Clinical Features and Risk Factors for Mortality Among Long-term Care Facility Residents Hospitalized Due to COVID-19 in Spain.
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Ramos-Rincón José-Manuel, Bernabeu-Wittel Máximo, Fiteni-Mera Isabel, López-Sampalo Almudena, López-Ríos Carmen, García-Andreu María-Del-Mar, Mancebo-Sevilla Juan-José, Jiménez-Juan Carlos, Matía-Sanz Marta, López-Quirantes Pablo, Rubio-Rivas Manuel, Paredes-Ruiz Diana, González-San-Narciso Candela, González-Vega Rocío, Sanz-Espinosa Pablo, Hernández-Milián Almudena, Gonzalez-Noya Amara, Gil-Sánchez Ricardo, Boixeda Ramon, Alcalá-Pedrajas José-Nicolás, Palop-Cervera Marta, Cortés-Rodríguez Begoña, Guisado-Espartero María-Esther, Mella-Pérez Carmen, Gómez-Huelgas Ricardo, SEMI-COVID-19 Network
Аннотация
METHODS: This is a cross-sectional analysis within a retrospective cohort of hospitalized patients ≥75 years with confirmed COVID-19 admitted to 160 Spanish hospitals. Differences between groups and factors associated with mortality among LTCF residents were assessed through comparisons and logistic regression analysis.
RESULTS: Of 6 189 patients ≥75 years, 1 185 (19.1%) were LTCF residents and 4 548 (73.5%) were community-dwelling. LTCF residents were older (median: 87.4 vs 82.1 years), mostly female (61.6% vs 43.2%), had more severe functional dependence (47.0% vs 7.8%), more comorbidities (Charlson Comorbidity Index: 6 vs 5), had dementia more often (59.1% vs 14.4%), and had shorter duration of symptoms (median: 3 vs 6 days) than community-dwelling patients (all, p < .001). Mortality risk factors in LTCF residents were severe functional dependence (adjusted odds ratios [aOR]: 1.79; 95% confidence interval [CI]: 1.13-2.83; p = .012), dyspnea (1.66; 1.16-2.39; p = .004), SatO2 < 94% (1.73; 1.27-2.37; p = .001), temperature ≥ 37.8°C (1.62; 1.11-2.38; p = .013); qSOFA index ≥ 2 (1.62; 1.11-2.38; p = .013), bilateral infiltrates (1.98; 1.24-2.98; p < .001), and high C-reactive protein (1.005; 1.003-1.007; p < .001). In-hospital mortality was initially higher among LTCF residents (43.3% vs 39.7%), but lower after adjusting for sex, age, functional dependence, and comorbidities (aOR: 0.74, 95%CI: 0.62-0.87; p < .001).
CONCLUSION: Basal functional status and COVID-19 severity are risk factors of mortality in LTCF residents. The lower adjusted mortality rate in LTCF residents may be explained by earlier identification, treatment, and hospitalization for COVID-19.