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 outcome of the disease in this group of patients, admitted to our Hospital in Rome. Methods 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 (Elderly: 65–80 years old; Very Elderly > 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. To assess significance among multiple groups of factors, we used the Bonferroni correction. The survival time was estimated by Kaplan-Meier method and Log Rank Test. Univariate and Multivariate logistic regression were performed to estimate associations between age, comorbidities, provenance from long-stay residential care homes (LSRCH) s and clinical outcomes. Results We found that Very Elderly patients had an increased mortality rate, also due to the frequent occurrence of multiple comorbidities. Moreover, we found that patients coming from LSRCHs 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. To establish a correct risk stratification, comorbidities and information about provenience from LSRCHs should be considered.

Angiotensin-converting enzyme-1 gene insertion/deletion polymorphism may be associated with COVID-19 clinical severity: a prospective cohort study

“…An important reason why advanced age contributes to morbidity is the increased frequency of comorbid conditions. 17 In our study, we found that the frequency of general comorbidity increased significantly from the asymptomatic disease group to the severe disease group, concurrent with age. We also found that DM and ischemic heart disease are significant risk factors for severe disease among all comorbid conditions.…”

Higher 90-Day Mortality after Surgery for Hip Fractures in Patients with COVID-19: A Case–Control Study from a Single Center in Italy

“…Thus, when calculating the risk difference between mortality of COVID-19 and non-COVID-19 patients, the rate of 26.2% appears similar to the overall fatality rate of 24.3% described for female patients aged between 80 and 89 years in Italy during the “first wave” [ 35 ], which is a demographic profile similar to the present study. Accordingly, further studies should be aimed at identifying if the HF itself represents a risk factor of increased mortality in patients with COVID-19, as demonstrated for obesity, neoplastic diseases, and diabetes [ 36 , 37 , 38 , 39 ], as the opposite situation (COVID-19 as a risk factor for HF patients) seems a piece of consolidated evidence [ 16 , 32 , 40 ].…”

Risk Factors for COVID-19 Morbidity and Mortality in Institutionalised Elderly People

“…Long-term health care facilities such as nursing homes and rehabilitation centres provide care to persons often of elderly age and with mental or physical impairment. The residents of long-term care homes represent a vulnerable population with a greater risk of adverse events and infections due to age, comorbidities, and living in close proximity to other persons [ 5 ]. Therefore, different international organisations recommended that long-term care facilities should adopt special measures to protect their residents, staff, and visitors [ 6 ].…”