Evaluation of Comorbidities, Laboratory Findings and Clinical Outcomes in Elderly Patients with COVID-19

Yıl 2023, Cilt: 20 Sayı: 1, 19 - 24, 27.04.2023

Gökhan Çakırca , Tuba Damar Çakırca

https://doi.org/10.35440/hutfd.1186111

Cited By: 1

Öz

Background: In this study, we aimed to analyze the underlying diseases, laboratory findings and clinical outcomes of elderly patients infected with COVID-19. We also investigated the value of laboratory parameters in the estimation of critical cases and mortality in elderly patients.
Materials and Methods: The study included 314 elderly patients aged 60 years and older who were diagnosed with COVID-19.The patients were divided into two groups according to age, as young old patients (60-74 years) and old old patients (≥75 years). Participants' age, gender, underlying diseases, laboratory findings, disease severity and survival data were obtained from hospital records.
Results: The most common comorbidities in elderly patients were hypertension (57.6%), diabetes mellitus (33.8%) and cardiovascular disease (28%). Old old patients had higher rates of critical type (63.4% vs 30.8%, P<0.001) and death (41.9% vs 21.3%, P<0.001) compared to young old patients. The leukocyte count, neutrophil count, urea, creatinine, C-reactive protein (CRP), procalcitonin, ferritin, troponin T, creatine kinase-MB, prothrombin time and D-dimer values were higher in the old old group compared to the young old group. In contrast, hemoglobin and albumin values were lower in the old old group. The areas under the curve (AUC) of albumin, CRP, procalcitonin, ferritin, troponin T and prothrombin time were greater than 0.80 to predict critically elderly COVID-19 patients. Ferritin had the highest AUC for predicting death (AUC: 0.819) followed by CRP (AUC: 0.805) and procalcitonin (AUC: 0.796).
Conclusions: We found higher rates of critical type and death in old old patients compared to young old patients. In addition, ferritin, CRP, and procalcitonin were strong predictors of both disease severity and mortality in COVID-19-infected elderly subjects.

Anahtar Kelimeler

COVID-19, Elderly patients, Clinical outcomes, Disease severity, Laboratory parameters

Destekleyen Kurum

YOK

Proje Numarası

YOK

Teşekkür

We thank Dr. Ayşe Torun and Dr. Reyhan Derya Portakal for assistance in data acquisition.

COVID-19'lu Yaşlı Hastalarda Komorbidite, Laboratuvar Bulguları ve Klinik Sonuçların Değerlendirilmesi

Öz

Amaç: Bu çalışmada COVID-19 ile enfekte yaşlı hastaların altta yatan hastalıklarını, laboratuvar bulgularını ve klinik sonuçlarını analiz etmeyi amaçladık. Ayrıca yaşlı hastalarda kritik vakaların ve mortalitenin tahmininde laboratuar parametrelerinin değerini araştırdık.
Materyal ve Metod: Çalışmaya COVID-19 teşhisi konan 60 yaş ve üzeri 314 yaşlı hasta dahil edildi. Çalışmaya dahil edilen hastalar yaşa göre genç yaşlı hasta (60-74 yaş) ve ileri yaşlı hasta (≥75 yaş ) olmak üzere ikiye ayrıldı. Katılımcıların yaşı, cinsiyeti, altta yatan hastalıkları, laboratuar bulguları hastalık şiddeti ve sağ kalım verileri hastane kayıtlarında elde edildi.
Bulgular: Yaşlı COVID-19 vakalarında en sık görülen komorbiditeler sırasıyla hipertansiyon (%57.6), diabetes mellitus (%33.8) ve kardiyovasküler hastalık (%28) idi. İleri yaşlı hastalarda, genç yaşlı hastalara kıyasla kritik tip (%63.4 vs %30.8, P<0.001) ve ölüm (%41.9 vs %21.3, P<0.001) oranları daha yüksekti. İleri yaşlı grubun lökosit sayısı, nötrofil sayısı, üre, kreatinin, C-reaktif protein (CRP), prokalsitonin, ferritin, troponin T, kreatin kinaz-MB, protrombin zamanı ve D-dimer değerleri genç yaşlı gruba göre daha yüksekti. Tam tersine, hemoglobin ve albümin değerleri ileri yaşlı grupta daha düşüktü. Kritik olan yaşlı COVID-19 hastalarını tahmin etmede albümin, CRP, prokalsitonin, ferritin, protrombin zamanı ve troponin T’nin ROC eğrisi altında kalan alanları (AUCs) 0.800'den büyüktü. Ferritin, ölümü öngörmede en yüksek AUC değerine sahipti (AUC: 0.819), ardından CRP (AUC: 0.805) ve prokalsitonin (AUC: 0.796) gelmekte idi.
Sonuç: İleri yaşlı hastalarda, genç yaşlı hastalara kıyasla hastalığın kritik tipini ve ölüm oranlarını daha yüksek bulduk. Ayrıca, ferritin, CRP ve prokalsitonin COVID-19 ile enfekte yaşlı bireylerde hem hastalık şiddetini hem de mortaliteyi öngörmede güçlü göstergeler idi.

Anahtar Kelimeler

COVID-19, Yaşlı Hastalar, Klinik sonuçlar, Hastalık şiddeti, Laboratuvar parametreleri

Proje Numarası

YOK

Kaynakça

• 1. Hui DS, I Azhar E, Madani TA, Ntoumi F, Kock R, Dar O, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health - The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis. 2020;91:264-6.
• 2. Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of Immune Response in Patients With Coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis. 2020;71(15):762-8.
• 3. Ritchie AI, Singanayagam A. Immunosuppression for hyperinflammation in COVID-19: a double-edged sword?. Lancet. 2020;395(10230):1111.
• 4. Nile SH, Nile A, Qiu J, Li L, Jia X, Kai G. COVID-19: Pathogenesis, cytokine storm and therapeutic potential of interferons. Cytokine Growth Factor Rev. 2020;53:66-70.
• 5. Li X, Geng M, Peng Y, Meng L, Lu S. Molecular immune pathogenesis and diagnosis of COVID-19. J Pharm Anal. 2020;10(2):102-8.
• 6. Biswas M, Rahaman S, Biswas TK, Haque Z, Ibrahim B. Association of Sex, Age, and Comorbidities with Mortality in COVID-19 Patients: A Systematic Review and Meta-Analysis. Intervirology. 2020;1-12.
• 7. Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: A comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-e18.
• 8. Niu S, Tian S, Lou J, Kang X, Zhang L, Lian H, et al. Clinical characteristics of older patients infected with COVID-19: A descriptive study. Arch Gerontol Geriatr. 2020;89:104058.
• 9. Wei PF. Diagnosis and treatment protocol for novel coronavirus pneumonia (Trial Version 7). Chin Med J. 2020;133(9):1087–95.
• 10. Godil SS, Parker SL, Zuckerman SL, Mendenhall SK, Devin CJ, Asher AL, et al. Determining the quality and effectiveness of surgical spine care: patient satisfaction is not a valid proxy. Spine J 2013;13(9):1006-12.
• 11. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62.
• 12. Choi KW, Chau TN, Tsang O, Tso E, Chiu MC, Tong WL, et al. Outcomes and prognostic factors in 267 patients with severe acute respiratory syndrome in Hong Kong. Ann Intern Med. 2003;139(9):715–23.
• 13. Hong KH, Choi JP, Hong SH, Lee J, Kwon JS, Kim SM, et al. Predictors of mortality in Middle East respiratory syndrome (MERS). Thorax. 2018;73(3):286–89.
• 14. Dai SP, Zhao X, Wu JH. Effects of Comorbidities on the Elderly Patients with COVID-19: Clinical Characteristics of Elderly Patients Infected with COVID-19 from Sichuan, China. J Nutr Health Aging. 2021;25(1):18-24.
• 15. Wei C, Liu Y, Liu Y, Zhang K, Su D, Zhong M, et al. Clinical characteristics and manifestations in older patients with COVID-19. BMC Geriatr. 2020;20(1):395.
• 16. Sanyaolu A, Okorie C, Marinkovic A, Patidar R, Younis K, Desai P, et al. Comorbidity and its Impact on Patients with COVID-19. SN Compr Clin Med. 2020;2(8):1069-1076.
• 17. Guo T, Shen Q, Guo W, He W, Li J, Zhang Y, et al. Clinical Characteristics of Elderly Patients with COVID-19 in Hunan Province, China: A Multicenter, Retrospective Study. Gerontology. 2020;66(5):467-75.
• 18. Bedock D, Bel Lassen P, Mathian A, Moreau P, Couffignal J, Ciangura C, et al. Prevalence and severity of malnutrition in hospitalized COVID-19 patients. Clin Nutr ESPEN. 2020;40:214-9.
• 19. Aguila EJT, Cua IHY, Singh R. Effects of coronavirus disease 2019 on the digestive system and its nutritional implications. Curr Opin Clin Nutr Metab Care. 2021;24(5):440-5.
• 20. Barazzoni R, Bischoff SC, Breda J, Wickramasinghe K, Krznaric Z, Nitzan D, et al. ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection. Clin Nutr. 2020;39(6):1631-8.
• 21. Huang W, Li C, Wang Z, Wang H, Zhou N, Jiang J, et al. Decreased serum albumin level indicates poor prognosis of COVID-19 patients: hepatic injury analysis from 2,623 hospitalized cases. Sci China Life Sci 2020;63(11):1678-87.
• 22. Wang R, He M, Yin W, Liao X, Wang B, Jin X, et al. The Prognostic Nutritional Index is associated with mortality of COVID-19 patients in Wuhan, China. J Clin Lab Anal 2020;34(10):e23566.
• 23. Çakırca G, Damar Çakırca T, Üstünel M, Torun A, Koyuncu İ. Thiol level and total oxidant/antioxidant status in patients with COVID-19 infection. Ir J Med Sci 2021;1-6.
• 24. Paliogiannis P, Mangoni AA, Cangemi M, Fois AG, Carru C, Zinellu A. Serum albumin concentrations are associated with disease severity and outcomes in coronavirus 19 disease (COVID-19): a systematic review and meta-analysis. Clin Exp Med 2021;21(3):343-54.
• 25. Li P, Chen L, Liu Z, Pan J, Zhou D, Wang H, et al. Clinical features and short-term outcomes of elderly patients with COVID-19. Int J Infect Dis. 2020;97:245-50.
• 26. Torun A, Çakırca TD, Çakırca G, Portakal RD. The value of C-reactive protein/albumin, fibrinogen/albumin, and neutrophil/lymphocyte ratios in predicting the severity of CoVID-19. Rev Assoc Med Bras (1992). 2021;67(3):431-6.
• 27. Damar Çakırca T, Torun A, Çakırca G, Portakal RD. Role of NLR, PLR, ELR and CLR in differentiating COVID-19 patients with and without pneumonia. Int J Clin Pract. 2021;75(11):e14781.
• 28. Hwang J, Ryu HS, Kim HA, Hyun M, Lee JY, Yi HA. Prognostic Factors of COVID-19 Infection in Elderly Patients: A Multicenter Study. J Clin Med. 2020;9(12):3932.
• 29. Gao S, Jiang F, Jin W, Shi Y, Yang L, Xia Y, et al. Risk factors influencing the prognosis of elderly patients infected with COVID-19: a clinical retrospective study in Wuhan, China. Aging (Albany NY). 2020;12(13):12504-16.
• 30. Chen T, Dai Z, Mo P, Li X, Ma Z, Song S, et al. Clinical Characteristics and Outcomes of Older Patients with Coronavirus Disease 2019 (COVID-19) in Wuhan, China: A Single-Centered, Retrospective Study. J Gerontol A Biol Sci Med Sci. 2020;75(9):1788-95.