Clinical characteristics of coronavirus disease 2019 in patients aged 80 years and older

Objective: Coronavirus disease 2019（COVID-19） has raised concern around the world as an epidemic or pandemic. As data on COVID-19 has grown, it has become clear that older adults have a disproportionately high rate of death from COVID-19. This study describes the early clinical characteristics of COVID-19 in patients with more than 80 years of age.Methods: Epidemiological, clinical, laboratory, radiological, and treatment data from 17 patients diagnosed with COVID-19 between January 20 and February 20, 2020 were collected and analyzed retrospectively. Treatment outcomes among subgroups of patients with non-severe and severe symptoms of COVID-19 were compared.Results: Of the 17 hospitalized patients with COVID-19, the median age was 88.0 years（interquartile range, 86.6–90.0 years; range, 80.0–100.0 years） and 12（70.6%） were men. The age distribution of patients was not significantly different between non-severe group and severe group. All patients had chronic pre-existing conditions. Hypertension and cardiovascular diseases were the most common chronic conditions in both subgroups. The most common symptoms at the onset of COVID-19 were fever（n = 13; 76.5%）, fatigue（n = 11; 64.7%）, and cough（n = 5; 29.4%）. Lymphopenia was observed in all patients, and lymphopenia was significantly more severe in the severe group than that in non-severe group（0.4×10;/L vs 1.2×10;/L, P = 0.014）. The level of serum creatinine was higher in the severe group than in the non-severe group（99.0 lmol/L vs 62.5 lmol/L, P = 0.038）. The most common features of chest computed tomography images were nodular foci in 10（58.8%） patients and pleural thickening in 7（41.2%） patients. All patients received antiviral therapy, while some patients also received intravenous antibiotics therapy（76.5%）, Chinese medicinal preparation therapy（Lianhuaqingwen capsule, 64.7%）, corticosteroids（35.3%） or immunoglobin（29.4%）. Eight patients（47.1%） were transferred to the intensive care unit because of complications. Ten patients（58.8%） received intranasal oxygen, while 3（17.6%）received non-invasive mechanical ventilation, and 4（23.5%） received high-flow oxygen. As of June 20,7（41.2%） patients had been discharged and 10（58.8% of this cohort, 77.8% of severe patients） had died.Conclusion: The mortality of patients aged 80 years and older with severe COVID-19 symptoms was high.Lymphopenia was a characteristic laboratory result in these patients, and the severity of lymphopenia was indicative of the severity of COVID-19. However, the majority of patients with COVID-19 in this age cohort had atypical symptoms, and early diagnosis depends on prompt use of a viral nucleic acid test.