Clinical Characteristics of Hospitalized Individuals Dying With COVID-19 by Age Group in Italy
Authors: 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 ,   Italian National Institute of Health COVID-19 Mortality Group, Palmieri Luigi , Andrianou Xanthi , Barbariol Pierfrancesco , Bella Antonino , Bellino Stefania , Benelli Eva , Bertinato Luigi , Boros Stefano , Brambilla Gianfranco , Calcagnini Giovanni , Canevelli Marco , Rita Castrucci Maria , Censi Federica , Ciervo Alessandra , Colaizzo Elisa , D’Ancona Fortunato , Del Manso Martina , Donfrancesco Chiara , Fabiani Massimo , Facchiano Francesco , Filia Antonietta , Floridia Marco , Galati Fabio , Giuliano Marina , Grisetti Tiziana , Kodra Yllka , Langer Martin , Lega Ilaria , Lo Noce Cinzia , Maiozzi Pietro , Malchiodi Albedi Fiorella , Manno Valerio , Martini Margherita , Mateo Urdiales Alberto , Mattei Eugenio , Meduri Claudia , Meli Paola , Minelli Giada , Nebuloni Manuela , Nisticò Lorenza , Nonis Marino , Onder Graziano , Palmisano Lucia , Petrosillo Nicola , Pezzotti Patrizio , Pricci Flavia , Punzo Ornella , Puro Vincenzo , Raparelli Valeria , Rezza Giovanni , Riccardo Flavia , Cristina Rota Maria , Salerno Paolo , Serra Debora , Siddu Andrea , Stefanelli Paola , De Bella Manuela Tamburo , Tiple Dorina , Unim Brigid , Vaianella Luana , Vanacore Nicola , Vichi Monica , Rocco Villani Emanuele , Zona Amerigo , Brusaferro Silvio 
Published: June 2020

Abstract

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 (&lt;65 years) and older adults (≥65 years).

Method
Medical charts of 3,032 patients dying with COVID-19 in Italy (368 aged &lt; 65 years and 2,664 aged ≥65 years) were revised to extract information on demographics, preexisting comorbidities, and in-hospital complications leading to death.

Results
Older adults (≥65 years) presented with a higher number of comorbidities compared to those aged &lt;65 years (3.3 ± 1.9 vs 2.5 ± 1.8, p &lt; .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 (&lt;65 years); 10.9% of younger patients (&lt;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 occur in healthy adults with no preexisting 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.