Department of Medical Science, University of Ferrara, Ferrara, Italy.
Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy.
Rejuvenation Res. 2022 Jun;25(3):129-140. doi: 10.1089/rej.2021.0063. Epub 2022 Jun 6.
COVID-19 may have a heterogeneous onset, especially in older age. However, whether and how COVID-19 signs and symptoms may present and aggregate together according to sociodemographic and health factors is unclear, as well as their prognostic value. This study included 981 COVID-19 inpatients who participated in the GeroCovid Observational study. Signs/symptoms at disease onset, sociodemographic, health, cognitive status, and mobility were systematically recorded. Clusters of signs/symptoms were identified through agglomerative hierarchical clustering. The associations of single signs/symptoms and symptom clusters with longer hospitalization (≥16 days) and in-hospital mortality were explored through logistic and Cox regressions. The signs/symptoms most reported in our sample (age 78.3 ± 9.39 years; 49.4% women) were fever (62.5%), cough (45.5%), and dyspnea (62.7%). Atypical symptoms were reported by up to one-third of patients, and delirium by 9.1%. Atypical symptoms were more frequent with advancing age and with lower pre-COVID-19 cognitive and mobility levels. Older men more likely reported respiratory symptoms than women. Dyspnea (hazard ratio [HR] = 1.47, 95% confidence interval [CI]: 1.02-2.12), tachypnea (HR = 1.53, 95% CI: 1.14-2.07), low oxygen saturation (HR = 1.95, 95% CI: 1.32-2.88) and delirium (HR = 1.60, 95% CI: 1.13-2.28) were associated with higher in-hospital mortality. Four symptom clusters were identified. Compared with the cluster, the cluster was associated with higher mortality (HR = 2.57, 95% CI: 1.58-4.18). The and symptoms clusters were associated with longer hospitalization (odds ratio [OR] = 2.38, 95% CI: 1.56-3.63, and OR = 1.75, 95% CI: 1.08-2.83, respectively). Multiple health aspects influence COVID-19 clinical presentation. A symptom clusters approach may help predict adverse health outcomes in older patients. In addition to respiratory symptoms, delirium is independently associated with mortality risk. ClinicalTrials.gov (NCT04379440).
COVID-19 可能具有异质的发病，尤其是在老年人中。然而，COVID-19 的症状和体征根据社会人口学和健康因素如何表现和聚集在一起尚不清楚，以及它们的预后价值。本研究纳入了 981 名参与 GeroCovid 观察性研究的 COVID-19 住院患者。在疾病发作时系统地记录了体征/症状、社会人口学、健康、认知状态和活动能力。通过聚合层次聚类识别体征/症状聚类。通过逻辑回归和 Cox 回归探讨了单个体征/症状和症状聚类与住院时间延长（≥16 天）和住院死亡率的关系。在我们的样本中报告的最常见症状（年龄 78.3 ± 9.39 岁；49.4%女性）是发热（62.5%）、咳嗽（45.5%）和呼吸困难（62.7%）。多达三分之一的患者报告有不典型症状，9.1%的患者有谵妄。不典型症状在年龄较大和 COVID-19 发病前认知和活动能力水平较低的患者中更为常见。老年男性比女性更有可能报告呼吸系统症状。呼吸困难（危险比 [HR] = 1.47，95%置信区间 [CI]：1.02-2.12）、呼吸急促（HR = 1.53，95% CI：1.14-2.07）、低血氧饱和度（HR = 1.95，95% CI：1.32-2.88）和谵妄（HR = 1.60，95% CI：1.13-2.28）与更高的住院死亡率相关。确定了四个症状聚类。与聚类相比，聚类与更高的死亡率相关（HR = 2.57，95% CI：1.58-4.18）。和症状聚类与住院时间延长相关（优势比 [OR] = 2.38，95% CI：1.56-3.63 和 OR = 1.75，95% CI：1.08-2.83）。多个健康方面影响 COVID-19 的临床表现。症状聚类方法可能有助于预测老年患者的不良健康结局。除呼吸系统症状外，谵妄与死亡风险独立相关。ClinicalTrials.gov（NCT04379440）。
