Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; II Medicina Generale, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25125, Brescia, Italy; Division of Internal Medicine, Cremona Hospital, Viale Concordia 1, 26100 Cremona, Italy.
Division of Internal Medicine, Cremona Hospital, Viale Concordia 1, 26100 Cremona, Italy.
Arch Gerontol Geriatr. 2021 May-Jun;94:104349. doi: 10.1016/j.archger.2021.104349. Epub 2021 Jan 21.
Mortality is high in Coronavirus disease 2019 patients with pre-existing comorbidities and advanced age. Associated complications have added to the negative prognosis. Nevertheless, many have fully recovered, even among the most fragile. Factors associated with their survival was investigated.
Retrospective study of patients aged ≥90 years admitted for COVID-19 to the Internal Medicine wards of two hospitals in Lombardy, Italy.
Among 34 patients with SARS-CoV-2 pneumonia, 33 (97.1%) had respiratory failure. Eighteen patients (52.9%) survived and 16 (47.1%) died during hospital stay. Survivors compared to deceased had a significantly longer hospitalization (19 vs. 10 days respectively; p = 0.02), a better PaO2:FiO2 ratio (241 vs. 171 respectively; p = 0.003), higher lymphocyte counts (p = 0.01) and lower serum LDH levels (p < 0.001) at admission. At multivariate analysis only higher PaO2:FiO2 was associated with survival (OR 1.06 [95%CI 1.0-1.03]; p = 0.02). Kaplan-Meier analysis showed a significant difference in event-free survival between patients treated or not with LMWH (p < 0.0001) and between those treated or not with beta-blockers (p = 0.008). Cox regression, performed in the subgroup of patients who received LMWH, did not show significant difference for sex (HR 2.7 [95% CI 0.53-14.3], p = 0.23), CCI (HR 0.7 [95% CI 0.37-1.45], p = 0.38), PaO2:FiO2 ratio (HR 0.98 [95% CI 0.97-1.0], p = 0.07), corticosteroid therapy (HR 0.99 [95% CI 0.22-4.5], p = 0.99) and beta-blocker therapy (HR 2.8 [95% CI 0.56-14,7], p = 0.21).
Despite higher mortality in elderly, treatment with LMWH and betablockers might be associated with better survival. Dedicated studies are required to confirm our result.
患有合并症和高龄的 2019 年冠状病毒病患者死亡率较高。相关并发症增加了不良预后。然而，许多人已经完全康复，即使是最脆弱的人。调查了与他们的生存相关的因素。
对意大利伦巴第两家医院内科病房因 COVID-19 住院的年龄≥90 岁的患者进行回顾性研究。
在 34 例 SARS-CoV-2 肺炎患者中，33 例（97.1%）有呼吸衰竭。18 例（52.9%）存活，16 例（47.1%）在住院期间死亡。与死亡患者相比，存活患者的住院时间明显更长（分别为 19 天和 10 天；p=0.02），PaO2:FiO2 比值更好（分别为 241 和 171；p=0.003），淋巴细胞计数更高（p=0.01），血清 LDH 水平更低（p<0.001）。多变量分析仅显示较高的 PaO2:FiO2 与生存相关（OR 1.06 [95%CI 1.0-1.03]；p=0.02）。Kaplan-Meier 分析显示，接受或不接受低分子量肝素治疗的患者之间无事件生存差异有统计学意义（p<0.0001），接受或不接受β受体阻滞剂治疗的患者之间也有统计学意义（p=0.008）。在接受低分子量肝素治疗的患者亚组中进行 Cox 回归分析，未显示性别（HR 2.7 [95%CI 0.53-14.3]；p=0.23）、CCI（HR 0.7 [95%CI 0.37-1.45]；p=0.38）、PaO2:FiO2 比值（HR 0.98 [95%CI 0.97-1.0]；p=0.07）、皮质类固醇治疗（HR 0.99 [95%CI 0.22-4.5]；p=0.99）和β受体阻滞剂治疗（HR 2.8 [95%CI 0.56-14.7]；p=0.21）有统计学差异。
尽管老年人死亡率较高，但使用低分子量肝素和β受体阻滞剂治疗可能与更好的生存相关。需要进行专门的研究来证实我们的结果。
