Age differences in clinical features and outcomes in patients with COVID-19, Jiangsu, China: a retrospective, multicentre cohort study

  1. Huanyuan Luo
  2. Songqiao Liu
  3. Yuancheng Wang
  4. Penelope A Phillips-Howard
  5. Shenghong Ju
  6. Yi Yang
  7. Duolao Wang

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Abstract

To determine the age-specific clinical presentations and incidence of adverse outcomes among patients with COVID-19 in Jiangsu, China.

Design and setting

Retrospective, multicentre cohort study performed at 24 hospitals in Jiangsu, China.

Participants

625 patients with COVID-19 enrolled between 10 January and 15 March 2020.

Results

Of the 625 patients (median age, 46 years; 329 (52.6%) men), 37 (5.9%) were children (18 years or younger), 261 (41.8%) young adults (19–44 years), 248 (39.7%) middle-aged adults (45–64 years) and 79 (12.6%) elderly adults (65 years or older). The incidence of hypertension, coronary heart disease, chronic obstructive pulmonary disease and diabetes comorbidities increased with age (trend test, p<0.0001, p=0.0003, p<0.0001 and p<0.0001, respectively). Fever, cough and shortness of breath occurred more commonly among older patients, especially the elderly, compared with children (χ 2 test, p = 0.0008, 0.0146 and 0.0282, respectively). The quadrant score and pulmonary opacity score increased with age (trend test, both p<0.0001). Older patients had many significantly different laboratory parameters from younger patients. Elderly patients had the highest proportion of severe or critically-ill cases (33.0%, χ 2 test p<0.0001), intensive care unit use (35.4%, χ 2 test p<0.0001), respiratory failure (31.6%, χ 2 test p<0.0001) and the longest hospital stay (median 21 days, Kruskal–Wallis test p<0.0001).

Conclusions

Elderly (≥65 years) patients with COVID-19 had the highest risk of severe or critical illness, intensive care use, respiratory failure and the longest hospital stay, which may be due partly to their having a higher incidence of comorbidities and poor immune responses to COVID-19.

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  1. Version published to 10.1136/bmjopen-2020-039887
  2. ScreenIT

    SciScore for 10.1101/2020.06.01.20086025: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    BlindingThe radiologists were blinded to the patients’ information.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has several limitations. First, the relative short follow-up time and a very small proportion of patients who remained in hospital after the 14-day follow-up period yield incomplete estimates for disease severity and clinical outcomes, making it difficult to fully assess age differences in the burden associated with COVID-19. However, this impact is minor and may not strongly affect the study results because we included analyses of outcomes at the end of study, and only a small number of patients were still in hospital at the end of the study. Second, we were unable to perform multiple regression analysis to control for possible bias in the observed age impact in clinical features and outcomes. As a result, the observed age differences may still be subject to possible confounding factors.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.06.01.20086025 on medRxiv