Clinical characteristics and predictors of mortality associated with COVID-19 in elderly patients from a long-term care facility

Abstract

Since December 2019, coronavirus disease 2019 (COVID-19) pandemic has spread from China all over the world and many COVID-19 outbreaks have been reported in long-term care facilities (LCTF). However, data on clinical characteristics and prognostic factors in such settings are scarce. We conducted a retrospective, observational cohort study to assess clinical characteristics and baseline predictors of mortality of COVID-19 patients hospitalized after an outbreak of SARS-CoV-2 infection in a LTCF. A total of 50 patients were included. Mean age was 80 years (SD, 12 years), and 24/50 (57.1%) patients were males. The overall in-hospital mortality rate was 32%. At Cox regression analysis, significant predictors of in-hospital mortality were: hypernatremia (HR 9.12), lymphocyte count < 1000 cells/µL (HR 7.45), cardiovascular diseases other than hypertension (HR 6.41), and higher levels of serum interleukin-6 (IL-6, pg/mL) (HR 1.005). Our study shows a high in-hospital mortality rate in a cohort of elderly patients with COVID-19 and hypernatremia, lymphopenia, CVD other than hypertension, and higher IL-6 serum levels were identified as independent predictors of in-hospital mortality. Given the small population size as major limitation of our study, further investigations are necessary to better understand and confirm our findings in elderly patients.

Development and validation of a prognostic COVID-19 severity assessment (COSA) score and machine learning models for patient triage at a tertiary hospital

“…There is ample evidence that end-stage kidney disease and renal impairment (as reflected by eGFR in our analysis) are prognostic of more severe disease, with case fatality rates on ICU of up to 50% [26,27]. Similarly, electrolyte disorders like hypernatremia have been linked to increased COVID-19 related mortality, possibly in relation to increased respiratory rate or dehydration from increased body temperature [28,29]. Finally, a systematic review and meta-analysis recently discussed the role of anemia and changes in iron metabolism, reflected by the low-normal cut-off for hemoglobin in our analysis, in the pathophysiology and disease course of COVID-19 [30].…”

Combined lymphocyte/monocyte count, D-dimer and iron status predict COVID-19 course and outcome in a long-term care facility

“…Of them, 45 patients with positive PCR Sars-Cov-2 laboratory-confirmed infection, presented all the required laboratory variables at baseline and further presented D-dimer, IL-6, and ferritin during the follow-up; thus, they were included in this retrospective analysis. Complete clinical data together with relative therapy have been recently published by Trecarichi et al [ 15 ]. Patients’ characteristics at baseline are reported in Table 1 .…”

“…To this end, we evaluated the difference in iron to ferritin ratio (IFR) as a surrogate marker of inflammation. Indeed, the increase of ferritin uncoupled from an iron increase (or in the presence of low iron values) leads to low IFR values and is usually associated with chronic inflammation [ 15 , 16 ]. Of note, we observed that the difference in IFR significantly segregates recovered and dead patients (high IFR better prognosis) in the intermediate-risk group (p: 0.012) (Fig.…”

Clinical Presentation, Course, and Risk Factors Associated with Mortality in a Severe Outbreak of COVID-19 in Rhode Island, USA, April–June 2020

“…Incidence, demographic associations [ 20 ], transmission and symptom status [ 9 , 10 , 11 , 12 , 13 , 15 , 16 , 19 ], and atypical presentation [ 17 , 18 , 21 ] in LTCF residents are widely discussed in the literature [ 14 ]. Less attention was paid to the clinical patterns of COVID-19 in LTCF residents, as it relates to mortality outcomes, and those that did were not in exclusively outpatient settings [ 22 , 23 ]. The unique combination of a congregate outpatient setting, staff interaction, and resident characteristics suggests differences in exposure, illness course, and risk of sequelae like venous thromboembolisms, when compared to hospitalized or community-dwelling patients [ 35 ].…”

“…Existing studies on COVID-19 outbreaks in the institutionalized elderly largely focus on epidemiological characteristics [ 9 , 10 , 11 , 12 ] and clinical symptoms related to initial presentation and transmission [ 13 , 14 , 15 , 16 , 17 , 18 ]. Few studies assessed the clinical course and past initial symptom status of residents, as it relates to mortality outcomes [ 19 , 20 , 21 ], especially in a non-hospital setting [ 22 , 23 ], with an infection and mortality rate as high as those documented here. In this study, we report a COVID-19 outbreak among 116 residents of a nursing home with a very high infection and mortality rates, with a specific focus on the clinical presentation and characteristics associated with mortality.…”