Coronavirus disease 2019 in elderly patients: Characteristics and prognostic factors based on 4-week follow-up

Abstract

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.

Keywords: Coronavirus infections; Pneumonia; Prognosis; SARS-CoV-2.

Fig. 1

Univariate Cox regression for prognostic factors. Univariate Cox regression analysis of risk factors associated with fatality. AKI, acute kidney injury; APTT, activated partial thromboplastin time; ARDS, acute respiratory distress syndrome; COPD, chronic obstructive pulmonary disease; CKD, chronic kidney disease; HR, hazard ratio. ^⁎⁎P < 0.01, ^⁎⁎⁎P < 0.001.

Fig. 2

Multivariate Cox regression for prognostic factors. Multivariate Cox regressions were performed for comorbidities (A) and complications (B), in which the “Age” factor was added to correct the models. AKI, acute kidney injury; ARDS, acute respiratory distress syndrome; COPD, chronic obstructive pulmonary disease; HR, hazard ratio. *P < 0.05, ^⁎⁎⁎P < 0.001.