Coronavirus disease 2019 in elderly patients: Characteristics and prognostic factors based on 4-week follow-up.
老年患者冠状病毒疾病 2019: 基于 4 周随访的特征和预后因素。
- 作者列表："Wang L","He W","Yu X","Hu D","Bao M","Liu H","Zhou J","Jiang H
OBJECTIVE:To investigate the characteristics and prognostic factors in the elderly patients with COVID-19. METHODS:Consecutive cases over 60 years old with COVID-19 in Renmin Hospital of Wuhan University from Jan 1 to Feb 6, 2020 were included. The primary outcomes were death and survival till March 5. Data of demographics, clinical features, comorbidities, laboratory tests and complications were collected and compared for different outcomes. Cox regression was performed for prognostic factors. RESULTS:339 patients with COVID-19 (aged 71±8 years,173 females (51%)) were enrolled, including 80 (23.6%) critical, 159 severe (46.9%) and 100 moderate (29.5%) cases. Common comorbidities were hypertension (40.8%), diabetes (16.0%) and cardiovascular disease (15.7%). Common symptoms included fever (92.0%), cough (53.0%), dyspnea (40.8%) and fatigue (39.9%). Lymphocytopenia was a common laboratory finding (63.2%). Common complications included bacterial infection (42.8%), liver enzyme abnormalities (28.7%) and acute respiratory distress syndrome (21.0%). Till Mar 5, 2020, 91 cases were discharged (26.8%), 183 cases stayed in hospital (54.0%) and 65 cases (19.2%) were dead. Shorter length of stay was found for the dead compared with the survivors (5 (3-8) vs. 28 (26-29), P < 0.001). Symptoms of dyspnea (HR 2.35, P = 0.001), comorbidities including cardiovascular disease (HR 1.86, P = 0.031) and chronic obstructive pulmonary disease (HR 2.24, P = 0.023), and acute respiratory distress syndrome (HR 29.33, P < 0.001) were strong predictors of death. And a high level of lymphocytes was predictive of better outcome (HR 0.10, P < 0.001). CONCLUSIONS:High proportion of severe to critical cases and high fatality rate were observed in the elderly COVID-19 patients. Rapid disease progress was noted in the dead with a median survival time of 5 days after admission. Dyspnea, lymphocytopenia, comorbidities including cardiovascular disease and chronic obstructive pulmonary disease, and acute respiratory distress syndrome were predictive of poor outcome. Close monitoring and timely treatment should be performed for the elderly patients at high risk.
目的: 探讨老年新型冠状病毒肺炎的临床特点及预后影响因素。 方法: 连续纳入 2020 年 1 月 1 日至 2 月 6 日在武汉大学人民医院住院的 60 岁以上新型冠状病毒肺炎患者。主要结局是截至 3 月 5 日的死亡和生存。收集人口统计学、临床特征、合并症、实验室检查和并发症的数据，并比较不同结局。对预后因素进行Cox回归分析。 结果: 入组 339 例新型冠状病毒肺炎患者 (年龄 71 ± 8 岁，女性 173 例 (51%))，其中危重 80 例 (23.6%)，重度 159 例 (46.9%)，中度 100 例 (29.5%) 案例。常见合并症为高血压 (40.8%) 、糖尿病 (16.0%) 和心血管疾病 (15.7%)。常见症状包括发热 (92.0%) 、咳嗽 (53.0%) 、呼吸困难 (40.8%) 和乏力 (39.9%)。淋巴细胞减少是常见的实验室发现 (63.2%)。常见并发症为细菌感染 (42.8%) 、肝酶异常 (28.7%) 和急性呼吸窘迫综合征 (21.0%)。截至 2020 年 3 月 5 日，出院 91 例 (26.8%)，住院 183 例 (54.0%)，死亡 65 例 (19.2%)。与存活者相比，死者的住院时间较短 (5 (3-8) 对 28 (26-29)，P <0.001)。呼吸困难症状 (HR 2.35，p = 0.001)，合并症包括心血管疾病 (HR 1.86，p = 0.031) 和慢性阻塞性肺疾病 (HR 2.24，P = 0.023) 和急性呼吸窘迫综合征 (HR 29.33，P <0.001) 是死亡的强预测因子。高淋巴细胞水平预测预后较好 (hr 0.10，P <0.001)。 结论: 新型冠状病毒肺炎老年患者中，重症与危重病例比例高，病死率高。死亡患者病情进展迅速，中位生存时间为入院后 5 天。呼吸困难、淋巴细胞减少症、合并症 (包括心血管疾病和慢性阻塞性肺病) 和急性呼吸窘迫综合征是预后不良的预测因素。对高龄高危患者应密切监测，及时治疗。
METHODS::The antimicrobial functions of neutrophils are facilitated by a defensive armamentarium of proteins stored in granules, and by the formation of neutrophil extracellular traps (NETs). However, the toxic nature of these structures poses a threat to highly vascularized tissues, such as the lungs. Here, we identified a cell-intrinsic program that modified the neutrophil proteome in the circulation and caused the progressive loss of granule content and reduction of the NET-forming capacity. This program was driven by the receptor CXCR2 and by regulators of circadian cycles. As a consequence, lungs were protected from inflammatory injury at times of day or in mouse mutants in which granule content was low. Changes in the proteome, granule content and NET formation also occurred in human neutrophils, and correlated with the incidence and severity of respiratory distress in pneumonia patients. Our findings unveil a 'disarming' strategy of neutrophils that depletes protein stores to reduce the magnitude of inflammation.
METHODS::Pneumonia is a common respiratory infectious disease that involves the inflammation of the pulmonary parenchyma. Periodontal disease is widespread and correlated with pneumonia. However, the relationship between periodontal treatment and clinical infectious outcomes in patients with pneumonia has remained undetermined. The aim of this study was to investigate the association between periodontal treatment and the risk of pneumonia events in the Taiwanese population. A nationwide population-based cohort study was conducted using data from the Taiwanese National Health Insurance Research Database (NHIRD). A total of 49,400 chronic periodontitis patients who received periodontal treatment from 2001 to 2012 were selected. In addition, 49,400 healthy individuals without periodontal diseases were picked randomly from the general population after propensity score matching according to age, gender, monthly income, urbanization, and comorbidities. The Cox proportional hazard regression analysis was adopted to assess the hazard ratio (HR) of pneumonia between the periodontal treatment cohort and the comparison cohort. The average ages of the periodontal treatment and comparison groups were 44.25 ± 14.82 years and 44.15 ± 14.5 years, respectively. The follow up durations were 7.66 and 7.41 years for the periodontal treatment and comparison groups, respectively. We found 2504 and 1922 patients with newly diagnosed pneumonia in the comparison cohort and the periodontal treatment cohort, respectively. The Kaplan-Meier plot revealed that the cumulative incidence of pneumonia was significantly lower over the 12 year follow-up period in the periodontal treatment group (using the log-rank test, p < 0.001). In conclusion, this nationwide population-based study indicated that the patients with periodontal treatment exhibited a significantly lower risk of pneumonia than the general population.
METHODS:OBJECTIVE:To describe the treatment of community-acquired pneumonia (CAP) in children under five years in Tanzania. METHODS:Between January and December 2017, children aged 2-59 months with chest radiography-confirmed CAP were enrolled. The parents were interviewed to collect information on the patients and home-based medication. Clinical information was derived from the patient files. Nasopharyngeal swab and blood samples were collected for isolation of the causative pathogens. Swab samples were analysed by quantitative PCR whereas blood samples were tested using BacT/Alert 3D. RESULTS:Overall, 109 children with CAP were included in this analysis. Provision of care to most children was delayed (median = 4.6 days). A quarter (26.6%) were given unprescribed/leftover antibiotics at home. Only one child had positive bacterial culture. Referrals were associated with nasopharyngeal carriage of Streptococcus pneumoniae (p = 0.003) and Haemophilus influenzae (p = 0.004). Of all admitted children, more than a quarter (n = 29) did not need to be hospitalised and inappropriately received injectable instead of oral antibiotics. CONCLUSION:We found high rates of home treatment, particularly with antibiotics. Appropriate health care was delayed for most children because of home treatment. Efforts are needed at the community level to improve awareness of antimicrobial resistance.