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.
School of Biotechnology and Biomolecular Sciences, The University of New South Wales, NSW 2052, Australia.
J Infect. 2020 Jun;80(6):639-645. doi: 10.1016/j.jinf.2020.03.019. Epub 2020 Mar 30.
To investigate the characteristics and prognostic factors in the elderly patients with COVID-19.
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.
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).
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.
探讨 COVID-19 老年患者的特征和预后因素。
纳入 2020 年 1 月 1 日至 2 月 6 日期间武汉大学人民医院年龄≥60 岁的 COVID-19 连续病例。主要结局为死亡和 3 月 5 日前的生存情况。收集并比较不同结局的人口统计学、临床特征、合并症、实验室检查和并发症数据。采用 Cox 回归分析预后因素。
共纳入 339 例 COVID-19 患者（年龄 71±8 岁，173 例女性（51%）），其中 80 例（23.6%）为危重症，159 例（46.9%）为重症，100 例（29.5%）为中度。常见合并症为高血压（40.8%）、糖尿病（16.0%）和心血管疾病（15.7%）。常见症状包括发热（92.0%）、咳嗽（53.0%）、呼吸困难（40.8%）和乏力（39.9%）。淋巴细胞减少是常见的实验室发现（63.2%）。常见并发症包括细菌感染（42.8%）、肝酶异常（28.7%）和急性呼吸窘迫综合征（21.0%）。截至 2020 年 3 月 5 日，91 例出院（26.8%），183 例住院（54.0%），65 例死亡（19.2%）。与幸存者相比，死亡患者的住院时间更短（5（3-8）vs. 28（26-29），P<0.001）。呼吸困难症状（HR 2.35，P=0.001）、合并症（包括心血管疾病 HR 1.86，P=0.031 和慢性阻塞性肺疾病 HR 2.24，P=0.023）和急性呼吸窘迫综合征（HR 29.33，P<0.001）是死亡的强烈预测因素。淋巴细胞水平较高提示预后较好（HR 0.10，P<0.001）。
COVID-19 老年患者中重症和危重症比例较高，死亡率较高。死亡患者疾病进展迅速，中位生存时间为入院后 5 天。呼吸困难、淋巴细胞减少、合并心血管疾病和慢性阻塞性肺疾病以及急性呼吸窘迫综合征是预后不良的预测因素。应密切监测和及时治疗高危老年患者。
