COVID-19: Clinical Presentation and Prognostic Factors of Severe Disease and Mortality in the Oldest-Old Population: A Cohort Study
César Gálvez-Barrón, Marta Arroyo-Huidobro, Antonio Miňarro, Gemma Añaños, Antonio Chamero, Mireia Martín, Clara Gris, Jose L Avalos, Anna M Capielo, Ester Ventosa, Gemma Tremosa, Alejandro Rodríguez-Molinero
Gerontology, doi:10.1159/000515159
Introduction: The oldest-old population (80 years or older) has the highest lethality from COVID-19. There is little information on the clinical presentation and specific prognostic factors for this group. This trial evaluated the clinical presentation and prognostic factors of severe disease and mortality in the oldest-old population. Methods: This is an ambispective cohort study of oldest-old patients hospitalized for respiratory infection associated with COVID-19 and with a positive test by RT-PCR. The clinical presentation and the factors associated with severe disease and mortality were evaluated (logistic regression). All patients were followed up until discharge or death. Results: A total of 103 patients (59.2% female) were included. The most frequent symptoms were fever (68.9%), dyspnoea (60.2%), and cough (39.8%), and 11.7% presented confusion. Fifty-nine patients (57.3%) presented severe disease, and 59 died, with 43 patients (41.7%) presenting both of these. In the multivariate analysis, female sex (odds ratio [OR] 0.31, 95% confidence interval [95% CI] 0.13-0.73, p 0.0074) and serum lactate dehydrogenase (LDH) (OR 2.55, 95% CI 1.21-5.37, p 0.0139) were associated with severe disease, and serum sodium was associated with mortality (OR 3.12, 95% CI 1.18-8.26, p 0.0222). No chronic disease or pharmacological treatment was associated with worse outcomes. Conclusions: The typical presenting symptoms of respiratory infection in COVID-19 are less frequent in the oldest-old population. Male sex and LDH level are associated with severe disease, and the serum sodium level is associated with mortality in this population.
Statement of Ethics The present study has been performed in accordance with the Declaration of Helsinki, and it was approved by the Research Ethics Committee of the Hospital Universitari de Bellvitge (act 12/20, PR 252/20, date June 25, 2020), which approved the study without the need for the informed consent of the patients, given the observational nature of the study and the anonymous nature of the data collected.
Conflict of Interest Statement The authors have no conflicts of interest to declare.
Author Contributions César Gálvez-Barrón and Marta Arroyo-Huidobro analysed and interpreted the data and wrote the manuscript. Alejandro Rodríguez-Molinero designed the trial and analysed and interpreted the data. Antonio Miñarro analysed and interpreted the data. Gemma Añaños, Antonio, Chamero, Mireia Martín, Clara Gris, Jose L. Avalos, Anna M. Capielo, Ester Ventosa, and Gemma Tremosa collected and analysed the data. All authors read and approved the final manuscript. A preprint version of this article is available on Research Square [38] .
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