Liu Zhelong, Wu Danning, Han Xia, Jiang Wangyan, Qiu Lin, Tang Rui, Yu Xuefeng
Department of Endocrinology, Tongji Hospital, affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Eight-Year Program of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Int Immunopharmacol. 2021 Mar;92:107343. doi: 10.1016/j.intimp.2020.107343. Epub 2021 Jan 4.
The differences in the characteristics and main causes of critical COVID-19 infection in non-elderly and elderly severe patients remain unknown.
We included 273 adult patients with confirmed severe COVID-19 from Tongji Hospital, Wuhan, China from February 10 to March 8, 2020. Clinical characteristics and risk factors for outcomes were compared between the young and middle-aged and the elderly severe patients.
Hemoglobin, neutrophil percentage, inflammatory markers, hepatic, renal, and cardiovascularparameters differed between the non-elderly and elderly severe patients. In young and middle-aged patients, critical patients showed higher high-sensitivity C-reactive protein (hsCRP) during hospitalization than severe patients. However, in the elderly patients, critical patients showed decreased hsCRP during hospitalization and higher proBNP values. The hsCRP fluctuation and proBNP were independent risk factors for intensive care unit (ICU) admission in young and middle-aged severe patients (OR=1.068) and elderly severe patients (OR=1.026), respectively.
The study revealed different potential causes of disease and predictive factors for non-elderly and elderly critical patients and treatment recommendations. Deterioration of inflammatory state was the main cause of ICU admission in young and middle-aged severe COVID-19 patients, while a decline in hsCRP was not associated with better outcomes in elderly severe patients, indicating the need for different treatments for non-elderly and elderly severe patients. Anti-inflammatory therapy with corticosteroids should be considered in the early disease stage among non-elderly severe patients, but cardiovascular protection plays a more important role in elderly severe patients.
非老年和老年重症新冠肺炎患者在关键感染特征及主要病因方面的差异尚不清楚。
我们纳入了2020年2月10日至3月8日来自中国武汉同济医院的273例确诊为重症新冠肺炎的成年患者。比较了中青年和老年重症患者的临床特征及预后危险因素。
非老年和老年重症患者在血红蛋白、中性粒细胞百分比、炎症标志物、肝脏、肾脏及心血管参数方面存在差异。在中青年患者中，危重症患者住院期间的高敏C反应蛋白（hsCRP）高于重症患者。然而，在老年患者中，危重症患者住院期间hsCRP降低，而脑钠肽前体（proBNP）值升高。hsCRP波动和proBNP分别是中青年重症患者（OR=1.068）和老年重症患者（OR=1.026）入住重症监护病房（ICU）的独立危险因素。
该研究揭示了非老年和老年危重症患者不同的潜在病因、预测因素及治疗建议。炎症状态恶化是中青年重症新冠肺炎患者入住ICU的主要原因，而hsCRP降低与老年重症患者的较好预后无关，这表明非老年和老年重症患者需要不同的治疗方法。对于非老年重症患者，在疾病早期应考虑使用糖皮质激素进行抗炎治疗，但心血管保护在老年重症患者中起着更重要的作用。
