J Am Geriatr Soc. 2020 Oct 12. doi: 10.1111/jgs.16894. Online ahead of print.
BACKGROUND: Clinical presentation and risk factors of death in COVID-19 in oldest adults have not been well characterized.
OBJECTIVES: To describe clinical features and outcome of COVID-19 in patients above the age of 85 years and study risk factors for mortality.
DESIGN: Prospective cohort.
PARTICIPANTS AND SETTING: Patients, 85 years and older admitted in non-critical care units at the University Hospital Lariboisière Fernand-Widal (Paris, France) for confirmed SARS-CoV-2 infection were included and followed for 21 days.
MEASUREMENTS: Clinical and laboratory findings were collected. Cox survival analysis was performed to explore factors associated with death.
RESULTS: From March 14th to April 9th , 76 patients (median age: 90 [86-92]; women: 55.3%) were admitted for confirmed COVID-19. 64.5% of patients presented with 3 or more comorbidities. Most common symptoms were asthenia (76.3%), fever (75.0%), confusion and delirium (71.1%). Inaugural fall was reported in 25.0% of cases and digestive symptoms in 22.4%. COVID-19 was severe in 51.3% of cases, moderate in 32.9% and mild in 15.8%. Complications included acute respiratory syndrome (28.9%), cardiac decompensation (14.5%) and hypotensive shock (9.0%). Fatality at 21 days was 28.9%, after a median course of disease of 13 (8-17) days. Males were overrepresented in non-survivors (68.2%). In survivors, median length of stay was 12 (9-19.5) days. Independent predictive factors of death were CRP level at admission and lymphocytes count at nadir.
CONCLUSION: Specific clinical features, multi-organ injury and high case fatality rate are observed in older adults with COVID-19. Rapid diagnosis, appropriate care and monitoring seem however to improve prognosis.
PMID:33045106 | DOI:10.1111/jgs.16894