COVID-19: Clinical Presentation and Prognostic Factors of Severe Disease and Mortality in the Oldest-Old Population: A Cohort Study

Abstract

<b><i>Introduction:</i></b> The oldest-old population (80 years or older) has the highest lethality from COVID-19. There is little information on the clinical presentation and specific prognostic factors for this group. This trial evaluated the clinical presentation and prognostic factors of severe disease and mortality in the oldest-old population. <b><i>Methods:</i></b> This is an ambispective cohort study of oldest-old patients hospitalized for respiratory infection associated with COVID-19 and with a positive test by RT-PCR. The clinical presentation and the factors associated with severe disease and mortality were evaluated (logistic regression). All patients were followed up until discharge or death. <b><i>Results:</i></b> A total of 103 patients (59.2% female) were included. The most frequent symptoms were fever (68.9%), dyspnoea (60.2%), and cough (39.8%), and 11.7% presented confusion. Fifty-nine patients (57.3%) presented severe disease, and 59 died, with 43 patients (41.7%) presenting both of these. In the multivariate analysis, female sex (odds ratio [OR] 0.31, 95% confidence interval [95% CI] 0.13–0.73, <i>p</i> 0.0074) and serum lactate dehydrogenase (LDH) (OR 2.55, 95% CI 1.21–5.37, <i>p</i> 0.0139) were associated with severe disease, and serum sodium was associated with mortality (OR 3.12, 95% CI 1.18–8.26, <i>p</i> 0.0222). No chronic disease or pharmacological treatment was associated with worse outcomes. <b><i>Conclusions:</i></b> The typical presenting symptoms of respiratory infection in COVID-19 are less frequent in the oldest-old population. Male sex and LDH level are associated with severe disease, and the serum sodium level is associated with mortality in this population.

Spread of COVID-19 Infection in Long-Term Care Facilities of Trieste (Italy) during the Pre-Vaccination Era, Integrating Findings of 41 Forensic Autopsies with Geriatric Comorbidity Index as a Valid Option for the Assessment of Strength of Causation

“…Hypertension, complications of diabetes mellitus, and chronic obstructive pulmonary disease were most frequently reported as expected in consideration of the data observed in other studies, where diabetes was seen in 8–44% of the cases, hypertension in 22–100% of the deceased, and chronic obstructive pulmonary disease in 6–55% of the patients who underwent an autopsy [ 43 , 48 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ]. The severe walking impairment/bed rest syndrome and the severe cognitive impairment observed in most cases characterized our population and can be considered as an independent prognostic factor for death, highly impacting on the severity of frailty [ 44 , 70 ]; in fact, walking impairment was not identified in any of the previous studies, and chronic neurological conditions were seen in 10–41% of the cases [ 43 , 48 , 63 , 64 , 65 , 66 , 68 , 69 ]. As observed by other authors, fever, dyspnea, and respiratory failure were described in the days prior to death in 55–68%% of cases [ 49 , 65 , 68 ].…”

“…In the biggest autopsy studies in the literature, mean age was between 69 and 79 years, with a prevalence of male patients (58–87%) [ 48 , 50 , 63 , 64 , 65 , 66 , 67 ]. Only two case series of elder patients or patients who died in community settings had a prevalence of female patients (55–59%), with a mean age of 88 and 72 years [ 49 , 68 ].…”

Prognostic value of neutrophile-to-lymphocyte ratio (NLR) and lactate dehydrogenase (LDH) levels for geriatric patients with COVID-19

“…A cohort study in oldest-old geriatric population (80 years or older) with COVID-19 also revealed that serum LDH levels were associated with severe disease ( p = 0.013; OR 2.55; 95% CI: 1. 21-5.37) [ 20 ]. Similar to this, De Smet et al also showed that baseline LDH level was found as an independent risk factor for mortality in geriatric patients with COVID-19 (OR:1.005, 95% CI: 1.000–1.011) [ 21 ].…”

Elements and COVID-19: A Comprehensive Overview of Studies on Their Blood/Urinary Levels and Supplementation with an Update on Clinical Trials

“…Moreover, hyponatremia was found to be associated with COVID-19 in patients requiring ICU admission. Gálvez-Barrón et al [ 195 ], who analyzed the most important prognostic factors of severe disease and mortality in a cohort of oldest-old people with COVID-19 ≥ 80 years of age, demonstrated that the serum Na level was associated with mortality in these subjects. As Na deficiency may increase the risk of developing severe and fatal COVID-19 infection [ 196 , 197 ], the monitoring of the level of this element in severe COVID-19 seems be desirable.…”