This article identifies the characteristics of COVID-19 related deaths in a sample population from Italy, describing the clinical course and phenotype of these COVID-19 related deaths in the hospital of young adults (age < 65) as compared to older adults (age ≥ 65).

Introduction

It is well documented that the mortality rate of COVID-19 is greater in older adults and, more generally, in patients with pre-existing conditions. This study examines a sample population from the national surveillance system established by the Italian National Institute of Health to collect information on people diagnosed with COVID-19. Univariate, bivariate, and simple statistics were used to describe the results.

Study Population

• As of May 21, 2020, there were 31,096 COVID-19 related deaths documented and reported in Italy.

This study includes 3,032 patients who died in the hospital with COVID-19 in Italy (9.8% of COVID-19 related deaths at that time) and were selected to be representative of the overall population.

• COVID-19 related deaths in this study were defined as those who tested positive for SARS-CoV-2 through rtPCR, independent of pre-existing conditions that may have caused or contributed to deaths.
• Of the 3,032 patients included, 368 (12.1%) were aged < 65 (range 5-64) and 2,664 were aged ≥ 65 (range 6-105).

Results-Comorbidities

• Older adults (≥ 65) with COVID-19 who died in the hospital had a higher number of comorbidities. Common comorbidities across all age groups were hypertension, diabetes, and ischemic heart disease.
• Common comorbidities in the older group were: ischemic heart disease, atrial fibrillation, heart failure, stroke, hypertension, dementia, COPD, and chronic renal.
• Common comorbidities in the younger group were: obesity, chronic liver disease, and HIV infection.
• 9% of younger adults (< 65) had no pre-existing comorbidities compared to 3.2% of older adults (≥ 65), suggesting that healthy adults can still develop COVID-19 related complications that may lead to death.

Results-symptoms, diagnoses, and hospital course

• The most common symptoms for all ages were fever and dyspnea and Acute Respiratory Distress Syndrome (ARDS) was diagnosed in a majority of patients.
• Diarrhea was more common in younger adults (< 65) and non respiratory complications were a more common sequelae (cardiac, renal, and superinfection).
• Younger adults received more antiviral and steroidal treatments than older adults (≥ 65).
• Older adults had a shorter time from symptom onset to COVID-19 testing, and to hospitalization and a shorter time from hospital admission to death.

Palmieri L, Vanacore N, Donfrancesco C, et al. Clinical Characteristics of Hospitalized Individuals Dying with COVID-19 by Age Group in Italy. The Journals of Gerontology. Published online June 7, 2020. doi: 10.1093/gerona/glaa146

Summary authored by Daniel Chimitt with editing by Dr. Jennifer Carnahan