Coronavirus disease 2019 in elderly patients: Characteristics and prognostic factors based on 4-week follow-up
Coronavirus disease 2019 in elderly patients: Characteristics and prognostic factors based on 4-week follow-up
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DOI：
10.1016/j.jinf.2020.03.019
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发表时间：
2020-06-01
影响因子：
28.2
通讯作者：
Jiang, Hong
中科院分区：
文献类型：
--
作者：
Wang, Lang;He, Wenbo;Jiang, Hong
目的：目的探讨老年新冠肺炎患者的临床特征及影响预后的因素。方法：收集2020年1月1日至2月6日武汉大学人民医院收治的60岁以上老年新冠肺炎患者的临床资料。主要结局是死亡和生存至3月5日。收集人口统计学、临床特征、合并症、实验室检查和并发症的数据，并比较不同结局。结果：339例COVID-19患者（年龄71 ± 8岁，女性173例（51%））入选，其中危重80例（23.6%），重度159例（46.9%），中度100例（29.5%）。常见合并症为高血压（40.8%）、糖尿病（16.0%）和心血管疾病（15.7%）。常见症状有发热（92.0%）、咳嗽（53.0%）、呼吸困难（40.8%）和乏力（39.9%）。淋巴细胞减少是常见的实验室检查结果（63.2%）。常见并发症为细菌感染（42.8%）、肝酶异常（28.7%）和急性呼吸窘迫综合征（21.0%）。截至2020年3月5日，出院91例（26.8%），住院183例（54.0%），死亡65例（19.2%）。死亡者住院时间短于存活者（5（3-8）vs.28（26-29），P < 0.001）。呼吸困难症状（HR 2.35，P=0.001）、合并症包括心血管疾病（HR 1.86，P=0.031）和慢性阻塞性肺疾病（HR 2.24，P=0.023）以及急性呼吸窘迫综合征（HR 29.33，P < 0.001）是死亡的强预测因子。淋巴细胞水平越高，预后越好（HR 0.10，P < 0.001）。结论：老年COVID-19患者中，重症至危重症比例高，病死率高。死亡病例病情进展迅速，入院后中位生存时间为5天。呼吸困难、淋巴细胞减少、合并症包括心血管疾病和慢性阻塞性肺疾病以及急性呼吸窘迫综合征是预后不良的预测因素。对高危老年患者应密切监测，及时治疗。(C)2020年英国传染病协会。由爱思唯尔有限公司出版。保留所有权利。
Objective: To investigate the characteristics and prognostic factors in the elderly patients with COVID-19.Methods: Consecutive cases over 60 years old with COVID-19 in Renmin Hospital of Wuhan University from Jan 1 to Feb 6, 2020 were included. The primary outcomes were death and survival till March 5. Data of demographics, clinical features, comorbidities, laboratory tests and complications were collected and compared for different outcomes. Cox regression was performed for prognostic factors.Results: 339 patients with COVID-19 (aged 71 +/- 8 years,173 females (51%)) were enrolled, including 80 (23.6%) critical, 159 severe (46.9%) and 100 moderate (29.5%) cases. Common comorbidities were hypertension (40.8%), diabetes (16.0%) and cardiovascular disease (15.7%). Common symptoms included fever (92.0%), cough (53.0%), dyspnea (40.8%) and fatigue (39.9%). Lymphocytopenia was a common laboratory finding (63.2%). Common complications included bacterial infection (42.8%), liver enzyme abnormalities (28.7%) and acute respiratory distress syndrome (21.0%). Till Mar 5, 2020, 91 cases were discharged (26.8%), 183 cases stayed in hospital (54.0%) and 65 cases (19.2%) were dead. Shorter length of stay was found for the dead compared with the survivors (5 (3-8) vs. 28 (26-29), P < 0.001). Symptoms of dyspnea (HR 2.35, P=0.001), comorbidities including cardiovascular disease (HR 1.86, P=0.031) and chronic obstructive pulmonary disease (HR 2.24, P=0.023), and acute respiratory distress syndrome (HR 29.33, P < 0.001) were strong predictors of death. And a high level of lymphocytes was predictive of better outcome (HR 0.10, P < 0.001).Conclusions: High proportion of severe to critical cases and high fatality rate were observed in the elderly COVID-19 patients. Rapid disease progress was noted in the dead with a median survival time of 5 days after admission. Dyspnea, lymphocytopenia, comorbidities including cardiovascular disease and chronic obstructive pulmonary disease, and acute respiratory distress syndrome were predictive of poor outcome. Close monitoring and timely treatment should be performed for the elderly patients at high risk. (C) 2020 The British Infection Association. Published by Elsevier Ltd. All rights reserved.