Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.
Envida Care Organization, Maastricht, The Netherlands.
J Am Geriatr Soc. 2020 Aug;68(8):1647-1652. doi: 10.1111/jgs.16664. Epub 2020 Jul 21.
BACKGROUND/OBJECTIVES: Nursing home (NH) residents are a vulnerable population, susceptible to respiratory disease outbreaks such as coronavirus disease 2019 (COVID-19). Poor outcome in COVID-19 is at least partly attributed to hypercoagulability, resulting in a high incidence of thromboembolic complications. It is unknown whether commonly used antithrombotic therapies may protect the vulnerable NH population with COVID-19 against mortality. This study aimed to investigate whether the use of oral antithrombotic therapy (OAT) was associated with a lower mortality in NH residents with COVID-19.
A retrospective case series.
Fourteen NH facilities from the NH organization Envida, Maastricht, the Netherlands PARTICIPANTS: A total of 101 NH residents with COVID-19 were enrolled.
The primary outcome was all-cause mortality. The association between age, sex, comorbidity, OAT, and mortality was assessed using logistic regression analysis.
Overall mortality was 47.5% in NH residents from 14 NH facilities. Age, comorbidity, and medication use were comparable among NH residents who survived and who died. OAT was associated with a lower mortality in NH residents with COVID-19 in the univariable analysis (odds ratio (OR) = 0.89; 95% confidence interval (CI) = 0.41-1.95). However, additional adjustments for sex, age, and comorbidity attenuated this difference. Mortality in males was higher compared with female residents (OR = 3.96; 95% CI = 1.62-9.65). Male residents who died were younger compared with female residents (82.2 (standard deviation (SD) = 6.3) vs 89.1 (SD = 6.8) years; P < .001).
NH residents in the 14 facilities we studied were severely affected by the COVID-19 pandemic, with a mortality of 47.5%. Male NH residents with COVID-19 had worse outcomes than females. We did not find evidence for any protection against mortality by OAT, necessitating further research into strategies to mitigate poor outcome of COVID-19 in vulnerable NH populations. J Am Geriatr Soc 68:1647-1652, 2020.
背景/目的：养老院（NH）居民是一个弱势群体，容易受到 2019 年冠状病毒病（COVID-19）等呼吸道疾病的爆发的影响。COVID-19 不良结局至少部分归因于高凝状态，导致血栓栓塞并发症的发生率很高。目前尚不清楚常用的抗血栓治疗是否可以保护患有 COVID-19 的脆弱 NH 人群免于死亡。本研究旨在调查口服抗血栓治疗（OAT）是否与 NH 居民 COVID-19 死亡率降低有关。
回顾性病例系列。
荷兰马斯特里赫特 Envida 组织的 14 个 NH 设施。
共纳入 101 名 COVID-19 住院的 NH 居民。
主要结局是全因死亡率。使用逻辑回归分析评估年龄、性别、合并症、OAT 与死亡率之间的关系。
14 家 NH 机构的 NH 居民的总死亡率为 47.5%。在存活和死亡的 NH 居民中，年龄、合并症和药物使用情况相似。在单变量分析中，OAT 与 COVID-19 的 NH 居民死亡率降低相关（比值比（OR）=0.89；95%置信区间（CI）=0.41-1.95）。然而，对性别、年龄和合并症进行额外调整后，这种差异减弱了。与女性居民相比，男性居民的死亡率更高（OR=3.96；95%CI=1.62-9.65）。死亡的男性居民比女性居民年轻（82.2（标准差（SD）=6.3）岁比 89.1（SD=6.8）岁；P<.001）。
我们研究的 14 家 NH 机构的 NH 居民受到 COVID-19 大流行的严重影响，死亡率为 47.5%。患有 COVID-19 的 NH 男性居民的预后比女性差。我们没有发现 OAT 对死亡率有任何保护作用的证据，因此需要进一步研究减轻脆弱 NH 人群 COVID-19 不良结局的策略。美国老年学会杂志 68:1647-1652，2020。
