Clinical profile and outcome of elderly COVID-19 patients

Authors

  • Diwakar Narashima Murthy Tumkur Department of General Medicine, Banglore Medical College and Research Institution, Bengaluru, Karnataka, India
  • Thejaswi Kuchalu Gurumurthy Department of General Medicine, Banglore Medical College and Research Institution, Bengaluru, Karnataka, India
  • Rajeshwari Channagoudar Department of General Medicine, Banglore Medical College and Research Institution, Bengaluru, Karnataka, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20212755

Keywords:

COVID-19, Neutrophil lymphocyte ratio, D-dimer

Abstract

Background: Emerging and reemerging infectious disease have plagued mankind and have been potential killer since historic times. The current pandemic of COVID-19 is the latest crisis that has challenged leadership and health infrastructure globally. Since, elderly are more susceptible, understanding risk factor and clinical feature in them is critically important to improve the outcome and efficacy of treatment.

Methods: The prospective study included 1187 patients, aged ≥65 years diagnosed with COVID-19. Necessary record like demographic data, comorbidities and clinical features were collected. Relevant laboratory investigation done. Patients were grouped as survival and death. Different parameters were compared using t-test for continuous variables and Chi-square test for categorical data. Receiver operating curve (ROC) drawn using SPSS software.

Results: Out of 1187 elderly people,316 (26%) have succumbed to death. Mortality was more in Male (68.7%). Fever (42%), cough (33.2%), dyspnea (26.9%) were the major symptom. Among patient who succumbed to death 45.9% people had diabetes with hypertension, 15.2% had only diabetes, 17.1% had only hypertension, 12.3% had chronic kidney disease and 15.56% had IHD. ROC curve drawn for TLC (AUC=0.72), NLR ratio (AUC=0.844), LDH (AUC=0.842), D-dimer (AUC=0.851), CRP (AUC=0.82), ferritin (AUC=0.823) which were statistically significant as predictor of disease outcome. D-dimer at cut-off 1 mcg/ml has specificity 89% and sensitivity 76% which is highest among the parameter, followed by NLR ratio at 6.9 has specificity (82%), sensitivity (73%).

Conclusions: D-dimer of 1 mcg/ml, NLR ratio of 6.9 may assist in triaging patient requiring ICU care and deciding intervention. Also, elderly with multiple comorbidity should be treated aggressively, so that chance of survival can be increased.

References

Shi Z, Hu Z. A review of studies on animal reservoirs of the SARS coronavirus. Virus Res. 2008;133(1):74-87.

Donnelly CA, Ghani AC, Leung GM, Hedley AJ, Fraser C, Riley S, et al. Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong. Lancet. 2003;361(9371):1761-6.

Cauchemez S, Fraser C, Kerkhove MD, Donnelly CA, Riley S, Rambaut A, et al. Middle East respiratory syndrome coronavirus: quantification of the extent of the epidemic, surveillance biases, and transmissibility. Lancet Infect Dis. 2014;14(1):50-6.

Wu P, Hao X, Lau EHY, Wong JY, Leung KSM, Wu JT, et al. Real-time tentative assessment of the epidemiological characteristics of novel coronavirus infections in Wuhan, China, as at 22 January 2020. Euro Surveill. 2020;25(3):2000044.

Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004;203(2):631-7.

Li JY, You Z, Wang Q, Zhou ZJ, Qiu Y, Luo R, Ge XY. The epidemic of 2019-novel-coronavirus (2019-nCoV) pneumonia and insights for emerging infectious diseases in the future. Microbes Infect. 2020;22(2):80-5.

Guan WJ, Ni ZY, Zhong NS, Shan H, Liu L, Ou CQ, et al. Clinical characteristics of 2019 novel coron- avirus infection in China. MedRxiv. 2020.

Romero SK, Petereit HG, Schubert M, Kampf D, Schliebner A, Hegewald J, et al. The Age-Related Risk of Severe Outcomes Due to COVID-19 Infection: A Rapid Review, Meta-Analysis, and Meta-Regression. Int J Environ Res Public Health. 2020;17(16):5974.

Bonanad C, Garcia BS, Tarazona SF, Sanchis J, Bertomeu GV, Facila L, et al. The Effect of Age on Mortality in Patients With COVID-19: A Meta-Analysis With 611,583 Subjects. J Am Med Dir Assoc. 2020;21(7):915-8.

Zhang B, Zhou X, Qiu Y, Song Y, Feng F, Feng J, et al. Clinical characteristics of 82 cases of death from COVID-19. PLoS One. 2020;15(7):235458.

Gupta N, Agrawal S, Ish P, Mishra S, Gaind R, Usha G, et al. Clinical and epidemiologic profile of the initial COVID-19 patients at a tertiary care centre in India. Monaldi Arch Chest Dis. 2020;90(1).

Saluja M, Pillai D, Jeliya S, Bauddh N, Chandel R. COVID 19- Clinical Profile, Radiological Presentation, Prognostic Predictors, Complications and Outcome: A Perspective from the Indian Subcontinent. J Assoc Physicians India. 2020;68(7):13-8.

Singh AK, Misra A. Impact of COVID-19 and comorbidities on health and economics: Focus on developing countries and India. Diabetes Metab Syndr. 2020;14(6):1625-30.

Singh P, Kumar A, Singh S, Kelkar A, Doshi P, Nimbargi R, et al. Utility of routine haematological parameters and infectious biomarkers to assess the disease severity in COVID-19 positive patients, analysis and early trend from India. Research Square. 2020;1-13.

Downloads

Published

2021-07-23

Issue

Section

Original Research Articles