Xiao-Yu Zhang,1,* Lin Zhang,2,3,* Yang Zhao,3,4 Liang Chen1
1Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, People’s Republic of China; 2School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People’s Republic of China; 3Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria 3100, Australia; 4WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, Melbourne, Victoria 3100, Australia
*These authors contributed equally to this work
Correspondence: Liang Chen
Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, People’s Republic of China
Email chenliang65@yeah.net
Purpose: This study is to investigate the risk prediction of severe or critical events of COVID-19 in older adults in China and provide the evidence to support the management of older adults with COVID-19.
Materials and Methods: The clinical data of older adults with COVID-19 admitted to the Shanghai Public Health Clinical Center during January 20, 2020 to March 16, 2020 were collected. The possible risk factors of severe or critical illness were investigated with Cox proportional hazards (PH) regression models for univariate and multivariate analyses to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). For the prediction indicators, optimum cut-off points were determined by calculating Youden’s index. The efficacy of risk prediction of severe or critical illness was examined through the receiver operating characteristic (ROC) curve.
Results: A total of 110 older adults with COVID-19 were included, in which 21 (19.1%) patients had severe or critical illness of COVID-19. Multivariable regression analysis showed that CD4 cells and D-dimer were independent risk factors. D-dimer, CD4 cells, and CD cells/D-dimer ratio with cut-off values of 0.65 (mg/L), 268 (cell/μL) and 431 were in the prediction of severe or critical illness of older adults with COVID-19. The AUC value of D-dimer, CD4 cells, CD4 cells/D-dimer ratio, the tandem combination and the parallel combination to predict severe or critical illness of the older adults with COVID-19 were 0.703, 0.804, 0.794, 0.812 and 0.694, respectively.
Conclusion: D-dimer and CD4 cells either by themselves or in combination have demonstrated predictive value in risk stratification as well as established the prognosis of severe or critical illness in older adults with COVID-19.
Keywords: COVID-19, SARS-CoV-2, older adults, risk assessment, risk prediction
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