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.
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.
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.
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.Le texte complet de cet article est disponible en PDF.
Keywords : Covid-19, Elderly patients, Sars-CoV-2, Prognostic factors, Computed tomography