COVID-19: a retrospective cohort study with focus on the over-80s and hospital-onset disease

Abstract

Background Data from the UK COVID-19 outbreak are emerging, and there are ongoing concerns about a disproportionate effect on ethnic minorities. There is very limited information on COVID-19 in the over-80s, and the rates of hospital-onset infections are unknown. Methods This was a retrospective cohort study from electronic case records of the first 450 patients admitted to our hospital with PCR-confirmed COVID-19, 77% of the total inpatient caseload to date. Demographic, clinical and biochemical data were extracted. The primary endpoint was death during the index hospital admission. The characteristics of all patients, those over 80 years of age and those with hospital-onset COVID-19 were examined. Results The median (IQR) age was 72 (56, 83), with 150 (33%) over 80 years old and 60% male. Presenting clinical and biochemical features were consistent with those reported elsewhere. The ethnic breakdown of patients admitted was similar to that of our underlying local population. Inpatient mortality was high at 38%. Patients over 80 presented earlier in their disease course and were significantly less likely to present with the typical features of cough, breathlessness and fever. Cardiac co-morbidity and markers of cardiac dysfunction were more common, but not those of bacterial infection. Mortality was significantly higher in this group (60% vs 28%, p < 0.001). Thirty-one (7%) patients acquired COVID-19 having continuously been in hospital for a median of 20 (14, 36) days. The peak of hospital-onset infections occurred at the same time as the overall peak of admitted infections. Despite being older and more frail than those with community-onset infection, their outcomes were no worse. Conclusions Inpatient mortality was high, especially among the over-80s, who are more likely to present atypically. The ethnic composition of our caseload was similar to the underlying population. While a significant number of patients acquired COVID-19 while already in hospital, their outcomes were no worse.

Clinical features and inpatient trajectories of older inpatients with COVID-19: a retrospective observational study.

“…Overall in hospital mortality was 34.6% which re ects the severity of the disease and the older age of our population and is similar to mortality reported in other studies [22][23]. Frail patients were more likely to die than non-frail patients and a dose response relationship was observed between frailty and mortality which persisted after adjustment for age, sex, illness acuity and multimorbidity.…”

“…Frail patients were more likely to die than non-frail patients and a dose response relationship was observed between frailty and mortality which persisted after adjustment for age, sex, illness acuity and multimorbidity. This nding has not been consistent across all recent reports, with some supporting our ndings [22,33] and others either equivocal [27] or failing to nd an association [28]. Intuitively, we would expect to nd an association between a clinical syndrome such as frailty, which is de ned by the presence of low physiological reserve and 'vulnerability', and mortality from an acute severe viral illness such as COVID-19.…”

Ethnicity and clinical outcomes in COVID-19: A systematic review and meta-analysis

“…A total of 18,728,893 patients from 50 papers were included in the meta-analyses after excluding any missing data within the studies; 14,506,023 (77%) were White; 1,267,802 (7%) were Asian; 527,944 (3%) were Black, 1,578,192 (8%) were Hispanic, 1,113 were Native American, 229,822 (2%) were Mixed, and 617,997(3%) were of Other ethnic group [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [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] , 81] .…”

Outcomes from COVID-19 across the range of frailty: excess mortality in fitter older people

“…These findings add to emerging reports quantifying the relationship between frailty and mortality in COVID-19. In another London hospitalised cohort, crude deaths in COVID-19 were higher in patients who were frailer (median Clinical Frailty Scale score of 5 versus 4, p = 0.01) [ 13 ]. Other UK case series have shown that patients who died without ventilatory support had a median Clinical Frailty Scale score of 7 [ 14 ].…”