J Korean Med Sci.  2020 Jun;35(23):e223. 10.3346/jkms.2020.35.e223.

Risk Factors for Mortality and Respiratory Support in Elderly Patients Hospitalized with COVID-19 in Korea

• Lee JY
• Kim HA
• Huh K
• Hyun M
• Rhee JY
• Jang S
• Kim JY
• Peck KR
• Chang HH

• KMID: 2502927
• DOI: http://doi.org/10.3346/jkms.2020.35.e223

Abstract

Background
The mortality risk of coronavirus disease 2019 (COVID-19) is higher in patients with older age, and many elderly patients are reported to require advanced respiratory support.
Methods
We reviewed medical records of 98 patients aged ≥ 65 years who were hospitalized with COVID-19 during a regional outbreak in Daegu/Gyeongsangbuk-do province of Korea. The outcome measures were in-hospital mortality and the treatment with mechanical ventilation (MV) or high-flow nasal cannula (HFNC).
Results
The median age of the patients was 72 years; 55.1% were female. Most (74.5%) had at least one underlying condition. Overall case fatality rate (CFR) was 20.4%, and median time to death after admission was 8 days. The CFR was 6.1% among patients aged 65–69 years, 22.7% among those aged 70–79 years, and 38.1% among those aged ≥ 80 years. The CFR among patients who required MV was 43.8%, and the proportion of patients received MV/HFNC was 28.6%. Nosocomial acquisition, diabetes, chronic lung diseases, and chronic neurologic diseases were significant risk factors for both death and MV/HFNC. Hypotension, hypoxia, and altered mental status on admission were also associated with poor outcome. CRP > 8.0 mg/dL was strongly associated with MV/HFNC (odds ratio, 26.31; 95% confidence interval, 7.78–88.92; P < 0.001), and showed better diagnostic characteristics compared to commonly used clinical scores.
Conclusion
Patients aged ≥ 80 years had a high risk of requiring MV/HFNC, and mortality among those severe patients was very high. Severe initial presentation and laboratory abnormalities, especially high CRP, were identified as risk factors for mortality and severe hospital course.

Keyword

COVID-19; Outcome; Elderly; Risk Factors

Figure

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  Fig. 1 Daily number of new cases in Daegu/Gyeongsangbuk-do and in Korea.

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  Fig. 2 Mortality and the highest respiratory support by age group.(A) Survival curve of study patients by age group. (B) Case fatality rate by the highest respiratory support and age group. (C) Highest respiratory support by age group. Number of patients and proportions among each age group were shown.HFNC = high flow nasal cannula, MV = mechanical ventilation.

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