Current best evidence for clinical care (more info)
INTRODUCTION: The novel coronavirus (COVID-19), which has affected over 100 countries in a short while, progresses more mortally in elderly patients with comorbidities. In this study, we examined the epidemiological, clinical, and laboratory characteristics of the patients aged 60 and over who had been infected with COVID-19.
METHODS: The data of the patients admitted to the hospital within 1 month from May 8, 2020 onwards and hospitalized for COVID-19 pneumonia were obtained from the hospital medical records, and the epidemiological, clinical, and laboratory parameters of the patients during the admission to the emergency department were examined. Patients were divided into 2 groups regarding the criteria of having in-hospital mortality (mortality group) and being discharged with full recovery (survivor group). The factors, which could have an impact on the mortality, were investigated using a univariate and multivariate logistic regression analysis.
RESULTS: This retrospective study included 113 patients aged 60 years and older, with a confirmed diagnosis of COVID-19 pneumonia. The mean age of the patients was 70.7 ± 7.9, and 64.6% (n = 73) of them were male. The mortality rate was 19.4% (n = 22). Among the comorbid illnesses, only renal failure was significant in the mortality group (p = 0.04). A CURB-65score =3 or pneumonia severity index (PSI) class =4 manifested a remarkable discrimination ability to predict 30-day mortality (p < 0.001). When the laboratory parameters were considered, the value of neutrophil to lymphocyte ratio (NLR) was significant in predicting mortality in univariate and multivariate analysis (odds ratio [OR] = 1.11; 95% confidence interval [95% CI], 1.03-1.21; p = 0.006, and OR = 1.51; 95% CI, 1.11-2.39; p = 0.044, respectively).
CONCLUSION: In our study, NLR was determined to be an independent marker to predict in-hospital mortality among patients with COVID-19. PSI and CURB-65 revealed a considerably precise prognostic accuracy for the patients with COVID-19 in our study as well. Moreover, thanks to that NLR results in a very short time, it can enable the clinician to predict mortality before the scoring systems are calculated and hasten the management of the patients in the chaotic environment of the emergency room.
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In this paper on COVID-19 in older patients from a single center over a short period, CURB-65 and neutrophil to lymphocyte ratio served as good prognostic markers of survival. The study had a small number of patients and was retrospective. Most are familiar with such data.
Yavuz et, al. in their prospective trial followed the criteria of Covid-19 infected patients in elderly to identify factors predicting mortality. It is timely and helpful especially with importance of scoring system and severity indicator to prioritise treatment. Strength: 1. Good numbers of patients followed and several parameters evaluated. 2. In addition to clinical and lab parameters, there are predicting values of two scoring system in determining severity which can guide clinicians to prioritise care. Weakness: 1. Single centre observational study without any randomisation of blinding which risks bias. 2. Although divided ultimately in two groups later on, they were done afterwards, which put doubts about real difference. Impression: Considering the few gaps, it is still a much welcomed trial to guide the treatment of this imposing threat where much progress is still to be had.