Department of Emergency, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang District, Dalian, 116011, Liaoning, China.
Department of Emergency, General Hospital of Tianjin Medical University, Tianjin, 300052, China.
Sci Rep. 2020 Dec 22;10(1):22369. doi: 10.1038/s41598-020-79508-3.
We aimed to analyse clinical characteristics and identify risk factors predicting all-cause mortality in older patients with severe coronavirus disease 2019 (COVID-19). A total of 281 older patients with severe COVID-19 were categorized into two age groups (60-79 years and ≥ 80 years). Epidemiological, clinical, and laboratory data, and outcome were obtained. Patients aged ≥ 80 years had higher mortality (63.6%) than those aged 60-79 years (33.5%). Anorexia and comorbidities including hypertension, diabetes and COPD, higher levels of lactate dehydrogenase (LDH), osmotic pressure, C-reactive protein, D-dimer, high-sensitivity troponin I and procalcitonin, and higher SOFA scores were more common in patients aged > 80 years than those aged 60-79 years and also more common and higher in non-survivors than survivors. LDH, osmotic pressure, C-reactive protein, D-dimer, high-sensitivity troponin I, and procalcitonin were positively correlated with age and sequential organ failure assessment (SOFA), whereas CD8+ and lymphocyte counts were negatively correlated with age and SOFA. Anorexia, comorbidities including hypertension, diabetes, and chronic obstructive pulmonary disease (COPD), LDH, osmotic pressure, and SOFA were significantly associated with 28-day all-cause mortality. LDH, osmotic pressure and SOFA were valuable for predicting 28-day all-cause mortality, whereas the area under the receiver operating characteristic curve of LDH was the largest, with sensitivity of 86.0% and specificity of 80.8%. Therefore, patients with severe COVID-19 aged ≥ 80 years had worse condition and higher mortality than did those aged 60-79 years, and anorexia and comorbidities including hypertension, diabetes, COPD, elevated plasma osmotic pressure, LDH, and high SOFA were independent risk factors associated with 28-day all-cause mortality in older patients with severe COVID-19. LDH may have the highest predictive value for 28-day all-cause mortality in all examined factors.
我们旨在分析临床特征，并确定预测 2019 年冠状病毒病（COVID-19）重症老年患者全因死亡率的危险因素。将 281 名重症 COVID-19 老年患者分为两个年龄组（60-79 岁和≥80 岁）。获得了流行病学、临床和实验室数据及结果。年龄≥80 岁的患者死亡率（63.6%）高于 60-79 岁的患者（33.5%）。与 60-79 岁的患者相比，年龄≥80 岁的患者更常见厌食和合并症（包括高血压、糖尿病和 COPD）、乳酸脱氢酶（LDH）、渗透压、C 反应蛋白、D-二聚体、高敏肌钙蛋白 I 和降钙素原水平较高，以及 SOFA 评分较高；与幸存者相比，非幸存者中这些指标更为常见和更高。LDH、渗透压、C 反应蛋白、D-二聚体、高敏肌钙蛋白 I 和降钙素原与年龄和序贯器官衰竭评估（SOFA）呈正相关，而 CD8+和淋巴细胞计数与年龄和 SOFA 呈负相关。厌食、合并症（包括高血压、糖尿病和慢性阻塞性肺疾病（COPD））、LDH、渗透压和 SOFA 与 28 天全因死亡率显著相关。LDH、渗透压和 SOFA 对预测 28 天全因死亡率有价值，其中 LDH 的受试者工作特征曲线下面积最大，敏感性为 86.0%，特异性为 80.8%。因此，与 60-79 岁的患者相比，患有严重 COVID-19 的年龄≥80 岁的患者病情更差，死亡率更高，厌食和合并症（包括高血压、糖尿病、COPD、血浆渗透压升高、LDH 和 SOFA 升高）是与严重 COVID-19 老年患者 28 天全因死亡率相关的独立危险因素。在所有检查因素中，LDH 对 28 天全因死亡率的预测价值可能最高。
