Disease 2019 (COVID-19) infection among the elderly population is expected to rise. Our study compares the clinical and computed tomographical (CT) features of pulmonary thromboembolic (PTE) disease associated with COVID-19 infection in geriatric and non-geriatric cases, and explores the 60-day mortality rate in these two groups.
Materials And Methods:
We conducted this retrospective cross-sectional study in Hospital Tengku Ampuan Rahimah, Selangor, Malaysia. Patients admitted in April 2021 and May 2021 with concomitant COVID-19 infection and PTE disease were included. Demographic, clinical and laboratory data were retrieved, whilst CTPA images were analysed by a senior radiologist.
Results:
A total of 150 patients were recruited, comprising 45 geriatric patients and 105 non-geriatric patients. The prevalence rate of hypertension, diabetes mellitus and dyslipidaemia were higher among the geriatric cohort. Evidently, the percentage of patients with fever and diarrhoea were significantly higher among the non-geriatric cohort. The geriatric cohort also recorded a significantly lower absolute lymphocyte count at presentation and albumin level during admission. Despite earlier presentation, the geriatric cohort suffered from more severe diseases. Analysis of the CT features demonstrated that the most proximal pulmonary thrombosis specifically limited to the segmental and subsegmental pulmonary arteries in both cohorts. The elderly suffered from a significantly higher inhospital mortality rate and their cumulative probability of survival was significantly lower.
Conclusion:
Typical COVID-19 symptoms may be absent among the elderly, prompting a lower threshold of suspicion during the COVID-19 pandemic. Additionally, the elderly demonstrated a higher probability of adverse outcomes despite earlier presentation and treatment.
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