COVID-19 pneumonia in older patients: clinical features and outcomes of a 400 case series

Abstract

Background Since late 2019, COVID-19 has been a major health issue worldwide. Older patients seemed more susceptible to severe forms and complications with higher mortality rates. This study aimed to identify the clinical features and outcomes of SARS-Cov-2 pneumonia in elderly patients. Methods Retrospective monocentric study in the internal medicine Covid-19 unit of the Ben Arous regional hospital, enrolling admitted patients with confirmed SARS-CoV-2 pneumonia, aged 65 years and above from September 2020 to September 2021. Results The study group counted 222 women (55.5%). The mean age was 74 years. At least one chronic disease was found in 84.75% of patients. The most common comorbidities were high blood pressure (55.75%), and diabetes mellitus (50%). The most frequent symptoms were dyspnoea (69.8%), fatigue (66.8%) and dry cough (65.8%). Corrected Qt interval was prolonged in 24.2% of cases. Chest computed tomography were performed in 277 cases (69.3%). Ground glass opacities (93.86%), consolidations (73.3%) and crazy paving (36%) were the main findings. Assessment of pulmonary extent found important involvement (41.87%), sever lesions (23.82%), moderate involvement (21.29%) and critical involvement (1.8%). C-reactive protein (CRP) was elevated in 94.25% of patients. Elevated D-dimer levels were common (68.8%). Antinuclear antibodies were positive in 22.85% cases, and lupus anticoagulant in 35.41%. Acute kidney failure was noted in 25% of patients. The incidence of pulmonary embolism in the current study was 12.99%. The death rate was 8%. According to multivariate logistic regression: older age (odds ratio:1.11, 95% CI: 1.058-1.167; P P< .005), elevated C-reactive protein levels (odds ratio: 1.008, 95% CI: 1.003-1.013; P< .005) and duration of hospital stay (odds ratio: 1.131, 95% CI: 1.062-1.204; P< .005) were predictive factors of mortality. Conclusions Clinical presentation of covid-19 pneumonia in elderly patients is particular due to pre-existing comorbidities and frailty. Mortality risk factors are age, elevated CRP and length of hospitalization.