Clinical Profile of Elderly Patients with COVID-19 hospitalised in Indonesia’s National General Hospital

Muhammad Khifzhon Azwar, Siti Setiati, Aulia Rizka, Ika Fitriana, Siti Rizny F Saldi, Eka Dian Safitri

Abstract


Latar Belakang

Sebanyak 38.6% kasus kematian pasien COVID-19 di Indonesia terjadi di populasi lansia. Data mengenai profil klinis pasien rawat inap lansia dengan COVID-19 masih tidak ada. Padahal kelompok pasien ini adalah pasien risiko tinggi selama pandemi ini yang memerlukan perhatian lebih.

Metode

Studi deskriptif ini menggunakan data lengkap pasien lansia dengan COVID-19 yang dirawat inap di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSUPN Cipto Mangunkusumo) dari April hingga akhir Agustus 2020. Data termasuk karakteristik klinis, gejala, komorbiditas, multimorbiditas dan luaran mortalitas pasien.

Hasil

Di populasi pasien lansia (n=44), mayoritas berusia di antara 60-69 tahun (68%), berjenis kelamin laki-laki (66%), dan tidak memiliki riwayat kontak erat dengan pasien COVID-19 sebelumnya (86%). Gejala tersering ialah demam, batuk, dan sesak yang merupakan gejala khas COVID-19, sedangkan penyakit kronis tersering adalah diabetes melitus, hipertensi, dan keganasan. Multimorbiditas ditemukan hanya di 14% pasien lansia, dan para pasien tersebut bertahan hidup pasca infeksi virus SARS-CoV-2. Angka kematian pasien lansia rawat inap dengan COVID-19 di studi ini adalah 23%, dan 90% dari kasus kematian berjenis kelamin laki-laki.

Kesimpulan

Pasien laki-laki mendominasi kasus terkonfirmasi dan kasus kematian lansia dengan COVID-19. Gejala khas COVID-19 hanya ditemukan di sekitar setengah pasien penelitian. Pasien yang meninggal dunia memiliki persentase gejala khas lebih tinggi. Gejala tidak khas pun mungkin ditemukan di pasien lansia. Immunosenescence dan fungsi imunoregulasi jenis kelamin tertentu dihipotesiskan memiliki peran penting dalam menyebabkan kematian lansia di studi ini.

Kata Kunci: Profil Klinis, Lansia, Pasien Geriatri, COVID-19, Indonesia

 


 

ABSTRACT

Background

Older people contributed to 38.6% of death cases related to COVID-19 in Indonesia. Data regarding clinical profile of hospitalised elderly with COVID-19 in Indonesia were still lacking. Older people are at-risk population in the pandemic, whom we should pay attention to.

Methods

This single centre descriptive study utilised complete data of elderly inpatients with COVID-19 in Indonesia’s national general hospital from April to late August 2020. The data consisted of clinical characteristics, symptoms, comorbidities, multimorbidity, and mortality outcome.

Results

Among elderly patients (n=44), a majority of patients were aged 60-69 years (68%), were male (66%), and had no history of close contact with COVID-19 patient (86%). The most common symptoms were fever, cough and shortness of breath (classic symptoms of COVID-19), whereas the most common chronic diseases were diabetes mellitus, hypertension, and malignancy. Multimorbidity was only found in 14% of patients, all of whom remained alive following SARS-CoV-2 infection. The death rate among elderly inpatients with COVID-19 in this study was 23%, and male older adults contributed to 90% of death cases.

Conclusion

Male patients dominated both confirmed cases and death cases among elderly with COVID-19. Classic symptoms of COVID-19 were only found in about half of the study patients. Non-survivors had higher percentage of the classic symptoms of COVID-19 than survivors. Atypical COVID-19 presentations are possible in older adults. We postulated that immunosenescence and sex-specific immunoregulatory function play an important role in causing death in this study cohort.

 

Keywords: Clinical Profile, Elderly, Geriatric Patient, COVID-19, Indonesia


Keywords


Clinical Profile; Elderly; Geriatric Patient; COVID-19; Indonesia

References


Setiati S, Azwar MK. COVID-19 and Indonesia. Acta Med Indones [Internet]. 2020 Jan 1;52(1):84–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32291377

Satuan Tugas Penanganan COVID-19. Peta Sebaran | Gugus Tugas Percepatan Penanganan COVID-19 [Internet]. 2020 [cited 2020 Aug 29]. p. 1. Available from: https://covid19.go.id/peta-sebaran

Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: A comparison with young and middle-aged patients. J Infect [Internet]. 2020;80(6):e14–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32171866

Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature [Internet]. 2020;584(7821):430–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32640463

Azwar MK, Kirana F, Kurniawan A, Handayani S, Setiati S. Gastrointestinal Presentation in COVID-19 in Indonesia: A Case Report. Acta Med Indones [Internet]. 2020 Jan;52(1):63–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32291373

Tay MZ, Poh CM, Rénia L, MacAry PA, Ng LFP. The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol [Internet]. 2020 Jun 28;20(6):363–74. Available from: http://www.nature.com/articles/s41577-020-0311-8

Taneja V. Sex Hormones Determine Immune Response. Front Immunol [Internet]. 2018 Aug 27;9. Available from: https://www.frontiersin.org/article/10.3389/fimmu.2018.01931/full

Channappanavar R, Fett C, Mack M, Ten Eyck PP, Meyerholz DK, Perlman S. Sex-Based Differences in Susceptibility to Severe Acute Respiratory Syndrome Coronavirus Infection. J Immunol [Internet]. 2017 May 15;198(10):4046–53. Available from: http://www.jimmunol.org/lookup/doi/10.4049/jimmunol.1601896

Pozzilli P, Lenzi A. Commentary: Testosterone, a key hormone in the context of COVID-19 pandemic. Metabolism [Internet]. 2020 Jul;108:154252. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0026049520301165

Perrotta F, Corbi G, Mazzeo G, Boccia M, Aronne L, D’Agnano V, et al. COVID-19 and the elderly: insights into pathogenesis and clinical decision-making. Aging Clin Exp Res [Internet]. 2020 Aug;32(8):1599–608. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32557332

Bencivenga L, Rengo G, Varricchi G. Elderly at time of COronaVIrus disease 2019 (COVID-19): possible role of immunosenescence and malnutrition. GeroScience [Internet]. 2020 Aug 23;42(4):1089–92. Available from: http://link.springer.com/10.1007/s11357-020-00218-9

Ho JC, Chan KN, Hu WH, Lam WK, Zheng L, Tipoe GL, et al. The effect of aging on nasal mucociliary clearance, beat frequency, and ultrastructure of respiratory cilia. Am J Respir Crit Care Med [Internet]. 2001 Mar;163(4):983–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11282777

Gao Z, Xu Y, Sun C, Wang X, Guo Y, Qiu S, et al. A Systematic Review of Asymptomatic Infections with COVID-19. J Microbiol Immunol Infect [Internet]. 2020 May 15; Available from: http://www.ncbi.nlm.nih.gov/pubmed/32425996

Soedarsono S. A Family Cluster of Coronavirus Disease (COVID-19) Infection with Different Clinical Manifestations. Acta Med Indones [Internet]. 2020 Apr;52(2):155–62. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32778630

Norman DC. Fever in the Elderly. Clin Infect Dis [Internet]. 2000 Jul 1;31(1):148–51. Available from: https://academic.oup.com/cid/article-lookup/doi/10.1086/313896

Rong X, Yang L, Chu H, Fan M. Effect of delay in diagnosis on transmission of COVID-19. Math Biosci Eng [Internet]. 2020;17(3):2725–40. Available from: http://www.aimspress.com/article/10.3934/mbe.2020149

Guo T, Shen Q, Guo W, He W, Li J, Zhang Y, et al. Clinical Characteristics of Elderly Patients with COVID-19 in Hunan Province, China: A Multicenter, Retrospective Study. Gerontology [Internet]. 2020 May 29;1–9. Available from: https://www.karger.com/Article/FullText/508734

McQueenie R, Foster HME, Jani BD, Katikireddi SV, Sattar N, Pell JP, et al. Multimorbidity, polypharmacy, and COVID-19 infection within the UK Biobank cohort. Feng Y-M, editor. PLoS One [Internet]. 2020 Aug 20;15(8):e0238091. Available from: https://dx.plos.org/10.1371/journal.pone.0238091


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