Risk Factors for Mortality and Respiratory Support in Elderly Patients Hospitalized with COVID-19 in Korea

J Korean Med Sci. 2020 Jun 15;35(23):e223. doi: 10.3346/jkms.2020.35.e223.

Abstract

Background: The mortality risk of coronavirus disease 2019 (COVID-19) is higher in patients with older age, and many elderly patients are reported to require advanced respiratory support.

Methods: We reviewed medical records of 98 patients aged ≥ 65 years who were hospitalized with COVID-19 during a regional outbreak in Daegu/Gyeongsangbuk-do province of Korea. The outcome measures were in-hospital mortality and the treatment with mechanical ventilation (MV) or high-flow nasal cannula (HFNC).

Results: The median age of the patients was 72 years; 55.1% were female. Most (74.5%) had at least one underlying condition. Overall case fatality rate (CFR) was 20.4%, and median time to death after admission was 8 days. The CFR was 6.1% among patients aged 65-69 years, 22.7% among those aged 70-79 years, and 38.1% among those aged ≥ 80 years. The CFR among patients who required MV was 43.8%, and the proportion of patients received MV/HFNC was 28.6%. Nosocomial acquisition, diabetes, chronic lung diseases, and chronic neurologic diseases were significant risk factors for both death and MV/HFNC. Hypotension, hypoxia, and altered mental status on admission were also associated with poor outcome. CRP > 8.0 mg/dL was strongly associated with MV/HFNC (odds ratio, 26.31; 95% confidence interval, 7.78-88.92; P < 0.001), and showed better diagnostic characteristics compared to commonly used clinical scores.

Conclusion: Patients aged ≥ 80 years had a high risk of requiring MV/HFNC, and mortality among those severe patients was very high. Severe initial presentation and laboratory abnormalities, especially high CRP, were identified as risk factors for mortality and severe hospital course.

Keywords: COVID-19; Elderly; Outcome; Risk Factors.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Betacoronavirus
  • C-Reactive Protein / analysis
  • Coronavirus Infections / mortality*
  • Coronavirus Infections / pathology*
  • Female
  • Hospitalization
  • Humans
  • Hypoxia / pathology*
  • Intensive Care Units
  • Male
  • Pandemics
  • Pneumonia, Viral / mortality*
  • Pneumonia, Viral / pathology*
  • Republic of Korea
  • Respiration, Artificial / statistics & numerical data*
  • Respiratory Insufficiency / mortality*
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • Ventilators, Mechanical / statistics & numerical data

Substances

  • C-Reactive Protein

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2