Week 4 outcomes suggest that intensive care unit (ICU) treatment of critically ill older adults hospitalized with severe COVID-19, including those with several comorbidities, may not be necessary, according to study results published in Infectious Diseases Now.
Between March and April 2020, researchers conducted a retrospective, single-center cohort study to assess the clinical, biological, and radiologic features of all patients aged 70 years and older hospitalized with confirmed SARS-CoV-2 infection. The primary outcome was vital status (survival or death) 4 weeks after initial hospitalization. The researchers reviewed data obtained from electronic health records, including clinical features, results of laboratory studies and computed tomographic (CT) imaging, therapeutic management, and complications.
Data from 100 patients, 49 of whom were aged 80 years and older, were analyzed. The median patient age was 79 years (interquartile range [IQR], 74-85); 59 were men, and 71 had at least 2 comorbidities. The most prevalent comorbidities were hypertension (56%), chronic heart failure (31%), dementia (25%), diabetes (24%), and active cancer (21%). The median time from onset of symptoms to hospital admission was 4 days (IQR, 2-7). The most prevalent symptoms on admission were fever (69%), cough (50%), dyspnea (36%), diarrhea (16%), and confusion (14%).
Among the 43 patients who underwent CT of the lungs, 39 (91%) had abnormal lung changes, 29 (65%) had mild to severe parenchymal impairment, and 33 (88%) had bilateral impairment. Of the 32 patients who developed respiratory distress requiring oxygen support (≥6 L/min), 8 (25%) were transferred to the ICU. Overall, 24 deaths occurred within 4 weeks of initial hospital admission: 21 were in the hospital, 2 were in the ICU, and 1 was at home after discharge. The overall mortality rate 4 weeks after hospital admission was 24%, with age, acute kidney injury, and respiratory distress as the associated factors.
The limitations of the study included its small sample size, retrospective design, and inclusion of only hospitalized patients. In addition, some patients did not have available biological data, and the study did not use standardized geriatric scales to monitor clinical progression.
The researchers concluded that as most elderly patients with severe COVID-19 survived without requiring mechanical ventilation, and “given the extremely poor prognosis of [older adult] patients in the ICU, our findings underline the need for medical departments to provide maximum and optimized care for this population.”
Palich R, Wakim Y, Itani O, et al. Clinical, biological and radiological features, 4-week outcomes and prognostic factors in COVID-19 elderly inpatients. Infect Dis Now. 2021;51(4):368-373. doi: 10.1016/j.idnow.2020.12.004