Clinical characteristics on admission predict in-hospital fatal outcome in patients aged ≥75 years with novel coronavirus disease (COVID-19): a retrospective cohort study

Abstract

Background Novel coronavirus disease 2019 (COVID-19) has become a worldwide pandemic and precise fatality data by age group is needed urgently. This study to delineate the clinical characteristics and outcome of COVID-19 patients aged ≥75 years and identify the risk factors of in-hospital death. Methods A total of 141 consecutive patients aged ≥75 years who were admitted to the hospital between 12th and 19th February 2020. In-hospital death, clinical characteristics and laboratory findings on admission were obtained from medical records. The final follow-up observation was on the 31st March 2020. Results The median age was 81 years (84 female, 59.6%). Thirty-eight (27%) patients were classified as severe or critical cases. 18 (12.8%) patients had died in hospital and the remaining 123 were discharged. Patients who died were more likely to present with fever (38.9% vs. 7.3%); low percutaneous oxygen saturation (SpO2) (55.6% vs. 7.3%); reduced lymphocytes (72.2% vs. 35.8%) and platelets (27.8% vs. 4.1%); and increased D-dimer (94.4% vs. 42.3%), creatinine (50.0% vs. 22.0%), lactic dehydrogenase (LDH) (77.8% vs. 30.1%), high sensitivity troponin I (hs-TnI) (72.2% vs. 14.6%), and N-terminal pro-brain natriuretic peptide (NT-proBNP) (72.2% vs. 6.5%; all P < 0.05) than patients who recovered. Male sex (odds ratio [OR] = 13.1, 95% confidence interval [CI] 1.1 to 160.1, P = 0.044), body temperature > 37.3 °C (OR = 80.5, 95% CI 4.6 to 1407.6, P = 0.003), SpO2 ≤ 90% (OR = 70.1, 95% CI 4.6 to 1060.4, P = 0.002), and NT-proBNP> 1800 ng/L (OR = 273.5, 95% CI 14.7 to 5104.8, P < 0.0001) were independent risk factors of in-hospital death. Conclusions In-hospital fatality among elderly COVID-19 patients can be estimated by sex and on-admission measurements of body temperature, SpO2, and NT-proBNP.

Serum CK-MB, COVID-19 severity and mortality: An updated systematic review and meta-analysis with meta-regression

“…Two studies were conducted in Turkey [ 34 , 58 ], 1 in the USA [ 57 ], 1 in Korea [ 52 ], and the remaining 51 in China [ 14 , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [53] , [54] , [55] , [56] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] ]. Three studies were prospective [ 42 , 53 , 68 ], 47 retrospective [ [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] ...…”

“…Three studies were prospective [ 42 , 53 , 68 ], 47 retrospective [ [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [43] , [44] , [45] , [46] , [47] , [48] , [50] , [51] , [52] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , 67 , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , 87 ], whereas the remaining 5 did not report information regarding the study design [ 14 , 49 , 66 , 71 , 86 ]. Clinical endpoints included disease severity based on current clinical guidelines in 21 studies [ 38 , 43 , 45 , [48] , [49] , [50] , [51] , [52] , 54 ...…”

“…In 5 studies, patients with high severity or non-survivor status had lower CK-MB concentrations when compared to those with low severity or survivor status (mean difference range, -0.07 to -0.97) [ 37 , 51 , 60 , 66 , 86 ], although only 1 study reported a statistically significant difference [ 66 ]. In 1 study, no difference was observed (mean difference 0.00) [ 38 ], whereas in the remaining 49 studies the CK-MB concentrations were lower in patients with low severity or survivor status (mean difference range, 0.11 to 2.91), with a non-significant difference in 17 [ 34 , 38 , 41 , 42 , 46 , 57 , [62] , [63] , [64] , [65] , [70] , [71] , [72] , 74 , 77 , 78 , 85 ]. The pooled results confirmed that the CK-MB concentrations were statistically significantly higher in patients with high disease severity or non-survivor status during follow up (SMD 0.81, 95% CI 0.61 to 1.01, p<0.001) ( Figure 2 ).…”

“…An extreme heterogeneity between studies was observed (I 2 =93.4%, p<0.001). A sub-group of 11 studies reported the proportion of patients with CK-MB concentrations above the normal range in COVID-19 patients with high severity or non-survivor status vs. those with low severity or survivor status during follow-up [ 38 , 41 , 44 , 48 , 51 , 52 , 58 , 76 , 77 , 81 , 86 ]. The rate of participants with CK-MB values above the normal range was statistically significantly higher in the former than the latter (60/350 vs 98/1,780; RR=2.84, 95%CI 1.89 to 4.27, p<0.001; I 2 =19.9, p=0.254) ( Figure 3 ).…”

“…In particular, a sub-group of 13 retrospective studies conducted in China [ 40 , 44 , 47 , 55 , 62 , 69 , 73 , [75] , [76] , [77] , 81 , 83 , 87 ] assessed survival and measured CK-MB using an assay based on activity evaluation. Funnel plot analysis showed that 3 of these studies were located outside of the plot ( Figure 8 A) [ 62 , 77 , 83 ]. After removing these studies, the effect size of the remaining 10 studies confirmed that the CK-MB concentrations were statistically significantly higher in patients with high disease severity or non-survivor status during follow up (SMD 0.97, 95% CI 0.84 to 1.09, p<0.001) ( Figure 8 B).…”