COVID-19 is a highly infectious respiratory disease caused by Severe Acute Respiratory Syndrome - Coronavirus - 2 (SARS-COV2), a human coronavirus. This virus was first reported in Wuhan, Hubei Province, China, after which it rapidly spread to the other countries [1] and mostly in regions with higher levels of pollution [3]. In January 30, 2020, the World Health Organization (WHO) declared Public Health Emergency of International Concern and confirmed as a Pandemic on 11 February [4]. Although nasopharyngeal swab is the diagnostic method recommended by WHO, CT has been given increasing importance with regards to the diagnosis of false negatives [5,6], for monitoring the course of the disease and response to therapies [7]. Several efforts have been made to identify therapeutic strategies and prognostic indicators. Among risk factors for mortality in COVID-19 patients, arterial hypertension seems to be the most important one [8]. Laboratory markers that indicate poor outcome are thrombocytopenia [9, 10] and lower lymphocyte counts [11]. High CRP and LDH levels are also important indexes of severe disease: in particular it was observed that their levels are significantly higher in non-survivors respect to survivors [12, 13]. It has also been observed that SARS-COV2 infection strongly alters coagulations pathway. Non-survivors COVID-19 patients have shown significant higher levels of activated partial thromboplastin times, prothrombin times and plasma D-dymer levels compared to survivors. In particular, higher D-dymer levels seems to be the strongest independent factor that predicts mortality [14]. Among the anamnestic factors that indicate a poor prognosis, hypertension, cardiovascular diseases and pulmonary diseases such as chronic obstructive pulmonary disease have been clearly identified. Clinical conditions observed at time of admission are also important for prognostic stratification: it has been observed that absence of fever at time of respiratory symptoms onset and lower respiratory tract infection symptomatology correlate with poor outcome [15].
Many studies have analysed how age also plays a key role in mortality. Unlike other infectious lung diseases that have a “U shaped” lethality curve, mortality of novel coronavirus seems to increase in elderly patients [16]. However, although a higher vulnerability of geriatric patients has been observed, the literature on elderly COVID-19 patients has remained very scarce, especially in those over 80. Since the population in China aged 60 or above only accounted for about 6%, there are few studies in over 80 patients which describe the clinical course and the laboratory changes in this category of patients.
Against this picture, we describe an extremely severe case of coronavirus pneumonia in an over-80 years old patient that recovered despite having all the negative prognostic factors described above, and was successfully discharged thanks to a careful evaluation of the case and of the complications that have arisen. The aim of this paper is to provide important elements to better understand this disease reporting a case that recovered despite the bad prognosis.