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

Author(s): Lang Wang , MD ^a ^, ^b ^, ^c ^, ¹ , Wenbo He , MD ^a ^, ^b ^, ^c ^, ¹ , Xiaomei Yu , MD ^a ^, ^b ^, ^c , Dalong Hu , PhD ^d , Mingwei Bao , MD ^a ^, ^b ^, ^c , Huafen Liu , MM ^a , Jiali Zhou , MSN ^a , Hong Jiang , MD ^a ^, ^b ^, ^c ^, ^*

Publication date (Electronic): 30 March 2020

Journal: The Journal of Infection

Publisher: The British Infection Association. Published by Elsevier Ltd.

Keywords: Coronavirus Infections, SARS-CoV-2, Pneumonia, Prognosis

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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

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 (OR = 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.

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Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Chaolin Huang, Yeming Wang, Xingwang Li … (2020)

Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.

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KDIGO Clinical Practice Guidelines for Acute Kidney Injury

Arif Khwaja, A. Khwaja (2012)

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[The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China].

(2020)

Objective: An outbreak of 2019 novel coronavirus diseases (COVID-19) in Wuhan, China has spread quickly nationwide. Here, we report results of a descriptive, exploratory analysis of all cases diagnosed as of February 11, 2020. Methods: All COVID-19 cases reported through February 11, 2020 were extracted from China's Infectious Disease Information System. Analyses included: 1) summary of patient characteristics; 2) examination of age distributions and sex ratios; 3) calculation of case fatality and mortality rates; 4) geo-temporal analysis of viral spread; 5) epidemiological curve construction; and 6) subgroup analysis. Results: A total of 72 314 patient records-44 672 (61.8%) confirmed cases, 16 186 (22.4%) suspected cases, 10567 (14.6%) clinical diagnosed cases (Hubei only), and 889 asymptomatic cases (1.2%)-contributed data for the analysis. Among confirmed cases, most were aged 30-79 years (86.6%), diagnosed in Hubei (74.7%), and considered mild (80.9%). A total of 1 023 deaths occurred among confirmed cases for an overall case-fatality rate of 2.3%. The COVID-19 spread outward from Hubei sometime after December 2019 and by February 11, 2020, 1 386 counties across all 31 provinces were affected. The epidemic curve of onset of symptoms peaked in January 23-26, then began to decline leading up to February 11. A total of 1 716 health workers have become infected and 5 have died (0.3%). Conclusions: The COVID-19 epidemic has spread very quickly. It only took 30 days to expand from Hubei to the rest of Mainland China. With many people returning from a long holiday, China needs to prepare for the possible rebound of the epidemic.

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Author and article information

Contributors

Hong Jiang

Journal

Journal ID (nlm-ta): J Infect

Journal ID (iso-abbrev): J. Infect

Title: The Journal of Infection

Publisher: The British Infection Association. Published by Elsevier Ltd.

ISSN (Print): 0163-4453

ISSN (Electronic): 1532-2742

Publication date PMC-release: 30 March 2020

Publication date (Electronic): 30 March 2020

Electronic Location Identifier:

Affiliations

[a ]Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, People's Republic of China

[b ]Cardiovascular Research Institute, Wuhan University, Wuhan, People's Republic of China

[c ]Hubei Key Laboratory of Cardiology, Wuhan, People's Republic of China

[d ]School of Biotechnology and Biomolecular Sciences, The University of New South Wales, NSW 2052, Australia

Author notes

[* ]Correspondence to: Hong Jiang, MD, Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang, Wuhan 430060, P.R. China, Tel: +86 27 88041911, Fax: +86 27 88040334. hong-jiang@ 123456whu.edu.cn

[1]

These two authors contributed equally to this work.

Article

Publisher ID: S0163-4453(20)30146-8

DOI: 10.1016/j.jinf.2020.03.019

PMC ID: 7118526

PubMed ID: 32240670

SO-VID: 9399e046-58c4-421f-80bd-3696efb17714

License:

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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

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Novel Coronavirus Disease COVID-19

Most cited references 6

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

KDIGO Clinical Practice Guidelines for Acute Kidney Injury

[The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China].

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