The aim of the present study was to describe the clinical presentation of patients aged ≥80 years with coronavirus disease 2019 , and provide insights regarding the prognostic factors and the risk stratification in this population.Methods: This was a single-center, retrospective, observational study, carried out in a referral center for COVID-19 in central Italy. We reviewed the clinical records of patients consecutively admitted for confirmed COVID-19 over a 1-month period (1-31 March 2020). We excluded asymptomatic discharged patients. We identified risk factors for death, by a uni-and multivariate Cox regression analysis. To improve model fitting and hazard estimation, continuous parameters where dichotomized by using Youden's index.Results: Overall, 69 patients, aged 80-98 years, met the inclusion criteria and were included in the study cohort. The median age was 84 years (82-89 years is interquartile range); 37 patients (53.6%) were men. Globally, 14 patients (20.3%) presented a mild, 30 (43.5%) a severe and 25 (36.2%) a critical COVID-19 disease. A total of 23 (33.3%) patients had died at 30 days' follow up. Multivariate Cox regression analysis showed that severe dementia, pO 2 ≤90 at admission and lactate dehydrogenase >464 U/L were independent risk factors for death. Conclusions:The present data suggest that risk of death could be not age dependent in patients aged ≥80 years, whereas severe dementia emerged is a relevant risk factor in this population. Severe COVID-19, as expressed by elevated lactate dehydrogenase and low oxygen saturation at emergency department admission, is associated with a rapid progression to death in these patients.

Aims To identify the most accurate early warning score (EWS) for predicting an adverse outcome in COVID-19 patients admitted to the emergency department (ED). Methods In adult consecutive patients admitted (March 1-April 15, 2020) to the ED of a major referral centre for COVID-19, we retrospectively calculated NEWS, NEWS2, NEWS-C, MEWS, qSOFA, and REMS from physiological variables measured on arrival. Sensitivity, specificity, positive (PPV) and negative predictive value (NPV), and the area under the receiver operating characteristic (AUROC) curve of each EWS for predicting admission to the intensive care unit (ICU) and death at 48 h and 7 days were calculated. Results We included 334 patients (119 [35.6%] females, median age 66 [54-78] years). At 7 days, the rates of ICU admission and death were 56/334 (17%) and 26/334 (7.8%), respectively. NEWS was the most accurate predictor of ICU admission within 7 days (AUROC 0.783 [95% CI, 0.735-0.826]; sensitivity 71.4 [57.8-82.7]%; NPV 93.1 [89.8-95.3]%), while REMS was the most accurate predictor of death within 7 days (AUROC 0.823 [0.778–0.863]; sensitivity 96.1 [80.4-99.9]%; NPV 99.4[96.2–99.9]%). Similar results were observed for ICU admission and death at 48 h. NEWS and REMS were as accurate as the triage system used in our ED. MEWS and qSOFA had the lowest overall accuracy for both outcomes. Conclusion In our single-centre cohort of COVID-19 patients, NEWS and REMS measured on ED arrival were the most sensitive predictors of 7-day ICU admission or death. EWS could be useful to identify patients with low risk of clinical deterioration.

Background/Objectives Several scoring systems have been specifically developed for risk stratification in COVID‐19 patients. Design We compared, in a cohort of confirmed COVID‐19 older patients, three specifically developed scores with a previously established early warning score. Main endpoint was all causes in‐hospital death. Setting This is a single‐center, retrospective observational study, conducted in the Emergency Department (ED) of an urban teaching hospital, referral center for COVID‐19. Participants We reviewed the clinical records of the confirmed COVID‐19 patients aged 60 years or more consecutively admitted to our ED over a 6‐week period (March 1st to April 15th, 2020). A total of 210 patients, aged between 60 and 98 years were included in the study cohort. Measurements International Severe Acute Respiratory Infection Consortium Clinical Characterization Protocol‐Coronavirus Clinical Characterization Consortium (ISARIC‐4C) score, COVID‐GRAM Critical Illness Risk Score (COVID‐GRAM), quick COVID‐19 Severity Index (qCSI), National Early Warning Score (NEWS). Results Median age was 74 (67–82) and 133 (63.3%) were males. Globally, 42 patients (20.0%) deceased. All the score evaluated showed a fairly good predictive value with respect to in‐hospital death. The ISARIC‐4C score had the highest area under ROC curve (AUROC) 0.799 (0.738–0.851), followed by the COVID‐GRAM 0.785 (0.723–0.838), NEWS 0.764 (0.700–0.819), and qCSI 0.749 (0.685–0.806). However, these differences were not statistical significant. Conclusion Among the evaluated scores, the ISARIC‐4C and the COVID‐GRAM, calculated at ED admission, had the best performance, although the qCSI had similar efficacy by evaluating only three items. However, the NEWS, already widely validated in clinical practice, had a similar performance and could be appropriate for older patients with COVID‐19.