This retrospective cohort study evaluated the clinical characteristics of patients admitted to a UK hospital with community-acquired SARS-CoV-2 infections (particularly those over the age of 80), as well as nosocomial SARS-CoV-2 infections acquired by already hospitalized patients.

• 450 patients were analyzed (77% of COVID-19 caseload to date) with an average age of 72 (56, 83).
  • Common comorbidities were hypertension (43%), cardiac disease (31%), diabetes (30%), respiratory conditions (19%), and immunosuppression (9%).
• In hospital mortality was 38% (under-80s mortality 28%; over-80s mortality 60%) with a trend towards lower median temperature in those who died.
  • Those who died had significantly higher respiratory rates, neutrophil counts, CRP, procalcitonin, troponin, lactate, and acute kidney injury.
• Over-80 patients were less likely to present with breathlessness, cough, or fever, and had lower respirations and heart rates, with higher troponin, D-dimer, and lactate. Lymphocyte count was decreased.
  • Those who died were frailer (measured by the Clinical Frailty Scale), had a higher level of cardiac disease, and had higher respiratory rates, heart rates, and CRP.
• 7% of SARS-CoV-2 infections were identified as nosocomial (average patient age of 80), and these patients experienced shorter symptom duration than patients admitted from the community with active infections.
  • Outcomes were no worse than for those with community-admitted infections.
• 78% of patients admitted from local nursing facilities died, with authors identifying them as the frailest members of the cohort. Additionally, authors note that local policy recommended care homes avoid hospitalization when possible, resulting in overall lower numbers of these patients as well as an expectation that the patients who did transfer from care homes were the sickest from that population.

Brill SE, Jarvis HC, Ozcan E, et al. COVID-19: a retrospective cohort study with focus on the over-80s and hospital-onset disease. BMC Medicine. 2020;18(1):194. doi:10.1186/s12916-020-01665-z

This review was posted on behalf of Lauren Albert, medical student at IU School of Medicine, and approved by Dr. Kathleen Unroe, IU School of Medicine associate professor, geriatrician, and IU Center for Aging Research Scientist.