Clinical presentation, therapeutic approach, and outcome of young patients admitted for COVID-19, with respect to the elderly counterpart

Abstract

There is limited information on the presenting characteristics, prognosis, and therapeutic approaches of young patients hospitalized for coronavirus disease 2019 (COVID-19). We sought to investigate the baseline characteristics, in-hospital treatment, and outcomes of a wide cohort < 65 years admitted for COVID-19. Using the international multicenter HOPE-COVID-19 registry, we evaluated the baseline characteristics, clinical presentation, therapeutic approach, and prognosis of patients < 65 years discharged (deceased or alive) after hospital admission for COVID-19, also compared with the elderly counterpart. Of the included 5746 patients, 2676 were < 65 and 3070 ≥ 65 years. All risk factors and several parameters suggestive of worse clinical presentation augmented through increasing age classes. In-hospital mortality rates were 6.8% and 32.1% in the younger and older cohort, respectively (p < 0.001). Among young patients, mortality, access to ICU and treatment with IMVwere positively correlated with age. Contrariwise, over 65 years of age this trend was broken so that only the association between age and mortality was persistent, while the rates of access to ICU and IMV started to decline. Younger patients also recognized specific predictors of case fatality, such as obesity and gender. Age negatively impacts on mortality, access to ICU and treatment with IMV in patients < 65 years. In elderly patients only case fatality rate keeps augmenting in a stepwise manner through increasing age categories, while therapeutic approaches become more conservative. Besides age, obesity, gender, history of cancer, and severe dyspnea, tachypnea, chest X-ray bilateral abnormalities, abnormal level of creatinine and leucocyte among admission parameters seem to play a central role in the outcome of patients younger than 65 years. Supplementary information The online version contains supplementary material available at (10.1007/s10238-021-00684-1).

Predictors of poor prognosis in healthy, young, individuals with SARS-CoV-2 infections

“…We fixed 65 years old as the age cut off point because in a previous HOPE publication, we found that this age was the best cut off value for predicting in-hospital mortality (through a Youden index calculation). 17 …”

Risk assessment and rationalization of health resource allocation: Lessons from the Brazilian COVID-19 cohort in 2020

“…Considering the comorbidities associated with COVID-19-related death, nosocomial transmission, diabetes, immunosuppression, kidney disease, and obesity were important risk factors, regardless of age strata. Concordant results were reported for one or more of these comorbidities ( Moura et al, 2020 , de Souza et al, 2020 , Marcolino et al, 2021 , Yacobitti et al, 2021 , Pepe et al, 2021 , Ceballos et al, 2021 , Olivas-Martínez et al, 2021 , Rocha et al, 2021 , Escalera-Antezana et al, 2020 , Marques et al, 2021 ). Also, some comorbidities were associated with some, but not all, of the observed outcomes.…”

“…A similar pattern also manifested itself among the older patients, but less pronouncedly, possibly due to the prevalent accumulation of comorbidities among individuals in these strata. Our results confirmed the association of aging with the demand for healthcare resources and COVID-19-related deaths reported in different Brazilian states, ( Sousa et al, 2020 , Macedo et al, 2020 , Cobre et al, 2020 , Escosteguy et al, 2020 , Moura et al, 2020 , Leal et al, 2021 , Policarpo et al, 2021 , Bastos et al, 2020 ) in population restricted to a clinical condition or not, or even in national population studies, ( Santos et al, 2021 , de Souza et al, 2020 , Nascimento et al, 2020 , Marcolino et al, 2021 , Castro et al, 2021 ) but also reported in studies in Latin America, ( Escalera-Antezana et al, 2020 , Araujo et al, 2020 , Elizondo et al, 2021 , Galindo et al, 2021 , Yacobitti et al, 2021 , Ortiz-Prado et al, 2021 ) and in international cohorts ( Pepe et al, 2021 ). Overall, frailty and the high prevalence of comorbidities made the elderly more susceptible to severe infection by COVID-19.…”

Association of Obesity with COVID-19 Severity and Mortality: A Systemic Review and Meta-Regression

“…Similarly, a total of 51 studies were included for meta-analysis for the secondary outcome i.e. mortality 42, 45, 46, 48–52, 55, 63, 66, 75, 79, 80, 82, 85, 88, 89, 92, 101, 109, 111–140 . These had a combined sample size of 380,130 with 118,351 patients reaching the endpoint of mortality.…”