Geriatric risk and protective factors for serious COVID-19 outcomes among older adults in Shanghai Omicron wave

Figures & data

Table 1. The basic characteristics of enrolled patients.

N	1377
Age, median (IQR)	76 (69–84)
61–70 years (N, %)	421 (30.57%)
71–80 years (N, %)	459 (33.33%)
>80 years (N, %)	497 (36.09%)
Gender, N (%)
Male	642 (46.62%)
Vaccination, N (%)
Unvaccinated	988 (71.75%)
One dose	14 (1.02%)
Two doses	147 (10.68%)
Three doses	215 (15.61%)
Unclear	13 (0.94%)
Viral Pneumonia on CT, N (%)	224 (16.27%)
Symptoms, N (%)
Fever	273 (19.83%)
Sore throat	247 (17.94%)
Cough	587 (42.63%)
Diarrhoea	4 (0.29%)
Nasal obstruction or rhinorrhoea	145 (10.53%)
Impaired sense of smell	2 (0.15%)
Treatment, N (%)
Respiratory support	161 (11.69%)
Dialysis	6 (0.44%)
Antiviral drug	553 (40.16%)
Glucocorticoid	120 (8.71%)
Hospitalization days, median (IQR)	8 (5–11)
Viral shedding time, median (IQR)	9 (6–12)
Outcome, N (%)
Death	7 (0.51%)
Relieve	1370 (99.49%)
Laboratory examinations
WBC <3.0*10^9/L	51/1212 (4.21%)
Lymphocyte <1*10^9/L	193/1095 (17.63%)
ALT >40 U/L	152/1175 (12.94%)
AST >35 U/L	253/1175 (21.53%)
D-dimer >0.5 mg/L	545/1067 (51.08%)
CRP >10 mg/L	337/1209 (27.87%)
IL-1β >5 pg/ml	111/579 (19.17%)
IL-2R >710 U/ml	167/514 (32.49%)
IL-6 >3.4 pg/ml	437/573 (76.27%)
IL-10 >9.1 pg/ml	34/503 (6.76%)
LDH >250 U/L	239/759 (38.60%)
BNP >100 pg/mL	244/818 (29.83%)

WBC: white blood cell; ALT: alanine aminotransferase; AST: Aspartate Transaminase; CRP: C-reactive protein; IL: interleukin; LDH: lactate dehydrogenase; BNP: N-terminal pro-B-type natriuretic peptide.

The cut-offs for laboratory examinations: WBC: 3.0*10^9/L; Lymphocyte: 1*10^9/L; ALT: 40 U/L; AST: 35 U/L; D-dimer: 0.5 mg/L; CRP: 10 mg/L; IL-1β: 5 pg/ml; IL-2R: 710 U/ml; IL-6 >3.4 pg/ml; IL-10: 9.1 pg/ml; LDH: 250 U/L; BNP: 100 pg/ml.

Figure 1. The proportion of viral shedding time ≤9 days and >9 days according to clinical diagnosis, vaccination, and paxlovid use. (a) The proportion of viral shedding time ≤9 days and >9 days according to clinical diagnosis. (b) The proportion of viral shedding time ≤9 days and >9 days according to paxlovid use. (c) The proportion of viral shedding time ≤9 days and >9 days according to vaccination.

Table 2. Influencing factors of viral shedding time among geriatric patients.

	Univariate		Multivariate
	HR	P	Adjusted HR	P
Age groups
Age <70	1.00		1.00
70–80	0.922 (0.807–1.054)	.234	0.963 (0.839–1.106)	.596
>80	0.829 (0.726–0.946)	.006	0.890 (0.771–1.028)	.112
Clinical diagnosis
Mild	1.00		1.00
Moderate	0.931 (0.832–1.041)	.21	0.946 (0.829–1.080)	.412
Severe/critical	0.679 (0.516–0.893)	.006	0.706 (0.533–0.935)	.015
Viral Pneumonia on CT	0.975 (0.844–1.127)	.733	1.010 (0.85301.196)	.907
Comorbidity	0.931 (0.821–1.057)	.268	0.706 (0.533–0.935)	.508
Vaccination status
Unvaccinated/partially	1.00		1.00
Fully vaccinated/booster doses	1.293 (1.144–1.461)	<.001	1.229 (1.076–1.402)	.002
Paxlovid	1.100 (0.986–1.227)	.089	1.140 (1.019–1.274)	.022

Cox regression was used in the analysis, covariates included age, clinical diagnosis, viral pneumonia on CT, comorbidity or not, vaccination status, and paxlovid use. For vaccination status, unvaccinated/partial vaccinated was used as the reference group. For age groups, age <70 was used as the reference group. For clinical diagnosis, mild was used as the reference group.

Table 3. Risk factors of progressing to severe/critical (n = 61) among geriatric patients.

	Univariate		Multivariate
	OR	P	Adjusted OR	P
Female	0.682 (0.407–1.143)	.147
Age groups
Age <70	1.00		1.00
70–80	1.674 (0.674–3.911)	.279	1.504 (0.611–3.702)	.375
>80	4.396 (2.031–9.516)	<.001	3.071 (1.352–6.976)	.007
Tumour	0.609 (0.218–1.704)	.345	0.769 (0.264–2.241)	.63
Hypertension	0.964 (0.576–1.613)	.888	0.659 (0.369–1.177)	.159
Diabetes	1.164 (0.649–2.088)	.611	0.979 (0.517–1.856)	.949
Cerebrovascular disease	4.026 (2.341–6.922)	<.001	3.275 (1.814–5.913)	<.001
Cardiovascular disease	0.560 (0.320–0.979)	.042	1.481 (0.805–2.275)	.207
Chronic kidney disease	3.932 (1.689–9.156)	.001	3.978 (1.595–9.922)	.003
Respiratory diseases	2.128 (1.019–4.444)	.045	1.477 (0.669–3.263)	.335
Hepatic disease	2.420 (0.302–19.415)	.405	5.767 (0.661–50.294)	.113
Vaccination status
Unvaccinated/partial vaccinated	1.00		1.00
Fully vaccinated/booster	0.135 (0.042–0.435)	<.001	0.237 (0.071–0.793)	.019
Viral Pneumonia on CT	1.010 (0.505–2.020)	.978	0.911 (0.443–1.873)	.800

Logistic regression was used, covariates included sex, age, different comorbidities, vaccination status, and viral pneumonia on CT. For vaccination status, unvaccinated/partial vaccinated was used as the reference group. For age groups, age <70 was used as the reference group.

Table 4. Risk factors of progressing to severe/critical among geriatric patients using comorbidity numbers.

	Univariate		Multivariate
	OR	P	Adjusted OR	P
Female	0.682 (0.407–1.143)	.147	0.651 (0.384–1.102)	.11
Age <70	1.00		1.00
70–80	1.674 (0.674–3.911)	.279	1.485 (0.612–3.605)	.382
>80	4.396 (2.031–9.516)	<.001	3.193 (1.449–7.036)	.004
Comorbidities ≥2	2.389 (1.407–4.056)	.001	2.068 (1.210–3.536)	.008
Unvaccinated/partial vaccinated	1.00		1.00
Fully vaccinated/booster	0.135 (0.042–0.435)	<.001	0.214 (0.065–0.705)	.011
Viral Pneumonia on CT	1.010 (0.505–2.020)	.978	0.886 (0.438–1.793)	.737

Logistic regression was used, and covariates included sex, age, comorbidity group, vaccination status, and viral pneumonia on CT. For vaccination status, unvaccinated/partial vaccinated was used as the reference group. For age groups, age <70 was used as the reference group.

Figure 2. The severe/critical rate according to comorbidity numbers, vaccination, and age. (a) The severe/critical rate in patients with comorbidities ≤1 and comorbidities ≥2. (b) The severe/critical rate in patients in different age groups with different vaccination doses.

Figure 3. Laboratory markers of severe/critical patients. The indicators include lymphocyte numbers, CRP, BNP, LDH, D-dimer, and cytokines (IL2R, IL6, IL8, IL10, TNF-α) and numbers of CD4⁺ and CD8⁺ cells.

Figure 4. ROC curve of lymphocyte, CD4, and CD8 in distinguishing severe/critical.