Older adults hospitalized with Covid-19: Clinical characteristics and early outcomes from a single center in Istanbul, Turkey

Abstract Objective: Older adults have been continuously reported to be at higher risk for adverse outcomes of Covid-19. We aimed to describe clinical characteristics and early outcomes of the older Covid-19 patients hospitalized in our center comparatively with the younger patients, and also to analyze the triage factors that were related to the in-hospital mortality of older adults.Design: Retrospective; observational studySetting: Istanbul Faculty of Medicine hospital, TurkeyParticipants: 362 hospitalized patients with laboratory-confirmed Covid-19 from March 11 to May 11, 2020.Measurements: The demographic information; associated comorbidities; presenting clinical, laboratory, radiological characteristics on admission and outcomes from the electronic medical records were analyzed comparatively between the younger (<65 years) and older (≥65 years) adults. Factors associated with in-hospital mortality of the older adults were analyzed by multivariate regression analyses.Results: The median age was 56 years (interquartile range [IQR], 46-67), and 224 (61.9%) were male. There were 104 (28.7%) patients ≥65 years of age. More than half of the patients (58%) had one or more chronic comorbidity. The three most common presenting symptoms in the older patients were fatigue/myalgia (89.4%), dry cough (72.1%), and fever (63.5%). Cough and fever were significantly less prevalent in older adults compared to younger patients (p=0.001 and 0.008, respectively). Clinically severe pneumonia was present in 31.5% of the study population being more common in older adults (49% vs. 24.4%) (p<0.001). The laboratory parameters that were significantly different between the older and younger adults were as follows: the older patients had significantly higher CRP, D-dimer, TnT, pro-BNP, procalcitonin levels, higher prevalence of lymphopenia, neutrophilia, increased creatinine, and lower hemoglobin, ALT, albumin level (p<0.05). In the radiological evaluation, more than half of the patients (54.6%) had moderate-severe pneumonia, which was more prevalent in older patients (66% vs. 50%) (p=0.006). The adverse outcomes were significantly more prevalent in older adults compared to the younger patients (ICU admission, 28.8% vs. 8.9%; mortality, 23.1% vs. 4.3%, p<0.001). Among the triage evaluation parameters, the only factor associated with higher mortality was the presence of clinically severe pneumonia on admission (Odds Ratio=12.3, 95% confidence interval=2.7-55.5, p=0.001).Conclusion: Older patients presented with more prevalent chronic comorbidities, less prevalent symptomatology but more severe respiratory signs and laboratory abnormalities than the younger patients. Among the triage assessment factors, the clinical evaluation of pulmonary involvement came in front to help clinicians to stratify the patients for mortality risk.

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Clinical Characteristics and Prognostic Factors of Early-Onset Pancreatic Neuroendocrine Tumors

Cancer Control ◽

10.1177/1073274820986827 ◽

2021 ◽

Vol 28 ◽

pp. 107327482098682

Author(s):

Min Shi ◽

Biao Zhou

Keyword(s):

Prognostic Factors ◽

Neuroendocrine Tumors ◽

Early Onset ◽

Older Patients ◽

Clinical Characteristics ◽

Clinicopathological Characteristics ◽

Pancreatic Neuroendocrine Tumors ◽

Chi Square ◽

Younger Patients ◽

Significant Difference

Background: The incidence of pancreatic neuroendocrine tumors (PNETs) has increased significantly. The purpose of this study was to analyze the clinical characteristics and prognosis of patients under 50 years old. Methods: Patients with PNETs recorded in the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015 were analyzed. The clinical characteristics were analyzed by Chi-square test. The Kaplan-Meier method was used to estimate overall survival (OS). Multivariate Cox proportional risk regression analysis was used to determine independent prognostic factors. Results: 2,303 patients included, of which 547 (23.8%) patients were younger than 50 years old. The number of younger patients has increased steadily, while the proportion in total PNETs decreased recently. Compared with older group, the proportion of the Black, grade I/II, and surgery were higher in early-onset PNETs. Liver was the most frequent metastatic site. There was no significant difference in the incidence of different metastatic sites between younger and older PNETs patients, while younger patients had better OS (P < 0.05). Grade, N stage, M stage, and surgery were independent prognostic factors for OS in early-onset PNETs. Conclusions: Younger patients have unique clinicopathological characteristics compared with older patients in PNETs. Better OS was observed in younger patients which might due to the higher proportion of well-differentiated tumor and surgery than older patients.

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Clinical features and outcomes of COVID-19 in older adults: a systematic review and meta-analysis

BMC Geriatrics ◽

10.1186/s12877-021-02261-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sunny Singhal ◽

Pramod Kumar ◽

Sumitabh Singh ◽

Srishti Saha ◽

Aparajit Ballav Dey

Keyword(s):

Systematic Review ◽

Older Adults ◽

Critically Ill ◽

Clinical Features ◽

Older Patients ◽

Clinical Characteristics ◽

Meta Analysis ◽

Severe Infection ◽

Factors Affecting ◽

Pooled Prevalence

Abstract Background Few studies have focused on exploring the clinical characteristics and outcomes of COVID-19 in older patients. We conducted this systematic review and meta-analysis to have a better understanding of the clinical characteristics of older COVID-19 patients. Methods A systematic search of PubMed and Scopus was performed from December 2019 to May 3rd, 2020. Observational studies including older adults (age ≥ 60 years) with COVID-19 infection and reporting clinical characteristics or outcome were included. Primary outcome was assessing weighted pooled prevalence (WPP) of severity and outcomes. Secondary outcomes were clinical features including comorbidities and need of respiratory support. Result Forty-six studies with 13,624 older patients were included. Severe infection was seen in 51% (95% CI– 36-65%, I2–95%) patients while 22% (95% CI– 16-28%, I2–88%) were critically ill. Overall, 11% (95% CI– 5-21%, I2–98%) patients died. The common comorbidities were hypertension (48, 95% CI– 36-60% I2–92%), diabetes mellitus (22, 95% CI– 13-32%, I2–86%) and cardiovascular disease (19, 95% CI – 11-28%, I2–85%). Common symptoms were fever (83, 95% CI– 66-97%, I2–91%), cough (60, 95% CI– 50-70%, I2–71%) and dyspnoea (42, 95% CI– 19-67%, I2–94%). Overall, 84% (95% CI– 60-100%, I2–81%) required oxygen support and 21% (95% CI– 0-49%, I2–91%) required mechanical ventilation. Majority of studies had medium to high risk of bias and overall quality of evidence was low for all outcomes. Conclusion Approximately half of older patients with COVID-19 have severe infection, one in five are critically ill and one in ten die. More high-quality evidence is needed to study outcomes in this vulnerable patient population and factors affecting these outcomes.

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Sex Differences in the Association between Atrial Fibrillation and 90-Day Adverse Outcomes among Older Adults with Heart Failure: A Retrospective Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052237 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2237

Author(s):

Youn-Jung Son ◽

Da-Young Kim ◽

Mi Hwa Won

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Older Adults ◽

Sex Differences ◽

Older Adult ◽

Hospital Readmission ◽

Older Patients ◽

Adverse Outcomes ◽

Prognostic Impact ◽

Male And Female

Sex differences in the prognostic impact of coexisting atrial fibrillation (AF) in older patients with heart failure (HF) have not been well-studied. This study, therefore, compared sex differences in the association between AF and its 90-day adverse outcomes (hospital readmissions and emergency room (ER) visits) among older adults with HF. Of the 250 older adult patients, the prevalence rates of coexisting AF between male and female HF patients were 46.0% and 31.0%, respectively. In both male and female older patients, patients with AF have a significantly higher readmission rate (male 46.0%, and female 34.3%) than those without AF (male 6.8%, and female 12.8%). However, there are no significant differences in the association between AF and ER visits in both male and female older HF patients. The multivariate logistic analysis showed that coexisting AF significantly increased the risk of 90-day hospital readmission in both male and female older patients. In addition, older age in males and longer periods of time after an HF diagnosis in females were associated with an increased risk of hospital readmission. Consequently, prospective cohort studies are needed to identify the impact of coexisting AF on short- and long-term outcomes in older adult HF patients by sex.

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Clinical Presentation of Primary Hyperparathyroidism in Older Adults

Journal of the Endocrine Society ◽

10.1210/js.2019-00316 ◽

2019 ◽

Vol 3 (12) ◽

pp. 2305-2312 ◽

Cited By ~ 2

Author(s):

Elena Castellano ◽

Roberto Attanasio ◽

Alberto Boriano ◽

Giorgio Borretta

Keyword(s):

Older Adults ◽

Primary Hyperparathyroidism ◽

Older Patients ◽

Clinical Presentation ◽

Renal Involvement ◽

Age Groups ◽

Urinary Calcium ◽

Interquartile Range ◽

Younger Patients ◽

Vitamin D Levels

Abstract Background The clinical presentation of primary hyperparathyroidism (PHPT) has changed greatly during the past few decades. Our aim was to evaluate whether the clinical presentation at diagnosis differed according to age. Methods We evaluated retrospectively a monocentric series of 462 consecutive patients with PHPT, dividing them according to a cutoff of 65 years of age. Results No differences were found in the mean serum PTH, calcium, or vitamin D levels. In older patients (n = 212; 45.9%), the urinary calcium levels were significantly lower (median, 205 mg/24 hour; interquartile range, 220 mg/24 hour) compared with those in younger patients (median, 308 mg/24 hour; interquartile range, 233 mg/24 hour). In addition, renal involvement was significantly less frequent (25% vs 49.2%), and bone involvement significantly more frequent (58% vs 44%) in older patients compared with younger patients. The clinical presentation was significantly different between the two age groups, with a lower frequency of symptomatic forms and a greater frequency of asymptomatic forms not meeting surgical criteria in the older patients (44.4% vs 57.2% and 18.4% vs 5.6%, respectively). Osteoporosis was significantly more frequent in the older adults than in their younger counterparts. The most affected bone site was the forearm in older adults and the lumbar spine in younger ones (50.3% and 50.5%, respectively). Conclusion The clinical presentation of PHPT differs according to age, and this difference can affect the selection of management modalities.

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Clinical Characteristics and Outcomes of Childbearing-Age Women With COVID-19 in Wuhan: Retrospective, Single-Center Study

Journal of Medical Internet Research ◽

10.2196/19642 ◽

2020 ◽

Vol 22 (8) ◽

pp. e19642

Author(s):

Lijie Wei ◽

Xuan Gao ◽

Suhua Chen ◽

Wanjiang Zeng ◽

Jianli Wu ◽

...

Keyword(s):

Pregnant Women ◽

Influenza A ◽

Clinical Characteristics ◽

Clinical Laboratory ◽

Outcome Data ◽

Fetal Movement ◽

Adverse Outcomes ◽

Elevated Concentration ◽

Childbearing Age ◽

Childbearing Age Women

Background Since December 2019, an outbreak of the coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly in Wuhan and worldwide. However, previous studies on pregnant patients were limited. Objective The aim of this study is to evaluate the clinical characteristics and outcomes of pregnant and nonpregnant women with COVID-19. Methods This study retrospectively collected epidemiological, clinical, laboratory, imaging, management, and outcome data of 43 childbearing-age women patients (including 17 pregnant and 26 nonpregnant patients) who presented with laboratory-confirmed COVID-19 in Tongji Hospital, Wuhan, China from January 19 to March 2, 2020. Clinical outcomes were followed up to March 28, 2020. Results Of the 43 childbearing-age women in this study, none developed a severe adverse illness or died. The median ages of pregnant and nonpregnant women were 33.0 and 33.5 years, respectively. Pregnant women had a markedly higher proportion of history exposure to hospitals within 2 weeks before onset compared to nonpregnant women (9/17, 53% vs 5/26, 19%, P=.02) and a lower proportion of other family members affected (4/17, 24% vs 19/26, 73%, P=.004). Fever (8/17, 47% vs 18/26, 69%) and cough (9/17, 53% vs 12/26, 46%) were common onsets of symptoms for the two groups. Abdominal pain (n=4, 24%), vaginal bleeding (n=1, 6%), reduced fetal movement (n=1, 6%), and increased fetal movement (n=2, 13%) were observed at onset in the 17 pregnant patients. Higher neutrophil and lower lymphocyte percent were observed in the pregnant group compared to the nonpregnant group (79% vs 56%, P<.001; 15% vs 33%, P<.001, respectively). In both groups, we observed an elevated concentration of high-sensitivity C-reactive protein, erythrocyte sedimentation rate, aminotransferase, and lactate dehydrogenase. Concentrations of alkaline phosphatase and D-dimer in the pregnant group were significantly higher than those of the nonpregnant group (119.0 vs 48.0 U/L, P<.001; 2.1 vs 0.3μg/mL, P<.001, respectively). Both pregnant (4/10, 40%) and nonpregnant (8/15, 53%) women tested positive for influenza A virus. A majority of pregnant and nonpregnant groups received antiviral (13/17, 76% vs 25/26, 96%) and antibiotic (13/17, 76% vs 23/26, 88%) therapy. Additionally, both pregnant (2/11, 18%) and nonpregnant (2/19, 11%) recovered women redetected positive for SARS-CoV-2 after discharge. Conclusions The epidemiology and clinical and laboratory features of pregnant women with COVID-19 were diverse and atypical, which increased the difficulty of diagnosis. Most pregnant women with COVID-19 were mild and moderate, and rarely developed severe pneumonia or severe adverse outcomes.

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The clinical features and prognosis of infective endocarditis in the elderly from 2007-2016 in a tertiary hospital in China

10.21203/rs.2.11660/v1 ◽

2019 ◽

Author(s):

Zhenzhu Wu ◽

Yi Chen ◽

Tingting Xiao ◽

Tianshui Niu ◽

Qingyi Shi ◽

...

Keyword(s):

Surgical Treatment ◽

Infective Endocarditis ◽

Renal Insufficiency ◽

Hospital Mortality ◽

Older Patients ◽

The Elderly ◽

Tertiary Hospital ◽

Old Patients ◽

Younger Patients ◽

One Year

Abstract Background Infective endocarditis (IE) is a serious disease, with a worse prognosis in the elderly. Aims To explore the clinical features and prognosis of old patients with IE in a tertiary hospital. Methods A retrospective cohort study was conducted. A total of 407 patients diagnosed as IE were divided into two groups: 348 patients under 65 years old and 59 patients over 65 years old. Results For older patients, clinical symptoms such as fever, anemia, and heart murmur were as common as in younger patients. Comorbidities like hypertension (P＜0.001) and diabetes (P=0.023) were more common in older patients. Complications like renal insufficiency (P=0.027) and arrhythmia (P＜0.001) were also more common in older patients. The old patients had a lower operation rate (40.7% vs 60.6%, P=0.004) and higher in-hospital mortality (20.3% vs 8.9%, P=0.008) compared with the younger patients. Pitt score ≥4 (P=0.043, OR=28.0, 95% CI 1.1-700.4) and renal insufficiency (P=0.011, OR=34.2, 95% CI 2.2-521.2) were independent risk factors of in-hospital mortality for older patients. Surgical treatment was a significant predictor of one-year mortality even after adjusting for the confounders (HR = 1.722, 95% CI 0.563-5.365, P = 0.005).The one-year survival rate was higher for older patients with surgical intervention than those without (95.8% vs 68.6%, P=0.007). Conclusions IE in older patients present with more comorbidities and complications as well as a higher mortality than younger patients. Surgery were underused in old patients and old patients with surgical treatment had better long-term prognosis.

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Clinical characteristics and comparison of the outcome in young versus older patients with upper gastrointestinal carcinoma

Journal of Cancer Research and Clinical Oncology ◽

10.1007/s00432-020-03302-x ◽

2020 ◽

Vol 146 (12) ◽

pp. 3313-3322

Author(s):

Hannah Christina Puhr ◽

Alexander Karner ◽

Hossein Taghizadeh ◽

Gerd Jomrich ◽

Sebastian Friedrich Schoppmann ◽

...

Keyword(s):

Elderly Patients ◽

Older Patients ◽

Clinical Characteristics ◽

Young Patients ◽

Screening Methods ◽

Gastrointestinal Carcinoma ◽

Younger Patients ◽

Metastatic Setting ◽

Initial Onset ◽

Tumour Location

Abstract Background The clinical behaviour and outcome of young patients with gastroesophageal tumours (GET) is surmised to differ from older patients, yet data on the comparison of these two patient subgroups is scarce. This study focuses on the investigation of the clinical characteristics and survival outcome of younger-age people with GET, when compared to older patients. Methods Patients diagnosed with GET at the Medical University of Vienna between 2004 and 2016 were included in this study. Clinical parameters and the overall survival (OS) were compared between young (≤ 45 years) and elderly (≥ 65 years) patients. Results Among 796 patients, who were eligible for this analysis, fifty-eight patients (7%) were ≤ 45 years at the initial onset of the disease. These 58 young patients were then matched to elderly patients based on the gender, tumour stage, histology and tumour location. The number of metastatic lesions was significantly higher among young patients (p < 0.05). In a non-metastatic setting younger patients showed a significant longer OS than older patients (median 1226 versus 801 days, p = 0.028). Furthermore, young patients with extensive metastatic disease (2 or more metastatic site) had a significantly poorer OS than elderly patients (median 450 versus 646 days, p = 0.033). Conclusion These results indicate that young patients might be diagnosed very late, which might lead to the development of a more aggressive disease compared to older patients, but a relatively long OS when diagnosed and treated in a non-metastatic setting. Thus, screening methods for younger patients might be considerable to enhance the outcome of young patients with GET.

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Age distribution of tumor gene expression in patients with stage II/III colon cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.552 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 552-552

Author(s):

Howard S. Hochster ◽

Anna Lau ◽

Michelle Turner ◽

Christy Ann Russell

Keyword(s):

Gene Expression ◽

Colon Cancer ◽

Older Patients ◽

Clinical Laboratory ◽

Stage Ii ◽

Age Group ◽

Younger Patients ◽

Incidence And Mortality ◽

Tumor Gene Expression ◽

Tumor Gene

552 Background: Colorectal cancer (CRC) incidence and mortality have been rising in the US among adults <55 y. Younger patients with CRC are more likely than older patients to receive postoperative systemic chemotherapy, despite lack of consensus on the prognostic value of age in this disease. CRC diagnosed in younger patients may be biologically different from that in older patients, but characteristics are unknown. Thus, we examined whether age-specific differences were measurable by tumor gene expression using the 12-gene Oncotype DX Colon Recurrence Score (RS) test (Genomic Health, Inc. [GHI]; Redwood City, CA). The Colon RS test is validated to predict risk of recurrence in patients with stage II/III colon cancer. Methods: We analyzed Colon RS test results and single-gene results for the 12 genes by age group (age <40, 40-54, 55-64, and ≥65) using data from the GHI clinical laboratory dated 1/2010 to 7/2017. Results: As of 7/2017, 21,925 Colon RS reports have been delivered. Median age was 63 y; 50% were male. About 23% of patients were <55 y (Table). Mean (SD) RS result was 25 (11). Colon RS result distributions were similar by age group (Table). Expression of individual tumor genes measured in the Colon RS test were also similar by age group (data to be presented). Conclusions: The etiology of the increase in both incidence and mortality from CRC in adults <55 y is poorly understood. Our findings suggest that colon cancer in younger patients is not biologically different from that in older patients, as measured by the Colon RS test in a large cohort referred for testing. As shown by this test in the GHI clinical laboratory experience, most patients with stage II/III colon cancer have low-risk disease, including patients <55 years. Our findings support a biology-driven approach to disease management of patients with stage II/III colon cancer regardless of age. This well-validated genomic assay may identify a group of younger patients for whom adjuvant chemotherapy might represent overtreatment. [Table: see text]

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Real-world outcomes in older adults treated with immunotherapy: A United Kingdom multicenter series of 2,049 patients.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.12026 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 12026-12026

Author(s):

Anna Claire Olsson-Brown ◽

Mark Baxter ◽

Caroline Dobeson ◽

Laura Feeney ◽

Rebecca Lee ◽

...

Keyword(s):

Older Adults ◽

Health Service ◽

Adverse Events ◽

Real World ◽

Older Patients ◽

Single Agent ◽

Receive Combination Therapy ◽

Younger Patients ◽

Increased Risk ◽

The Impact

12026 Background: Immune checkpoint inhibitor (ICI) therapy is now commonly used in a range of tumours and settings. Most data relating to outcomes and rates of immune-related adverse events (irAE) is derived from clinical trial or registry populations and small case series. Limited data exist for patients aged > 75 years. Here we present a multi-centre, real-world analysis of the outcomes and incidence of irAEs in older adults managed within a single comprehensive public health service. We also compare these outcomes to younger patients in the same cohort. Methods: A retrospective analysis of 2049 patients treated with ICIs was undertaken across 12 centres. All patients were managed within the UK National Health Service outside of a trial setting between June 2016 and September 2018. Patients received either ICI monotherapy (MT) or duel combination ICI therapy (CT) for malignant melanoma (MM), non-small cell lung cancer (NSCLC) or renal cell cancer (RCC). Data were collected using a standardised, collection tool. IrAEs ≥ grade 2 or all-grade endocrinopathies were recorded as per the Common Terminology Criteria for Adverse Events (V5) (CTCAE). Statistical analyses were performed using T-tests, Mann-Whitney and Chi-squared. Kaplan-Meier analysis and log-rank test were used for overall survival (OS) analysis. Results: 409 (20%) of patients were aged > 75 years(a), 1413 (69%) aged 50-75(b) and 227 (11.1%) aged < 50(c). There was no difference in sex, ethnicity or PD-L1 status (in the NSCLC cohort) between groups. Older patients were less likely to receive combination therapy (3%(a) v 13%(b) v 34%(c), p < 0.001). There was no difference in median OS across age groups in the cohort as a whole (p = 0.822) or for the individual tumour groups when treated with single agent ICI. Across the total cohort patients aged > 75 had no increased risk of any irAE (35%(a) v 33%(b) v 41%(c),p = 0.074). However there was an increase in irAEs in older patients treated with MT (36%(a) v 26(b) v 25%(c), p = 0.011) However there was no difference in the > 75s with regard to severe (G3/4) toxicity, toxicity type, admission or discontinuation due to toxicity in the aPD-1 group. In the overall cohort younger patients were more likely to develop irAEs and be admitted. Conclusions: Patients aged > 75 years treated with anti-PD1 therapy in the standard of care setting derive similar survival benefit to younger patients. There was no increase in ≥G3 toxicity. Our data support the safety of single agent aPD-1 ICI therapy in older adults and provide reassurance relating to the impact of toxicity.[Table: see text]

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Clinical Characteristics and Surgery of Primary Lung Cancer in Younger Patients

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230801600509 ◽

2008 ◽

Vol 16 (5) ◽

pp. 387-391 ◽

Cited By ~ 1

Author(s):

Yasunobu Funakoshi ◽

Shin-Ichi Takeda ◽

Yoshihisa Kadota ◽

Takashi Kusu ◽

Hajime Maeda

Keyword(s):

Lung Cancer ◽

Cell Carcinoma ◽

Older Patients ◽

Clinical Characteristics ◽

Early Stage ◽

Survival Rates ◽

Primary Lung Cancer ◽

Large Cell Carcinoma ◽

Large Cell ◽

Younger Patients

Controversy exists regarding the clinical characteristics, pathological findings, and prognosis of patients < 50 years of age with primary lung cancer. The medical records of 4,556 patients diagnosed with primary lung cancer between 1980 and 2004 were reviewed; of these, 305 were < 50 years old. Of 1,335 patients who were surgically treated, 122 were < 50 years old. Females were over-represented in the younger group. Younger patients had a significantly higher incidence of adenocarcinoma and large cell carcinoma, and a lower incidence of squamous cell carcinoma. The resectable rate in younger patients was significantly higher. Overall and among surgically treated patients, the survival rates of younger patients with stage 0-I disease were significantly better than those of older patients. Younger patients with early-stage primary lung cancer had a significantly better prognosis than older patients, although survival in the advanced stages was not significantly different.

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