شدت بيماري ناشي از كرونا ويروس جديد در سالمندان بستري در بيمارستان در بدو بستري، تاخير در مراجعه به بيمارستان و مرگ ناشي از بيماري

Severity of COVID-19 in hospitalized elderly at admission, delay in hospitalization, and death from COVID-19

سن، ريسك فاكتور قوي در افزايش خطر شدت و مرگ ناشي از بيماري COVID-19 است. از آن جايي كه سالمندان بخش بزرگي از بيماران COVID-19 را تشكيل مي دهند، بنابراين مطالعه حاضر جهت ارزيابي شدت بيماري در سالمندان بستري به دليل COVID-19 و تاخير در مراجعه به بيمارستان و مرگ ناشي از آن براي مديريت بهتر بيماري انجام شده است. روش بررسي مطالعه كوهورت گذشته نگر حاضر برروي 444 سالمند مبتلا به COVID-19 بستري از اول فروردين 1399 تا اواخر مهر سال 1399 در بيمارستان بهارلوي تهران انجام گرفت. بيماران براساس شدت بيماري به سه گروه متوسط، شديد و خيلي شديد تقسيم شدند. ازآزمون Analysis of variance براي مقايسه داده هاي كمي و از آزمون Chi-square test براي بررسي متغير هاي كيفي در گروه هاي بيماري استفاده شد. ﻓﺘﻪ ﻫﺎ: از ﺑﯿﻦ 444 ﺷﺮﮐﺖﮐﻨﻨﺪه، 73% ﺑﻪ ﻧﻮع ﻣﺘﻮﺳﻂ و 15% ﺑﻪ ﻧﻮع ﺷﺪﯾﺪ و12% ﺑﻪ ﻧﻮع ﺑﺴﯿﺎر ﺷﺪﯾﺪ ﺑﯿﻤﺎري ﻣﺒﺘﻼ ﺷﺪه ﺑﻮدﻧﺪ. ﻣﯿﺎﻧﮕﯿﻦ ﺳﻦ 72/90±8/42 ﺑﻮد. زﻣﺎن ﺷﺮوع ﻋﻼﯾﻢ ﺗﺎ ﻣﺮاﺟﻌﻪ ﺑﻪ ﺑﯿﻤﺎرﺳﺘﺎن ﺑﻪﻃﻮر ﻣﺘﻮﺳﻂ ﻫﻔﺖ روز ﺑﻮد. در ﺳﺎﻟﻤﻨﺪان ﺑﺎ ﻓﺮم ﺑﺴﯿﺎر ﺷﺪﯾﺪ ﺑﯿﻤﺎري، دﯾﺲﭘﻨﻪ ﺗﻨﻔﺴﯽ)P=0/002 و اﻓﺖ ﺳﻄﺢ ﻫﻮﺷﯿﺎري )P<0/0001 ﺑﺎﻻﺗﺮ ﺑﻮد. زﻣﺎن ﺑﺴﺘﺮي در ﺑﯿﻤﺎرﺳﺘﺎن ﺑﻪﻃﻮر ﻣﺘﻮﺳﻂ ﻫﻔﺖ روز ﺑﻮد. در ﻓﺮم ﺑﺴﯿﺎر ﺷﺪﯾﺪ ﺗﺎ 11روز اداﻣﻪ داﺷﺖ. ﻣﺮگ و ﺑﺴﺘﺮي در ICU در ﺑﯿﻤﺎران ﻓﺮم ﺑﺴﯿﺎر ﺷﺪﯾﺪ ﺑﯿﻤﺎري ﺑﯿﺸﺘﺮ ﺑﻮد. ﺑﺎ اﻓﺰاﯾﺶ ﺗﺎﺧﯿﺮ در روزﻫﺎي ﻣﺮاﺟﻌﻪ ﺑﻪ ﺑﯿﻤﺎرﺳﺘﺎن ﺷﺪت ﺑﯿﻤﺎري و و مرگ ومير افزايش پيدا كرده است. نتيجه گيري نتايج حاصل ازمطالعه نشان داد كه طولاني شدن زمان شروع علايم تا مراجعه به بيمارستان پيش آگهي را در سالمندان بدتر كرده و همچنين باعث تشديد بيماري و افزايش مرگ و مير در سالمندان مي شود.

Age is a strong risk factor for increasing the risk of severity and death from Covid-19. The risk of hospitalization for Covid-19 disease increases with age. Since the elderly constitute a large proportion of Covid-19 patients, the present study was performed to evaluate the severity of the disease in the hospitalized elderly due to Covid-19 and the delay in hospitalization and death resulting from it, for better disease management. Methods The present retrospective cohort study was performed on 444 elderly patients with Covid-19 admitted from 1 April until late October 2020 in Baharloo Hospital in Tehran, Iran. After being diagnosed using the results of RT-PCR and CT scan, patients, were divided into 3 groups: moderate, severe and very severe based on the severity of the disease. Analysis of variance was used to compare quantitative data and a chi-square test was used to examine qualitative variables in disease groups. Results From 444 elderly participants in the study, 73% were infected moderately, 15% severely, and 12% had a very severe form. The mean age was 72.90±8.42 and patients with a very severe form of the disease (75.68±8.28) were older. The average time from the onset of symptoms to hospitalization was 7 days. In the elderly with a very severe form of the disease, respiratory dyspnea (P=0.002) and decreased level of consciousness (P<0.0001) were higher. The average hospital stay was 7 days. In very severe form it lasted up to 11 days. ICU mortality and hospitalization were higher in patients with very severe forms of the disease. With the increasing delay in the days of hospitalization, the severity of the disease and mortality has increased. Conclusion The study showed that prolonging the onset of symptoms till hospitalization worsens prognosis and also exacerbates the disease and increases mortality in the elderly.