COVID-19: clinical presentation and mortality of the first 50 geriatric patients hospitalized at the Cliniques universitaires Saint-Luc in spring 2020

Cédric Mahiat, Séverine Henrard, Isabelle Gilard, Nicolas Lanthier, Peter Stärkel, Isabelle De Brauwer, Pascale Cornette, Benoit Boland Published in the journal : November 2020 Category : Geriatry

Summary :

Objectives. Although the majority of COVID-19-related in-hospital deaths were reported in patients over 75 years of age, this population has been scarcely described so far. This study was aimed at describing the clinical presentation and in-hospital mortality rate of these geriatric patients.

Methods. This retrospective cohort studied the first 50 patients that were affected with COVID-19 and admitted to geriatric wards at Cliniques universitaires Saint-Luc.

Results. Before admission, the patients (median age: 88 years) were vulnerable (16%), mildly/moderately frail (32%), and severely/very severely frail (52%) according to the clinical frailty scale, whilst presenting with geriatric syndromes (cognitive impairment in 54%, recurrent falls in 44%, and malnutrition in 40%). In 36% of patients, the initial COVID-19 presentation was atypical, consisting of delirium-related or digestive symptoms. The in-hospital mortality rate was high (52%), while being not associated with the degree of frailty; the patients’ mortality rate was associated upon diagnosis with older age, lower systolic blood pressure, higher serum lactate dehydrogenase levels, and marked lung infiltrates.

Conclusions. Concerning the first geriatric COVID-19-affected patients, the initial symptom was often misleading, and the in-hospital mortality rate was high (52%),whereas the prognosis factors still need to be better defined, particularly as for the impact of clinical frailty.

What is already known about the topic?

The majority of COVID-19 in-hospital deaths occur in patients over 75 years of age. The in-hospital mortality rate could not be validly calculated in most of the published studies, given that the data were analysed before the inpatients included in the study were discharged, possibly resulting in a censoring bias. Few studies have so far reported the influence of specific geriatric patient characteristics, such as atypical symptoms, frailty, and geriatric syndromes, on COVID-19-related in-hospital mortality.

What does this article bring up for us?

Our cohort of geriatric inpatients that were followed-up until hospital discharge of all patients included into the analysis enabled us to calculate a 52% in-hospital mortality rate. This in-hospital mortality was not associated with nursing home residency or degree of clinical frailty, nor was it associated with other geriatric syndromes. Nevertheless, this in-hospital mortality rate was revealed to be well associated with older age, lower systolic blood pressure, higher serum lactate dehydrogenase levels, and marked lung infiltrates observed upon COVID-19 diagnosis. The initial COVID-19 presentation is often atypical among geriatric patients, consisting of delirium-related manifestations or digestive symptoms. This atypical COVID-19 presentation may constitute a diagnosis trap.

Key Words

Geriatric medicine, COVID-19, cohort study, frailty, in-hospital mortality rate