Characteristics, outcome and predictors of in-hospital mortality in an elderly population from a SARS-CoV-2 outbreak in a long-term care facility

Abstract

<jats:p>Since December 2019, coronavirus disease 2019 (COVID-19) pandemic has spread from China all over the world, 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. A total of 42/50 (84%) patients experienced symptoms of SARS-CoV-2 infection. The overall in-hospital mortality rate was 32%. In Cox regression, significant predictors of in-hospital mortality were: hypernatremia (HR 9.12), lymphocyte count &lt;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. Further studies are necessary to better understand and confirm our findings in the setting of a LTCF outbreak of COVID-19.</jats:p>

Late-onset myocardial infarction and autoimmune haemolytic anaemia in a COVID-19 patient without respiratory symptoms, concomitant with a paradoxical increase in inflammatory markers: a case report

“…We feel that hyperinflammation was pathogenically linked to both myocardial infarction and AIHA. Indeed, in our cohort, IL-6 appeared to be an independent predictor of death, together with elevated CRP [19].…”

Individuals with obesity and COVID‐19: A global perspective on the epidemiology and biological relationships

“…A few studies showed that individuals with obesity may decrease in‐hospital mortality 31,75,87,89 . Some studies showed that obesity may insignificantly decrease 41,47,81,90 or increase 55,67,68,84,91–96 the odds of death among individuals with obesity. The majority of studies showed that obesity significantly increased the odds of death among COVID‐19 patients with obesity.…”

Characteristics, Management, and Outcomes of Elderly Patients With Diabetes in a COVID-19 Unit: Lessons Learned.

“…The present study suggests that, at least in elderly patients with COVID-19, adequate controlled diabetes at the time of admission and during hospitalization might reduce the risk of in-hospital mortality associated with T2D. This interpretation may explain why T2D per se was not demonstrated to be an independent predictor of death in our previous analysis in the same patients [16], in apparent contrast with other studies [17]. Zhu et al [18] have recently described, in a retrospective longitudinal study, that well-controlled blood glucose (blood glucose values within 70 to 180 mg/dl) was associated with markedly lower mortality compared to individuals with poorly controlled blood glucose (blood glucose values exceeding 180 mg/dl).…”

“…An alternative interpretation for the lack of an association between T2D and mortality could be that possible pre-existing complications of T2D are more important. In apparent support to this interpretation, in our previous analysis [16], CV diseases (and not T2D) emerged as an independent predictor of death over T2D per se. More in general, cardiovascular disease is a predictor of mortality in infected patients regardless of diabetes and even in non COVID-19 patients [21].…”