Risk Factors for Mortality and Respiratory Support in Elderly Patients Hospitalized with COVID-19 in Korea

Abstract

Background: The mortality risk of coronavirus disease 2019 (COVID-19) is higher in patients with older age, and many elderly patients are reported to require advanced respiratory support. Methods: We reviewed medical records of 98 patients aged ≥ 65 years who were hospitalized with COVID-19 during a regional outbreak in Daegu/Gyeongsangbuk-do province of Korea. The outcome measures were in-hospital mortality and the treatment with mechanical ventilation (MV) or high-flow nasal cannula (HFNC). Results: The median age of the patients was 72 years; 55.1% were female. Most (74.5%) had at least one underlying condition. Overall case fatality rate (CFR) was 20.4%, and median time to death after admission was 8 days. The CFR was 6.1% among patients aged 65-69 years, 22.7% among those aged 70-79 years, and 38.1% among those aged ≥ 80 years. The CFR among patients who required MV was 43.8%, and the proportion of patients received MV/HFNC was 28.6%. Nosocomial acquisition, diabetes, chronic lung diseases, and chronic neurologic diseases were significant risk factors for both death and MV/HFNC. Hypotension, hypoxia, and altered mental status on admission were also associated with poor outcome. CRP > 8.0 mg/dL was strongly associated with MV/HFNC (odds ratio, 26.31; 95% confidence interval, 7.78-88.92; P < 0.001), and showed better diagnostic characteristics compared to commonly used clinical scores. Conclusion: Patients aged ≥ 80 years had a high risk of requiring MV/HFNC, and mortality among those severe patients was very high. Severe initial presentation and laboratory abnormalities, especially high CRP, were identified as risk factors for mortality and severe hospital course.

Prevalence and Associated Risk Factors of Mortality Among COVID-19 Patients: A Meta-Analysis

“…The previous data seems to suggest patients with cancer are more prone to severe outcomes of COVID-19, including death [11,32,33,69,75]. Association between mortality among COVID-19 patients and increased chronic disease such as (cardiac, renal, liver, kidney and lung) were also found from several independent studies [13,30,32,33,37,39,42,65,66,69,70,74].…”

Mortality in COVID-19 patients with acute respiratory distress syndrome and corticosteroids use: a systematic review and meta-analysis

“…Among the 26 original articles which reported mortality in COVID-19 patients with ARDS, 25 were original studies [ Huang M et al [54] Jiangsu, China So et al [66] Tokyo, Japan Only for original studies included in the meta-analysis to determine mortality estimates of ARDS in COVID-19 (7 = good studies; 5-6 = fair studies; 0-4 = poor studies one [54] were conducted in the Wuhan city of China. The remaining six studies were originated from Spain (n = 2) [63,64], Canada (n = 1) [57], United States (n = 1) [65], Japan (n = 1) [66], and Korea (n = 1) [67]. Furthermore, 10 out of 23 studies are multicenter [34,35,41,[44][45][46][47]49,54,67], while the remaining 13 studies are single-center [31,33,37,38,40,42,51,52,57,[63][64][65][66].…”

Coping with Dementia in the Middle of the COVID-19 Pandemic

“…Dementia patients are especially vulnerable to COVID-19 infection due to their disease state, age, 37 and comorbid diseases. 38 Furthermore, COVID-19 positive dementia patients may manifest their neurological complications as behavioral and neuropsychological problems. Here, we review the underlying issues that make dementia patients especially vulnerable amid the COVID-19 pandemic.…”

“…In older individuals, comorbidities, such as hypertension, diabetes, obesity, and heart disease, are more likely to promote a cytokine storm resulting in life-threatening respiratory failure and multi-organ damage. 38 42 43 44 Also, respiratory distress is common among most late-stage Alzheimer's disease (AD) patients. 45 Bauer claims that individuals with dementia are more likely to have cardiovascular disease, diabetes, and pneumonia compared to individuals of the same age without dementia.…”