Division of Pneumology, Sant'Andrea Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy.
Department of Clinical and Molecular Medicine, Sapienza University, Viale Regina Elena n. 324, 00161, Rome, Italy.
BMC Geriatr. 2021 Jan 15;21(1):63. doi: 10.1186/s12877-021-02013-3.
The actual SARS-CoV-2 outbreak caused a highly transmissible disease with a tremendous impact on elderly people. So far, few studies focused on very elderly patients (over 80 years old). In this study we examined the clinical presentation and the outcome of the disease in this group of patients, admitted to our Hospital in Rome.
This is a single-center, retrospective study performed in the Sant'Andrea University Hospital of Rome. We included patients older than 65 years of age with a diagnosis of COVID-19, from March 2020 to May 2020, divided in two groups according to their age (Elderly: 65-80 years old; Very Elderly > 80 years old). Data extracted from the each patient record included age, sex, comorbidities, symptoms at onset, the Pneumonia Severity Index (PSI), the ratio of the partial pressure of oxygen in arterial blood (PaO2) to the inspired oxygen fraction (FiO2) (P/F) on admission, laboratory tests, radiological findings on computer tomography (CT), length of hospital stay (LOS), mortality rate and the viral shedding. The differences between the two groups were analyzed by the Fisher's exact test or the Wilcoxon signed-rank test for categorical variables and the Mann-Whitney U test for continuous variables. To assess significance among multiple groups of factors, we used the Bonferroni correction. The survival time was estimated by Kaplan-Meier method and Log Rank Test. Univariate and Multivariate logistic regression were performed to estimate associations between age, comorbidities, provenance from long-stay residential care homes (LSRCH) s and clinical outcomes.
We found that Very Elderly patients had an increased mortality rate, also due to the frequent occurrence of multiple comorbidities. Moreover, we found that patients coming from LSRCHs appeared to be highly susceptible and vulnerable to develop severe manifestations of the disease.
We demonstrate that there were considerable differences between Elderly and Very Elderly patients in terms of inflammatory activity, severity of disease, adverse clinical outcomes. To establish a correct risk stratification, comorbidities and information about provenience from LSRCHs should be considered.
实际的 SARS-CoV-2 爆发导致了一种具有高度传染性的疾病，对老年人产生了巨大影响。到目前为止，很少有研究关注非常高龄的患者（80 岁以上）。在这项研究中，我们检查了在罗马我院住院的这组患者的疾病临床表现和结局。
这是一项在罗马圣安德烈大学医院进行的单中心回顾性研究。我们纳入了 2020 年 3 月至 2020 年 5 月期间年龄大于 65 岁且被诊断为 COVID-19 的患者，根据年龄分为两组（老年：65-80 岁；非常老年：＞80 岁）。从每位患者的病历中提取的数据包括年龄、性别、合并症、发病时的症状、肺炎严重指数（PSI）、动脉血氧分压（PaO2）与吸入氧分数（FiO2）的比值（P/F）、入院时的实验室检查、计算机断层扫描（CT）的影像学发现、住院时间（LOS）、死亡率和病毒脱落。使用 Fisher 确切检验或 Wilcoxon 符号秩检验分析两组之间的差异，对连续变量使用 Mann-Whitney U 检验。为了评估多个因素组之间的显著性，我们使用了 Bonferroni 校正。使用 Kaplan-Meier 方法和 Log Rank 检验估计生存时间。进行单因素和多因素逻辑回归分析以评估年龄、合并症、来自长期护理院（LSRCH）和临床结局之间的关联。
我们发现非常高龄患者的死亡率更高，这也是由于多种合并症频繁发生所致。此外，我们发现来自 LSRCH 的患者似乎极易受到严重疾病的影响。
我们证明了老年和非常高龄患者在炎症活动度、疾病严重程度、不良临床结局方面存在明显差异。为了进行正确的风险分层，应考虑合并症和来自 LSRCH 的信息。
