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

Journal of Korean Medical Science 2020년 35권 23호 p.223 ~ 223
이지연, 김현아, 허경민, 현미리, 이지영, 장석빈, 김지연, 백경란, 장현하,
소속 상세정보
이지연 ( Lee Ji-Yeon ) - Keimyung University School of Medicine Department of Internal Medicine
김현아 ( Kim Hyun-Ah ) - Keimyung University School of Medicine Department of Internal Medicine
허경민 ( Huh Kyung-Min ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
현미리 ( Hyun Mi-Ri ) - Keimyung University School of Medicine Department of Internal Medicine
이지영 ( Rhee Ji-Young ) - Dankook University College of Medicine Department of Internal Medicine
장석빈 ( Jang Suk-Bin ) - Dankook University College of Medicine Department of Internal Medicine
김지연 ( Kim Ji-Yeon ) - Seongnam Citizens Medical Center Department of Medicine
백경란 ( Peck Kyong-Ran ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
장현하 ( Chang Hyun-Ha ) - Kyungpook National University School of Medicine Department of Internal Medicine

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.

키워드

COVID-19; Outcome; Elderly; Risk Factors

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