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Clinical, biological and radiological features, 4-week outcomes and prognostic factors in COVID-19 elderly inpatients - 08/05/21

Doi : 10.1016/j.idnow.2020.12.004 
R. Palich a, 1, , Y. Wakim a, 1, O. Itani a, O. Paccoud a, S. Boussouar b, M. Lévy-Soussan c, C. Soulie d, N. Godefroy a, A. Bleibtreu a

on behalf of the PSL-Covid working group

a Sorbonne Université, Inserm, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Infectious Diseases, 47-83, boulevard de l’hôpital, 75013 Paris, France 
b Sorbonne Université, LIB-Laboratoire d’imagerie biomédicale, Inserm, CNRS, ICAN Institute of CardioMetabolism and Nutrition, ACTION Study Group, Cardiothoracic Imaging Unit, AP-HP, Pitié-Salpêtrière Hospital, 75013 Paris, France 
c Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Department of Palliative Care, 75013 Paris, France 
d Sorbonne Université, Inserm, Pierre Louis Epidemiology and Public Health Institute (iPLESP), AP-HP, Pitié-Salpêtrière Hospital, Department of Virology, 75013 Paris, France 

Corresponding author.

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Highlights

Aim of the study What is the clinical outcome of COVID-19 in elderly patients hospitalized in a conventional medical unit?
Main findings At 4 weeks after admission, the mortality rate (24%) was high, associated as it was with age, acute renal failure and severe respiratory presentation. However, despite a number of poor prognostic factors, a substantial proportion of these patients survived.
Message Optimal care in a conventional medical unit, without invasive ventilation and without transfer to an intensive care unit, could be the best option for frail patients, with a real chance of recovery.

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Abstract

Objective

To describe clinical, biological, radiological presentation and W4 status in COVID-19 elderly patients.

Patients and methods

All patients ≥70 years with confirmed SARS-CoV-2 infection and hospitalized in the Infectious Diseases department of the Pitié-Salpêtrière hospital, Paris, France, from March 1st to April 15th 2020 were included. The primary outcome was death four weeks after hospital admission. Data on demographics, clinical features, laboratory tests, CT-scan findings, therapeutic management and complications were collected.

Results

All in all, 100 patients were analyzed, including 49 patients ≥80 years. Seventy percent had ≥2 comorbidities. Respiratory features were often severe as 48% needed oxygen support upon admission. Twenty-eight out of 43 patients (65%) with a CT-scan had mild to severe parenchymal impairment, and 38/43 (88%) had bilateral impairment. Thirty-two patients presented respiratory distress requiring oxygen support ≥6 liters/minute. Twenty-four deaths occurred, including 21 during hospitalization in our unit, 2 among the 8 patients transferred to ICU, and one at home after discharge from hospital, leading to a global mortality rate of 24% at W4. Age, acute renal failure and respiratory distress were associated with mortality at W4.

Conclusion

A substantial proportion of elderly COVID-19 patients with several comorbidities and severe clinical features survived, a finding that could provide arguments against transferring the most fragile patients to ICU.

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Keywords : Covid-19, Elderly patients, Sars-CoV-2, Prognostic factors, Computed tomography


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Vol 51 - N° 4

P. 368-373 - juin 2021 Retour au numéro
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