Department of Emergency Medicine, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
Department of Emergency Medicine, Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
Gerontology. 2021;67(4):433-440. doi: 10.1159/000514481. Epub 2021 Mar 30.
The novel coronavirus (COVID-19), which has affected over 100 countries in a short while, progresses more mortally in elderly patients with comorbidities. In this study, we examined the epidemiological, clinical, and laboratory characteristics of the patients aged 60 and over who had been infected with COVID-19.
The data of the patients admitted to the hospital within 1 month from May 8, 2020 onwards and hospitalized for COVID-19 pneumonia were obtained from the hospital medical records, and the epidemiological, clinical, and laboratory parameters of the patients during the admission to the emergency department were examined. Patients were divided into 2 groups regarding the criteria of having in-hospital mortality (mortality group) and being discharged with full recovery (survivor group). The factors, which could have an impact on the mortality, were investigated using a univariate and multivariate logistic regression analysis.
This retrospective study included 113 patients aged 60 years and older, with a confirmed diagnosis of COVID-19 pneumonia. The mean age of the patients was 70.7 ± 7.9, and 64.6% (n = 73) of them were male. The mortality rate was 19.4% (n = 22). Among the comorbid illnesses, only renal failure was significant in the mortality group (p = 0.04). A CURB-65score ≥3 or pneumonia severity index (PSI) class ≥4 manifested a remarkable discrimination ability to predict 30-day mortality (p < 0.001). When the laboratory parameters were considered, the value of neutrophil to lymphocyte ratio (NLR) was significant in predicting mortality in univariate and multivariate analysis (odds ratio [OR] = 1.11; 95% confidence interval [95% CI], 1.03-1.21; p = 0.006, and OR = 1.51; 95% CI, 1.11-2.39; p = 0.044, respectively).
In our study, NLR was determined to be an independent marker to predict in-hospital mortality among patients with COVID-19. PSI and CURB-65 revealed a considerably precise prognostic accuracy for the patients with COVID-19 in our study as well. Moreover, thanks to that NLR results in a very short time, it can enable the clinician to predict mortality before the scoring systems are calculated and hasten the management of the patients in the chaotic environment of the emergency room.
新型冠状病毒（COVID-19）在短时间内已蔓延至 100 多个国家，其对老年合并症患者的致死率更高。本研究旨在分析感染 COVID-19 的 60 岁及以上老年患者的流行病学、临床和实验室特征。
自 2020 年 5 月 8 日起，收集我院 1 个月内入院的 COVID-19 肺炎患者的住院病历资料，分析急诊就诊时患者的流行病学、临床和实验室参数。根据住院期间的院内死亡率（死亡组）和完全康复出院（存活组）标准将患者分为两组。采用单因素和多因素逻辑回归分析可能影响死亡率的因素。
本回顾性研究共纳入 113 例 60 岁及以上确诊为 COVID-19 肺炎的患者。患者平均年龄为 70.7±7.9 岁，其中 64.6%（n=73）为男性。死亡率为 19.4%（n=22）。在合并症中，只有肾衰竭在死亡组中具有统计学意义（p=0.04）。CURB-65评分≥3 分或肺炎严重指数（PSI）分级≥4 分对预测 30 天死亡率有显著的区分能力（p＜0.001）。当考虑实验室参数时，中性粒细胞与淋巴细胞比值（NLR）在单因素和多因素分析中均对死亡率有显著预测意义（优势比[OR]为 1.11；95%置信区间[95%CI]为 1.03-1.21；p=0.006，OR 为 1.51；95%CI 为 1.11-2.39；p=0.044）。
在本研究中，NLR 被确定为 COVID-19 患者住院死亡率的独立预测标志物。PSI 和 CURB-65 对本研究中的 COVID-19 患者具有相当精确的预后准确性。此外，由于 NLR 结果可在很短的时间内获得，它可以使临床医生在评分系统计算之前预测死亡率，并在急诊室混乱的环境中加速患者的管理。
