Risk Factors for Mortality in 244 Older Adults With COVID-19 in Wuhan, China

A Retrospective Study

Haiying Sun, MD; Ruoqi Ning, MD; Yu Tao, MD; Chong Yu, MD; Xiaoyan Deng, MD; Caili Zhao, MM; Silu Meng, MM; Fangxu Tang, MD; Dong Xu, MD, PhD

Disclosures

J Am Geriatr Soc. 2020;68(6):E19-E23. 

In This Article

Abstract and Introduction

Abstract

Background/Objectives: Previous studies have reported that older patients may experience worse outcome(s) after infection with severe acute respiratory syndrome coronavirus-2 than younger individuals. This study aimed to identify potential risk factors for mortality in older patients with coronavirus disease 2019 (COVID-19) on admission, which may help identify those with poor prognosis at an early stage.

Design: Retrospective case-control.

Setting: Fever ward of Sino-French New City Branch of Tongji Hospital, Wuhan, China.

Participants: Patients aged 60 years or older with COVID-19 (n = 244) were included, of whom 123 were discharged and 121 died in hospital.

Measurements: Data retrieved from electronic medical records regarding symptoms, signs, and laboratory findings on admission, and final outcomes of all older patients with COVID-19, were retrospectively reviewed. Univariate and multivariate logistic regression analyses were used to explore risk factors for death.

Results: Univariate analysis revealed that several clinical characteristics and laboratory variables were significantly different (ie, P < .05) between discharged and deceased patients. Multivariable logistic regression analysis revealed that lymphocyte (LYM) count (odds ratio [OR] = 0.009; 95% confidence interval [CI] = 0.001–0.138; P = .001) and older age (OR = 1.122; 95% CI = 1.007–1.249; P = .037) were independently associated with hospital mortality. White blood cell count was also an important risk factor (P = .052). The area under the receiver operating characteristic curve in the logistic regression model was 0.913. Risk factors for in-hospital death were similar between older men and women.

Conclusion: Older age and lower LYM count on admission were associated with death in hospitalized COVID-19 patients. Stringent monitoring and early intervention are needed to reduce mortality in these patients. J Am Geriatr Soc 68:E19–E23, 2020.

Introduction

In December 2019, a cluster of cases of novel virus-related pneumonia occurred in Wuhan, China,[1] and the number of infected persons has increased rapidly due to the high transmissibility and infectivity of the causative virus.[2] The virus has been isolated and identified as a novel enveloped RNA beta-coronavirus (termed severe acute respiratory syndrome coronavirus-2 [SARS CoV-2]) using epidemiological, clinical, laboratory, and genetic methods.[3] The World Health Organization has named this novel pneumonia as coronavirus disease 2019 (COVID-19) and declared it a global pandemic.[4]

The city of Wuhan—the epidemic source of COVID-19—medical institutions and clinicians have been facing unprecedented challenges due to the rapid spread of the COVID-19 and increase in the number of patients. As of March 5, 2020, a total of 49,797 cases were confirmed in Wuhan, of which 2,328 died of COVID-19.[5] The Sino-French New City Branch of Tongji Hospital was designated by the Chinese government as a specified hospital for treating severely and critically ill patients with COVID-19.

Older patients with COVID-19 have been reported to exhibit relatively higher mortality and severity of illness than younger patients.[6,7] However, to the best of our knowledge, no previous study has reported definitive outcomes in older patients. Accordingly, this retrospective, single-center study aimed to identify early-stage risk factors associated with death, and to compare the clinical characteristics on admission of in-hospital deceased and discharged older patients with COVID-19.

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