Age is not the only risk factor in COVID-19: the role of comorbidities and of long staying in residential care homes.

Abstract

Background: The actual SARS-CoV-2 outbreak caused a highly transmissible disease with a tremendous impact on elderly people. So far, few studies focused on very elderly patients (over 80 years old). In this study we examined the clinical presentation and the evolution of the disease in this group of patients, admitted to our Hospital in RomeMethods: This is a single-center, retrospective study performed in the Sant’Andrea University Hospital of Rome. We included patients older than 65 years of age with a diagnosis of COVID-19, from March 2020 to may 2020, divided in two groups according to their age (G1 65-80 years old; G2 >80 years old). Data extracted from the each patient record included age, sex, comorbidities, symptoms at onset, the Pneumonia Severity Index (PSI), the ratio of the partial pressure of oxygen in arterial blood (PaO2) to the inspired oxygen fraction (FiO2) (P/F) on admission, laboratory tests, radiological findings on computer tomography (CT), length of hospital stay (LOS), mortality rate and the viral shedding. The differences between the two groups were analyzed by the Fisher’s exact test or the Wilcoxon signed-rank test for categorical variables and the Mann-Whitney U test for continuous variables. The survival time was estimated by Kaplan-Meier method and Log Rank Test. Univariable Cox proportional hazard regression and ordinal logistic regression were performed to estimate associations between age, comorbidities and provenance from residential care homes and clinical outcomes.Results: We found that G2 patients had an increased mortaliy rate, also due to (the frequent prevalence of) multiple comorbidities. Moreover we found that patients coming from long-stay residential care homes appeared to be highly susceptible and vulnerable to develop severe manifestations of the disease.Conclusion: We demonstrate that there were considerable differences between Elderly and Very Elderly patients in terms of inflammatory activity, severity of disease, adverse clinical outcomes; moreover, to establish a correct risk stratification, comorbidities and information about provenience from residential care homes should be considered.

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“…It was found that most patients were 50 years of age or older. In keeping with this observation, it was evident that the elderly were more likely to contract COVID-19, compared to younger adults, and to progress to more severe disease with an unfavorable prognosis [19] . Animal model studies also demonstrated that viral replication of SARS coronavirus was enhanced in experimentally infected aged mice, compared to younger mice, and associated with alveolar damage, pneumonia, and clinical disease [20] .…”

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“…From the very beginning of the oandemic, the risk of developing severe COVID-19 and the mortality rate have been associated with advanced age. Although the picture has been complicated since by the identification of numerous comorbidities [ 36 ], this holds still true. As a direct consequence, most countries have decided to start their vaccination programs against SARS-CoV-2 with the elderly, alongside the healthcare personnel and high-risk individuals [ 37 ].…”