Clinical characteristics and manifestations in older patients with COVID-19

Chenchen Wei,Kai Zhang,Yapeng Liu,Xiao Meng,Ming Zhong,Dezhen Su,Ya Liu

doi:10.1186/s12877-020-01811-5

Abstract

BackgroundTo investigate the clinical characteristics and manifestations of older patients with coronavirus disease 2019 (COVID-19).MethodsIn this retrospective study, 566 patients with confirmed COVID-19 were enrolled and the clinical characteristics, laboratory findings, complications and outcome data were collected and analyzed.ResultsAmong the 566 patients (median age, 61.5 years) with COVID-19, 267 (47.2%) patients were male and 307 (54.2%) were elderly. Compared with younger patients, older patients had more underlying comorbidities and laboratory abnormalities. A higher rate of acute respiratory distress syndrome (ARDS), acute cardiac injury and heart failure was observed in the older group as compared with younger and middle-aged groups, particularly those oldest-old patients had more multi-organ damage. Older patients with COVID-19 were more likely to suffer from acute cardiac injury in cases with preexistenting cardiovascular diseases, while there was no difference among the three groups when patients had no history of cardiovascular diseases. Older patients presented more severe with the mortality of 18.6%, which was higher than that in younger and middle-aged patients (P < 0.05). Multivariable analysis showed that age, lymphopenia, ARDS, acute cardiac injury, heart failure and skeletal muscle injury were associated with death in older patients, while glucocorticoids might be harmful.ConclusionsOlder patients, especially the oldest-old patients were more likely to exhibit significant systemic inflammation, pulmonary and extrapulmonary organ damage and a higher mortality. Advanced age, lymphopenia, ARDS, acute cardiac injury, heart failure and skeletal muscle injury were independent predictors of death in older patients with COVID-19 and glucocorticoids should be carefully administered in older patients.

Highlights

To investigate the clinical characteristics and manifestations of older patients with coronavirus disease 2019 (COVID-19)
Compared with younger and middle-aged groups, systolic blood pressure and the incidence of any coexisting medical condition were higher in the older group, like the occurrence of hypertension, diabetes and coronary artery disease (CAD)
We showed that older patients with COVID-19 exhibited more coexisting diseases, acute respiratory distress syndrome (ARDS) and extrapulmonary organ damage, which were associated with a higher mortality

Summary

Introduction

To investigate the clinical characteristics and manifestations of older patients with coronavirus disease 2019 (COVID-19). COVID-19 caused by a novel coronavirus (SARS-CoV-2) has spread rapidly during the past several months. As a novel infectious disease, COVID-19 has the ability of human-to-human transmission and can lead to acute respiratory distress syndrome (ARDS), multiple organ dysfunction and even death [1]. In China, there were 241 million elderly people aged over 60 years old, among whom more than 30 million were more than 80 years old [2]. The population is generally susceptible to SARSCoV-2, older people have higher morbidity and mortality than younger individuals, those with serious underlying comorbidities [3]. The majority of patients infected by SARS-CoV-2 were over 50 years old, and nearly 80% of deaths occurred among individuals aged ≥ 60 years [4]

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