新型冠状病毒肺炎老年患者的临床特点及转归分析

Objective: To investigate the clinical characteristics, treatment and outcome of elderly patients with COVID-19. Methods: We made a retrospective analysis of the clinical data of elderly patients with COVID-19 admitted by the National Anti-epidemic Medical Team of The First Affiliated Hospital of Xi'an Jiaotong University in Department of the seventh ward of Renmin Hospital of Wuhan University between February 9 and March 15, 2020. We fully extracted the patients' demographics, epidemiological characteristics, clinical manifestations, laboratory examination, imaging performance, treatment and outcomes. Results: In this study we included a total of 30 patients(18 males and 12 females), with an average age of(71.1±14.4) years. Their underlying diseases included cardiovascular and cerebrovascular diseases(23 patients), chronic pulmonary disease(3 patients), digestive disease(2 patients), diabetes mellitus(3 patients), and chronic kidney disease(1 patients). Before admission, 22 patients received oral medication. The initial symptoms were fever and cough. The peak body temperature averaged(38.4±0.6)℃ The mean time from symptom onset to hospitalization was 15.0±7.7 days. The clinical classification was mainly severe type in 26 patients(87%). Laboratory examination revealed lower lymphocyte count(0.7±0.2)×10⁹/L, and higher blood D-D dimer lever(6.9±13)μg/L. Serum lactate dehydrogenase(LDH) significantly increased(310±136)U/L. Serum C-reactive protein(61±52)mg/L and erythrocyte sedimentation rate(ESR)(66±38)mmol/L slightly increased. Imaging performance revealed that diffuse lesions were located in bilateral pulmonary parenchyma(22 patients) and in single pulmonary parenchyma(7 patients). Ground-glass opacity was found in all the patients, and the average number of CT examination during hospitalization was 3.5±1.3. Viral load revealed that nucleic acid in nasopharyngeal swabs of 30 patients was all positive, nucleic acid in the feces of 6 patients was positive, and nucleic acid in nasopharyngeal swab of 1 patient was positive, whose nucleic acid in alveolar lavage fluid was negative. Serum IgG antibody level was(157.5±29.2)AU/mL and IgM antibody level was(69.0±148.7)AU/mL. Complications included ARDS in 5 patients, AKI in 5 patients, cardiac injury in 3 patients, shock in 2 patients, nosocomial infection in 3 patients, coagulation disorder in 3 patients, and gastrointestinal bleeding in 3 patients. Finally, 5 patients received non-invasive mechanical ventilation and 2 patients received invasive mechanical ventilation. Another 2 patients underwent CRRT and 1 patient received CRRT plus ECMO. Of the 3 patients with critical type, 2 died and 1 survived. There were 25 patients who turned from severe type into normal type/light type, and 1 patient finally died(turned from severe type into critical type). In the end, 15 patients were cured and discharged. The average time of viral nucleic acid from positive to negative was 12.4±5.6 and the average time of lesion absorption in computer tomography was 16.9±5.8 days. The total hospital stay was 22.9±8.1 days, and the 28-day mortality rate was 6.7%. Conclusion: COVID-19 in elderly patients is mostly severe and its initial symptoms are still fever and cough. Patients should be immediately hospitalized when symptoms develop. The time of viral nucleic acid transformation and imaging improvement is longer than that of others. The mortality in critically ill patients is higher than that of others. Clinicians should pay more attention to the elderly people.