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

  • Author Footnotes
    1 These two authors contributed equally to this work.
    Lang Wang
    Footnotes
    1 These two authors contributed equally to this work.
    Affiliations
    Department 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
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  • Author Footnotes
    1 These two authors contributed equally to this work.
    Wenbo He
    Footnotes
    1 These two authors contributed equally to this work.
    Affiliations
    Department 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
    Search for articles by this author
  • Xiaomei Yu
    Affiliations
    Department 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
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  • Dalong Hu
    Affiliations
    School of Biotechnology and Biomolecular Sciences, The University of New South Wales, NSW 2052, Australia
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  • Mingwei Bao
    Affiliations
    Department 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
    Search for articles by this author
  • Huafen Liu
    Affiliations
    Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang, Wuhan 430060, People's Republic of China
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  • Jiali Zhou
    Affiliations
    Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang, Wuhan 430060, People's Republic of China
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  • Hong Jiang
    Correspondence
    Corresponding author at: Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang, Wuhan 430060, People's Republic of China.
    Affiliations
    Department 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
    Search for articles by this author
  • Author Footnotes
    1 These two authors contributed equally to this work.
Published:March 30, 2020DOI:https://doi.org/10.1016/j.jinf.2020.03.019

      Highlights

      • COVID-19 in the elderly patients was severe and highly fatal.
      • COVID-19 progressed rapidly in patients who died.
      • Cardiovascular disease, COPD, dyspnea, lymphocytopenia and ARDS predict mortality.
      • The elderly patients need close monitoring and timely treatment.

      Summary

      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

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      References

        • Huang C.
        • Wang Y.
        • Li X.
        • et al.
        Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.
        Lancet. 2020; 395: 497-506
        • Guan W.J.
        • Ni Z.Y.
        • Hu Y.
        • et al.
        Clinical characteristics of coronavirus disease 2019 in China.
        N Engl J Med. 2020;
      1. Interim guidance for novel coronavirus pneumonia.
        6th Ed. National Health Commision of the People's Republic of China, 2020 (Accessed February 27th, 2020)
        • Report of the WHO-China Joint Mission on Coronavirus Disease
        2019 (Accessed Mar 5th, 2020)
        • Khwaja A.
        KDIGO clinical practice guidelines for acute kidney injury.
        Nephron Clin Pract. 2012; 120: c179-c184
        • Ferguson N.D.
        • Fan E.
        • Camporota L.
        • et al.
        The berlin definition of ARDS: an expanded rationale, justification, and supplementary material.
        Intensive Care Med. 2012; 38: 1573-1582
        • Jansen J.M.
        • Gerlach T.
        • Elbahesh H.
        • Rimmelzwaan G.F.
        • Saletti G.
        Influenza virus-specific CD4+ and CD8+ T cell-mediated immunity induced by infection and vaccination.
        J Clin Virol. 2019; 119: 44-52
        • Whitmire J.K.
        • Ahmed R.
        Costimulation in antiviral immunity: differential requirements for CD4(+) and CD8(+) t cell responses. Curr==70==.
        Opin Immunol. 2000; 12: 448-455
      2. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China.
        Zhonghua Liu Xing Bing Xue Za Zhi. 2020; 41: 145-151
        • Bellani G.
        • Laffey J.G.
        • Pham T.
        • et al.
        Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries.
        JAMA. 2016; 315: 788-800
        • Zumla A.
        • Hui D.S.
        • Perlman S.
        Middle east respiratory syndrome.
        Lancet. 2015; 386: 995-1007
        • Gu J.
        • Gong E.
        • Zhang B.
        • et al.
        Multiple organ infection and the pathogenesis of Sars.
        J Exp Med. 2005; 202: 415-424
        • Chu H.
        • Zhou J.
        • Wong B.H.
        • et al.
        Middle east respiratory syndrome coronavirus efficiently infects human primary t lymphocytes and activates the extrinsic and intrinsic apoptosis pathways.
        J Infect Dis. 2016; 213: 904-914