Should COVID-19 patients >75 years be Ventilated? An Outcome Study

QJM. 2021 May 19;114(3):182-189. doi: 10.1093/qjmed/hcab029.

Abstract

Background: Elderly patients with COVID-19 disease are at increased risk for adverse outcomes. Current data regarding disease characteristics and outcomes in this population are limited.

Aim: To delineate the adverse factors associated with outcomes of COVID-19 patients ≥75 years of age.

Design: Retrospective cohort study.

Methods: Patients were classified into mild/moderate, severe/very severe and critical disease (intubated) based on oxygen requirements. The primary outcome was in-hospital mortality.

Results: A total of 355 patients aged ≥75 years hospitalized with COVID-19 between 19 March and 25 April 2020 were included.Mean age was 84.3 years. One-third of the patients developed critical disease. Mean length of stay was 7.10 days. Vasopressors were required in 27%, with the highest frequency in the critical disease group (74.1%). Overall mortality was 57.2%, with a significant difference between severity groups (mild/moderate disease: 17.4%, severe/very severe disease: 71.3%, critical disease: 94.9%, P < 0.001).Increased age, dementia, and severe/very severe and critical disease groups were independently associated with increased odds for mortality while diarrhea was associated with decreased odds for mortality (OR: 0.12, 95% CI: 0.02-0.60, P < 0.05). None of the cardiovascular comorbidities were significantly associated with mortality.

Conclusion: Age and dementia are associated with increased odds for mortality in patients ≥75 years of age hospitalized with COVID-19. Those who require intubation have the greatest odds for mortality. Diarrhea as a presenting symptom was associated with lower odds for mortality.

Publication types

  • Observational Study

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • COVID-19 / epidemiology
  • COVID-19 / mortality
  • COVID-19 / therapy*
  • Decision Making*
  • Female
  • Hospital Mortality
  • Humans
  • Male
  • New York City / epidemiology
  • Pneumonia, Viral / epidemiology
  • Pneumonia, Viral / mortality
  • Pneumonia, Viral / therapy*
  • Pneumonia, Viral / virology
  • Respiration, Artificial*
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2
  • Severity of Illness Index