Age-Related Risk Factors and Complications of Patients With COVID-19: A Population-Based Retrospective Study

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Objective: To study the differences in clinical characteristics, risk factors, and complications across age-groups among the inpatients with the coronavirus disease 2019 (COVID-19).

Methods: In this population-based retrospective study, we included all the positive hospitalized patients with COVID-19 at Wuhan City from December 29, 2019 to April 15, 2020, during the first pandemic wave. Multivariate logistic regression analyses were used to explore the risk factors for death from COVID-19. Canonical correlation analysis (CCA) was performed to study the associations between comorbidities and complications.

Results: There are 36,358 patients in the final cohort, of whom 2,492 (6.85%) died. Greater age (odds ration [ OR] = 1.061 [95% CI 1.057–1.065], p < 0.001), male gender ( OR = 1.726 [95% CI 1.582–1.885], p < 0.001), alcohol consumption ( OR = 1.558 [95% CI 1.355–1.786], p < 0.001), smoking ( OR = 1.326 [95% CI 1.055–1.652], p = 0.014), hypertension ( OR = 1.175 [95% CI 1.067–1.293], p = 0.001), diabetes ( OR = 1.258 [95% CI 1.118–1.413], p < 0.001), cancer ( OR = 1.86 [95% CI 1.507–2.279], p < 0.001), chronic kidney disease (CKD) ( OR = 1.745 [95% CI 1.427–2.12], p < 0.001), and intracerebral hemorrhage (ICH) ( OR = 1.96 [95% CI 1.323–2.846], p = 0.001) were independent risk factors for death from COVID-19. Patients aged 40–80 years make up the majority of the whole patients, and them had similar risk factors with the whole patients. For patients aged <40 years, only cancer ( OR = 17.112 [95% CI 6.264–39.73], p < 0.001) and ICH ( OR = 31.538 [95% CI 5.213–158.787], p < 0.001) were significantly associated with higher odds of death. For patients aged >80 years, only age ( OR = 1.033 [95% CI 1.008–1.059], p = 0.01) and male gender ( OR = 1.585 [95% CI 1.301–1.933], p < 0.001) were associated with higher odds of death. The incidence of most complications increases with age, but arrhythmias, gastrointestinal bleeding, and sepsis were more common in younger deceased patients with COVID-19, with only arrhythmia reaching statistical difference ( p = 0.039). We found a relatively poor correlation between preexisting risk factors and complications.

Conclusions: Coronavirus disease 2019 are disproportionally affected by age for its clinical manifestations, risk factors, complications, and outcomes. Prior complications have little effect on the incidence of extrapulmonary complications.

Related collections

Most cited references 33

Record: found
Abstract: found
Article: not found

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Fei Zhou, Ting Yu, Ronghui Du … (2020)

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

0 comments Cited 13719 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).

Mervyn Singer, Clifford S Deutschman, Christopher Warren Seymour … (2016)

Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination.

0 comments Cited 6350 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Acute respiratory distress syndrome: the Berlin Definition.

V Ranieri, Gordon D Rubenfeld, B Taylor Thompson … (2013)

The acute respiratory distress syndrome (ARDS) was defined in 1994 by the American-European Consensus Conference (AECC); since then, issues regarding the reliability and validity of this definition have emerged. Using a consensus process, a panel of experts convened in 2011 (an initiative of the European Society of Intensive Care Medicine endorsed by the American Thoracic Society and the Society of Critical Care Medicine) developed the Berlin Definition, focusing on feasibility, reliability, validity, and objective evaluation of its performance. A draft definition proposed 3 mutually exclusive categories of ARDS based on degree of hypoxemia: mild (200 mm Hg < PaO2/FIO2 ≤ 300 mm Hg), moderate (100 mm Hg < PaO2/FIO2 ≤ 200 mm Hg), and severe (PaO2/FIO2 ≤ 100 mm Hg) and 4 ancillary variables for severe ARDS: radiographic severity, respiratory system compliance (≤40 mL/cm H2O), positive end-expiratory pressure (≥10 cm H2O), and corrected expired volume per minute (≥10 L/min). The draft Berlin Definition was empirically evaluated using patient-level meta-analysis of 4188 patients with ARDS from 4 multicenter clinical data sets and 269 patients with ARDS from 3 single-center data sets containing physiologic information. The 4 ancillary variables did not contribute to the predictive validity of severe ARDS for mortality and were removed from the definition. Using the Berlin Definition, stages of mild, moderate, and severe ARDS were associated with increased mortality (27%; 95% CI, 24%-30%; 32%; 95% CI, 29%-34%; and 45%; 95% CI, 42%-48%, respectively; P < .001) and increased median duration of mechanical ventilation in survivors (5 days; interquartile [IQR], 2-11; 7 days; IQR, 4-14; and 9 days; IQR, 5-17, respectively; P < .001). Compared with the AECC definition, the final Berlin Definition had better predictive validity for mortality, with an area under the receiver operating curve of 0.577 (95% CI, 0.561-0.593) vs 0.536 (95% CI, 0.520-0.553; P < .001). This updated and revised Berlin Definition for ARDS addresses a number of the limitations of the AECC definition. The approach of combining consensus discussions with empirical evaluation may serve as a model to create more accurate, evidence-based, critical illness syndrome definitions and to better inform clinical care, research, and health services planning.

0 comments Cited 2527 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Han Zhang: URI : http://loop.frontiersin.org/people/1075341/overview

Yingying Wu: URI : http://loop.frontiersin.org/people/1519597/overview

Yuqing He: URI : http://loop.frontiersin.org/people/1456802/overview

Mingqian Liu: URI : http://loop.frontiersin.org/people/1493481/overview

Shabei Xu: URI : http://loop.frontiersin.org/people/764430/overview

Minghuan Wang: URI : http://loop.frontiersin.org/people/1574588/overview

Wei Wang: URI : http://loop.frontiersin.org/people/1438552/overview

Journal

Journal ID (nlm-ta): Front Med (Lausanne)

Journal ID (iso-abbrev): Front Med (Lausanne)

Journal ID (publisher-id): Front. Med.

Title: Frontiers in Medicine

Publisher: Frontiers Media S.A.

ISSN (Electronic): 2296-858X

Publication date (Electronic): 11 January 2022

Publication date Collection: 2021

Publication date PMC-release: 11 January 2022

Volume: 8

Electronic Location Identifier: 757459

Affiliations

[1] ¹Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology , Wuhan, China

[2] ²Department of Oncology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology , Wuhan, China

[3] ³Wuhan Municipal Health Commission , Wuhan, China

[4] ⁴Winning Health Technology Group Co., Ltd. , Shanghai, China

Author notes

Edited by: Daisy Motta-Santos, Federal University of Minas Gerais, Brazil

Reviewed by: Juliana Beust de Lima, Clinical Hospital of Porto Alegre, Brazil; Daxian Wu, First Affiliated Hospital of Nanchang University, China

*Correspondence: Minghuan Wang minghuanwang@ 123456aliyun.com

Wei Wang wwang@ 123456vip.126.com

This article was submitted to Infectious Diseases – Surveillance, Prevention and Treatment, a section of the journal Frontiers in Medicine

†These authors have contributed equally to this work and share first authorship

Article

DOI: 10.3389/fmed.2021.757459

PMC ID: 8786909

PubMed ID: 35087843

SO-VID: 9b99f934-4768-4e43-ad28-8069cf25360c

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 12 August 2021

Date accepted : 26 November 2021

Page count

Figures: 3, Tables: 3, Equations: 0, References: 34, Pages: 12, Words: 7478

Comments

Comment on this article

scite_

Cited by 21

See all cited by

Most referenced authors 1,814

See all reference authors

Age-Related Risk Factors and Complications of Patients With COVID-19: A Population-Based Retrospective Study

Read this article at

Abstract

Related collections

Novel Coronavirus Disease COVID-19

Most cited references 33

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).

Acute respiratory distress syndrome: the Berlin Definition.

Author and article information

Contributors

Journal

Affiliations

Author notes

Article

History

Page count

Categories

Comments

Comment on this article

Similar content 179

Cited by 21

Most referenced authors 1,814