Clinical Characteristics of Hospitalized Individuals Dying with COVID-19 by Age Group in Italy

Palmieri, Luigi; Vanacore, Nicola; Donfrancesco, Chiara; Lo Noce, Cinzia; Canevelli, Marco; Punzo, Ornella; Raparelli, Valeria; Pezzotti, Patrizio; Riccardo, Flavia; Bella, Antonio; Fabiani, Massimo; D’Ancona, Fortunato Paolo; Vaianella, Luana; Tiple, Dorina; Colaizzo, Elisa; Palmer, Katie; Rezza, Giovanni; Piccioli, Andrea; Brusaferro, Silvio; Onder, Graziano

BACKGROUND: aim of the present study is to describe characteristics of COVID-19 related deaths and to compare the clinical phenotype and course of COVID-19 related deaths occurring in adults (< 65 years) and older adults (≥ 65 years). METHODS: medical charts of 3,032 patients dying with COVID-19 in Italy (368 aged < 65 years and 2,664 aged ≥ 65 years) were revised to extract information on demographics, pre-existing comorbidities, and in-hospital complications leading to death. RESULTS: Older adults (≥ 65 years) presented with a higher number of comorbidities compared to those aged < 65 years (3.3 ± 1.9 vs. 2.5 ± 1.8, p<0.001). Prevalence of ischemic heart disease, atrial fibrillation, heart failure, stroke, hypertension, dementia, COPD, and chronic renal failure was higher in older patients (≥ 65 years), while obesity, chronic liver disease, and HIV infection were more common in younger adults (< 65 years); 10.9% of younger patients (< 65 years) had no comorbidities, compared to 3.2% of older patients (≥ 65 years). The younger adults had a higher rate of non-respiratory complications than older patients including acute renal failure (30.0% vs 20.6%), acute cardiac injury (13.5% vs 10.3%) and superinfections (30.9% vs. 9.8%). CONCLUSIONS: individuals dying with COVID-19 present with high levels of comorbidities, irrespective of age group, but a small proportion of deaths occurs in healthy adults with no pre-existing conditions. Non-respiratory complications are common, suggesting that the treatment of respiratory conditions needs to be combined with strategies to prevent and mitigate the effects of non-respiratory complications.