Clinical Features and Risk Factors for Mortality Among Long-term Care Facility Residents Hospitalized Due to COVID-19 in Spain

Ramos‐Rincón, José‐Manuel; Bernabéu-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-Ruíz, Diana; González-San-Narciso, C.; González-Vega, Rocío; Sanz-Espinosa, Pablo; Hernández-Milián, Almudena; Gonzalez-Noya, A; Gil-Sánchez, Ricardo; Boixeda, Ramón; Alcalá-Pedrajas, J.N.; Palop-Cervera, Marta; Cortés-Rodríguez, Begoña; Guisado-Espartero, M. E.; Mella-Pérez, Carmen; Gómez‐Huelgas, Ricardo

doi:10.1093/gerona/glab305

Cited by 7 publications

(4 citation statements)

References 31 publications

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“…On the other hand, we observed a lower in-hospital mortality rate in older patients with COVID-19 who acquired the infection in long-term care facilities compared with patients with community-acquired disease. This finding has previously been described and explained by the possible earlier identification and treatment of COVID-19 symptoms as well as earlier hospitalization of these patients [ 57 ].…”

Section: Discussionsupporting

confidence: 73%

“…In support of the latter argument, we found that patients admitted after the first wave showed fewer clinical and laboratory criteria of severity and had a shorter duration of symptoms than patients hospitalized in the first wave. Fourth, we do not have data on the SARS-CoV-2 strains of patients hospitalized with COVID-19 and cannot rule out that the reduction in complications and mortality observed after the first wave may be at least partially explained by a lower virulence of SARS-CoV-2 in successive waves [ 57 ]. Finally, this study is limited to unvaccinated patients.…”

Section: Discussionmentioning

confidence: 99%

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Differences in clinical features and mortality in very old unvaccinated patients (≥ 80 years) hospitalized with COVID-19 during the first and successive waves from the multicenter SEMI-COVID-19 Registry (Spain)

et al. 2022

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Background Old age is one of the most important risk factors for severe COVID-19. Few studies have analyzed changes in the clinical characteristics and prognosis of COVID-19 among older adults before the availability of vaccines. This work analyzes differences in clinical features and mortality in unvaccinated very old adults during the first and successive COVID-19 waves in Spain. Methods This nationwide, multicenter, retrospective cohort study analyzes unvaccinated patients ≥ 80 years hospitalized for COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry). Patients were classified according to whether they were admitted in the first wave (March 1-June 30, 2020) or successive waves (July 1-December 31, 2020). The endpoint was all-cause in-hospital mortality, expressed as the case fatality rate (CFR). Results Of the 21,461 patients hospitalized with COVID-19, 5,953 (27.7%) were ≥ 80 years (mean age [IQR]: 85.6 [82.3–89.2] years). Of them, 4,545 (76.3%) were admitted during the first wave and 1,408 (23.7%) during successive waves. Patients hospitalized in successive waves were older, had a greater Charlson Comorbidity Index and dependency, less cough and fever, and met fewer severity criteria at admission (qSOFA index, PO2/FiO2 ratio, inflammatory parameters). Significant differences were observed in treatments used in the first (greater use of antimalarials, lopinavir, and macrolides) and successive waves (greater use of corticosteroids, tocilizumab and remdesivir). In-hospital complications, especially acute respiratory distress syndrome and pneumonia, were less frequent in patients hospitalized in successive waves, except for heart failure. The CFR was significantly higher in the first wave (44.1% vs. 33.3%; -10.8%; p < 0.001) and was higher among patients ≥ 95 years (54.4% vs. 38.5%; -15.9%; p < 0.001). After adjustments to the model, the probability of death was 33% lower in successive waves (OR: 0.67; 95% CI: 0.57–0.79). Conclusions Mortality declined significantly between the first and successive waves in very old unvaccinated patients hospitalized with COVID-19 in Spain. This decline could be explained by a greater availability of hospital resources and more effective treatments as the pandemic progressed, although other factors such as changes in SARS-CoV-2 virulence cannot be ruled out.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Differences in clinical features and mortality in very old unvaccinated patients (≥ 80 years) hospitalized with COVID-19 during the first and successive waves from the multicenter SEMI-COVID-19 Registry (Spain)

et al. 2022

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“…It is unclear whether the good outcomes observed in elderly patients treated with remdesivir could be due to immunosenescence in this population [25]. If so, the earlier use of antiviral therapy in these patients could be another explanation of the better response to antivirals, in light of the fact that they accessed medical care earlier [26], when the efficacy of treatment is higher.…”

Section: Discussionmentioning

confidence: 98%

Remdesivir in Very Old Patients (≥80 Years) Hospitalized with COVID-19: Real World Data from the SEMI-COVID-19 Registry

Ramos‐Rincón

Lopez-Carmona

Cobos-Palacios

et al. 2022

JCM

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(1) Background: Large cohort studies of patients with COVID-19 treated with remdesivir have reported improved clinical outcomes, but data on older patients are scarce. Objective: This work aims to assess the potential benefit of remdesivir in unvaccinated very old patients hospitalized with COVID-19; (2) Methods: This is a retrospective analysis of patients ≥ 80 years hospitalized in Spain between 15 July and 31 December 2020 (SEMI-COVID-19 Registry). Differences in 30-day all-cause mortality were adjusted using a multivariable regression analysis. (3) Results: Of the 4331 patients admitted, 1312 (30.3%) were ≥80 years. Very old patients treated with remdesivir (n: 140, 10.7%) had a lower mortality rate than those not treated with remdesivir (OR (95% CI): 0.45 (0.29–0.69)). After multivariable adjustment by age, sex, and variables associated with lower mortality (place of COVID-19 acquisition; degree of dependence; comorbidities; dementia; duration of symptoms; admission qSOFA; chest X-ray; D-dimer; and treatment with corticosteroids, tocilizumab, beta-lactams, macrolides, and high-flow nasal canula oxygen), the use of remdesivir remained associated with a lower 30-day all-cause mortality rate (adjusted OR (95% CI): 0.40 (0.22–0.61) (p < 0.001)). (4) Conclusions: Remdesivir may reduce mortality in very old patients hospitalized with COVID-19.

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“…Dyspnea has also been associated with mortality in many reports [ 22 , 23 ]. Other important factors independently associated with COVID-19 mortality in the literature included advanced age, increased C-reactive protein, reduced renal function, coronary artery disease, increased frailty [ 16 ], and poor preadmission functional status [ 24 , 25 , 26 ]. Mortality was 1.3 times greater in immunosuppressed patients with nosocomial compared to community-acquired infection [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Nosocomial COVID-19 Infection in a Long-Term Hospital in Spain: Retrospective Observational Study

Caro-Martínez¹,

Abad-Collado²,

Escrivá-Cerrudo³

et al. 2022

Medicina

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Background and Objectives. The aim of this study is to compare clinical and epidemiological characteristics and outcomes in patients with versus without nosocomial COVID-19 after exposure to SARS-CoV-2 and to analyze the risk factors for severe outcomes of COVID-19 in a long-term hospital in Spain. Materials and methods. This retrospective, single-center observational study included all inpatients in a long-term hospital during a COVID-19 outbreak from 21 January to 15 March 2021. Results. Of 108 admitted patients, 65 (60.2%) were diagnosed with nosocomial COVID-19 disease (n = 34 women (52.3%), median age 77 years). In the univariable analysis, risk factors associated with nosocomial COVID-19 were dementia (OR 4.98 95% CI 1.58–15.75), dyspnea (OR 5.34 95% CI 1.69–16.82), asthenia (OR 5.10, 95% CI 1.40–18.60) and NECesidades PALiativas (NECPAL) (OR 1.28 95% CI 1.10–1.48). In the multivariable analysis, risk factors independently associated with nosocomial COVID-19 infection were dyspnea (aOR 7.39; 95% CI 1.27–43.11) and NECPAL (aOR 1.25; 95% CI 1.03–1.52). Of the 65 patients diagnosed with nosocomial COVID-19, 29 (44.6%) died, compared to 7/43 (16.2%) non-infected patients (OR 4.14, 95% CI 1.61–10.67). Factors associated with mortality in nosocomial COVID-19 were confusion (aOR 3.83; 95% CI 1.03–14.27) and dyspnea (aOR 7.47; 95% CI 1.87–29.82). The NECPAL tool played an important predictive role in both nosocomial COVID-19 infection and mortality (aOR 1.19, 95% CI: 1.00–1.41). Conclusions. In a long-term hospital, nosocomial COVID-19 main clinical characteristics associated with infection were dyspnea and NECPAL. Mortality was higher in the group with nosocomial COVID-19; risk factors were confusion and dyspnea. The NECPAL tool may help to predict progression and death in COVID-19.

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Clinical Features and Risk Factors for Mortality Among Long-term Care Facility Residents Hospitalized Due to COVID-19 in Spain

Cited by 7 publications

References 31 publications

Differences in clinical features and mortality in very old unvaccinated patients (≥ 80 years) hospitalized with COVID-19 during the first and successive waves from the multicenter SEMI-COVID-19 Registry (Spain)

Differences in clinical features and mortality in very old unvaccinated patients (≥ 80 years) hospitalized with COVID-19 during the first and successive waves from the multicenter SEMI-COVID-19 Registry (Spain)

Remdesivir in Very Old Patients (≥80 Years) Hospitalized with COVID-19: Real World Data from the SEMI-COVID-19 Registry

Nosocomial COVID-19 Infection in a Long-Term Hospital in Spain: Retrospective Observational Study

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