Dadras Omid, SeyedAlinaghi SeyedAhmad, Karimi Amirali, Shamsabadi Ahmadreza, Qaderi Kowsar, Ramezani Maryam, Mirghaderi Seyed Peyman, Mahdiabadi Sara, Vahedi Farzin, Saeidi Solmaz, Shojaei Alireza, Mehrtak Mohammad, Azar Shiva A, Mehraeen Esmaeil, Voltarelli Fabrício A
Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors Tehran Iran.
Department of Global Public Health and Primary Care University of Bergen Bergen Norway.
Health Sci Rep. 2022 May 23;5(3):e657. doi: 10.1002/hsr2.657. eCollection 2022 May.
Older people have higher rates of comorbidities and may experience more severe inflammatory responses; therefore, are at higher risk of death. Herein, we aimed to systematically review the mortality in coronavirus disease 2019 (COVID-19) patients and its predictors in this age group.
We searched PubMed, Web of Science, and Science Direct using relevant keywords. Retrieved records underwent a two-step screening process consisting of title/abstract and full-text screenings to identify the eligible studies.
Summarizing findings of 35 studies demonstrated that older patients have higher mortality rates compared to the younger population. A review of articles revealed that increasing age, body mass index, a male gender, dementia, impairment or dependency in daily activities, presence of consolidations on chest X-ray, hypoxemic respiratory failure, and lower oxygen saturation at admission were risk factors for death. High d-dimer levels, 25-hydroxy vitamin D serum deficiencies, high C-reactive protein (≥5 mg/L) levels plus any other abnormalities of lymphocyte, higher blood urea nitrogen or lactate dehydrogenase, and higher platelet count were predictors of poor prognosis and mortality in the elderly. Studies have also shown that previous treatment with renin-angiotensin-aldosterone system inhibitors, pharmacological treatments of respiratory disorders, antibiotics, corticosteroids, vitamin K antagonist, antihistamines, azithromycin, Itolizumab (an anti-CD6 monoclonal antibody) in combination with other antivirals reduces COVID-19 worsening and mortality. Vaccination against seasonal influenza might also reduce COVID-19 mortality.
Overall, a critical consideration is necessary for the care and management of COVID-19 in the aged population considering the drastic contrasts in manifestation and prognosis compared to other age groups. Mortality from COVID-19 is independently associated with the patient's age. Elderly patients with COVID-19 are more vulnerable to poor outcomes. Thus, strict preventive measures, timely diagnosis, and aggressive therapeutic/nontherapeutic care are of great importance to reduce acute respiratory distress syndrome and severe complications in older people.
老年人合并症发生率更高，可能经历更严重的炎症反应，因此死亡风险更高。在此，我们旨在系统回顾2019冠状病毒病（COVID-19）患者的死亡率及其在该年龄组中的预测因素。
我们使用相关关键词在PubMed、科学网和科学Direct数据库中进行检索。检索到的记录经过两步筛选过程，包括标题/摘要筛选和全文筛选，以确定符合条件的研究。
总结35项研究的结果表明，老年患者的死亡率高于年轻人群。对文章的综述显示，年龄增长、体重指数、男性、痴呆、日常生活活动受损或依赖、胸部X光片出现实变、低氧性呼吸衰竭以及入院时较低的血氧饱和度是死亡的危险因素。高D-二聚体水平、25-羟基维生素D血清缺乏、高C反应蛋白（≥5mg/L）水平加上淋巴细胞的任何其他异常、较高的血尿素氮或乳酸脱氢酶以及较高的血小板计数是老年人预后不良和死亡的预测因素。研究还表明，先前使用肾素-血管紧张素-醛固酮系统抑制剂、呼吸系统疾病的药物治疗、抗生素、皮质类固醇、维生素K拮抗剂、抗组胺药、阿奇霉素、依托珠单抗（一种抗CD6单克隆抗体）联合其他抗病毒药物可降低COVID-19的病情恶化和死亡率。接种季节性流感疫苗也可能降低COVID-19的死亡率。
总体而言，考虑到与其他年龄组相比，老年人群在表现和预后方面存在巨大差异，对COVID-19在老年人群中的护理和管理需要进行关键考量。COVID-19的死亡率与患者年龄独立相关。患有COVID-19的老年患者更容易出现不良结局。因此，严格的预防措施、及时的诊断以及积极的治疗/非治疗性护理对于减少老年人的急性呼吸窘迫综合征和严重并发症至关重要。
