Risk factors associated with 28-day all-cause mortality in older severe COVID-19 patients in Wuhan, China: a retrospective observational study

Abstract

We aimed to analyse clinical characteristics and identify risk factors predicting all-cause mortality in older patients with severe coronavirus disease 2019 (COVID-19). A total of 281 older patients with severe COVID-19 were categorized into two age groups (60–79 years and ≥ 80 years). Epidemiological, clinical, and laboratory data, and outcome were obtained. Patients aged ≥ 80 years had higher mortality (63.6%) than those aged 60–79 years (33.5%). Anorexia and comorbidities including hypertension, diabetes and COPD, higher levels of lactate dehydrogenase (LDH), osmotic pressure, C-reactive protein, D-dimer, high-sensitivity troponin I and procalcitonin, and higher SOFA scores were more common in patients aged > 80 years than those aged 60–79 years and also more common and higher in non-survivors than survivors. LDH, osmotic pressure, C-reactive protein, D-dimer, high-sensitivity troponin I, and procalcitonin were positively correlated with age and sequential organ failure assessment (SOFA), whereas CD8+ and lymphocyte counts were negatively correlated with age and SOFA. Anorexia, comorbidities including hypertension, diabetes, and chronic obstructive pulmonary disease (COPD), LDH, osmotic pressure, and SOFA were significantly associated with 28-day all-cause mortality. LDH, osmotic pressure and SOFA were valuable for predicting 28-day all-cause mortality, whereas the area under the receiver operating characteristic curve of LDH was the largest, with sensitivity of 86.0% and specificity of 80.8%. Therefore, patients with severe COVID-19 aged ≥ 80 years had worse condition and higher mortality than did those aged 60–79 years, and anorexia and comorbidities including hypertension, diabetes, COPD, elevated plasma osmotic pressure, LDH, and high SOFA were independent risk factors associated with 28-day all-cause mortality in older patients with severe COVID-19. LDH may have the highest predictive value for 28-day all-cause mortality in all examined factors.

COPD and the risk of poor outcomes in COVID-19: A systematic review and meta-analysis

“…Six studies initially identified in preprint were subsequently excluded since they had not been peer-reviewed and published by 28 th January 2021; additionally, one study that was initially included based on preprint was subsequently removed since the peer-reviewed version did not meet our study's inclusion criteria. In total, 59 studies [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] were selected for the qualitative synthesis, of which 39[ [23] , [24] , [25] , …”

“…This is perhaps not surprising given the urgency with which data were being collected, reported and updated at that time. Subsequent comparison of the authors, site of the study and the date of recruitment and follow-up identified 22 studies with potentially overlapping populations [ 27 , [34] , [35] , [36] , [37] , 39 , 43 , 49 , 54 , 55 , [58] , [59] , [60] , 68 , 69 , 71 , 72 , 74 , 78 ]. To avoid the double counting of patients we included only the largest (by participant numbers) of the potentially overlapping studies in the quantitative analysis.…”

Rapid Evaluation of Coronavirus Illness Severity (RECOILS) in intensive care: Development and validation of a prognostic tool for in‐hospital mortality

“…A flowchart documenting the literature review process is shown in Figure S1 and a comprehensive list of variables that were found during this search is given in Table S1 . The variables were broadly categorized into the following groups: age 10 , 12 , 13 , 14 , 15 , 16 , 17 , 19 , 20 , 30 and comorbidities, 11 , 13 , 14 , 15 , 17 , 18 , 23 , 24 , 25 , 31 , 32 , 33 , 34 respiratory, 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 renal, 21 , 33 , 35 coagulation, 10 , 13 , 17 , 22 , 27 , 30 , 36 , 37 inflammatory,…”

“…In this regard, some demographic features and markers of illness severity have been reported as helpful in identifying patients at particularly high mortality risk. They have included older age, 10 , 12 , 13 , 14 , 15 , 16 , 17 , 19 , 20 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 male sex, 11 , 12 , 14 , 24 , 25 , 31 various comorbidities, 11 , 13 , 14 , 15 , 17 , 18 , 25 , 31 , 32 , 34 acute kidney injury, 21 , 33 , 35 coagulation problems, 10 , 13 , 17 , 22 , 27 , 30 , 36 , 37 increased markers of inflammation, 12 , 13 , 15 , 26 , 28 , 29 , 30 , 34 abnormal blood cell counts…”

“…They have included older age, 10,[12][13][14][15][16][17]19,20,[22][23][24][25][26][27][28][29][30] male sex, 11,12,14,24,25,31 various comorbidities, 11,[13][14][15]17,18,[23][24][25][31][32][33][34] acute kidney injury, 21,33,35 coagulation problems, 10,13,17,22,27,30,36,37 increased markers of inflammation, 12,13,15,26,…”