Associació Catalana de Recursos Assistencials, ACRA, Barcelona, Spain.
Centre de Recerca en Economia de la Salut-CRES UPF, Barcelona, Spain.
PLoS One. 2021 Jul 23;16(7):e0255141. doi: 10.1371/journal.pone.0255141. eCollection 2021.
The natural history of COVID-19 and predictors of mortality in older adults need to be investigated to inform clinical operations and healthcare policy planning. A retrospective study took place in 80 long-term nursing homes in Catalonia, Spain collecting data from March 1st to May 31st, 2020. Demographic and clinical data from 2,092 RT-PCR confirmed cases of SARS-CoV-2 infection were registered, including structural characteristics of the facilities. Descriptive statistics to describe the demographic, clinical, and molecular characteristics of our sample were prepared, both overall and by their symptomatology was performed and an analysis of statistically significant bivariate differences and constructions of a logistic regression model were carried out to assess the relationship between variables. The incidence of the infection was 28%. 71% of the residents showed symptoms. Five major symptoms included: fever, dyspnea, dry cough, asthenia and diarrhea. Fever and dyspnea were by far the most frequent (50% and 28%, respectively). The presentation was predominantly acute and symptomatology persisted from days to weeks (mean 9.1 days, SD = 10,9). 16% of residents had confirmed pneumonia and 22% required hospitalization. The accumulated mortality rate was 21.75% (86% concentrated during the first 28 days at onset). A multivariate logistic regression analysis showed a positive predictive value for mortality for some variables such as age, pneumonia, fever, dyspnea, stupor refusal to oral intake and dementia (p<0.01 for all variables). Results suggest that density in the nursing homes did not account for differences in the incidence of the infection within the facilities. This study provides insights into the natural history of the disease in older adults with high dependency living in long-term nursing homes during the first pandemic wave of March-May 2020 in the region of Catalonia, and suggests that some comorbidities and symptoms have a strong predictive value for mortality.
需要研究 COVID-19 的自然史和老年人的死亡率预测因素，以为临床操作和医疗保健政策规划提供信息。在西班牙加泰罗尼亚的 80 家长期护理院进行了一项回顾性研究，该研究于 2020 年 3 月 1 日至 5 月 31 日期间收集数据。登记了 2092 例经 RT-PCR 确认的 SARS-CoV-2 感染病例的人口统计学和临床数据，包括设施的结构特征。对我们样本的人口统计学、临床和分子特征进行了描述性统计，分别对整体和症状进行了描述，并对有统计学意义的双变量差异进行了分析，并构建了逻辑回归模型，以评估变量之间的关系。感染发生率为 28%。71%的居民出现症状。五种主要症状包括：发热、呼吸困难、干咳、乏力和腹泻。发热和呼吸困难是迄今为止最常见的症状（分别为 50%和 28%）。发病以急性为主，症状持续数天至数周（平均 9.1 天，标准差=10.9）。16%的居民被确诊患有肺炎，22%需要住院治疗。累积死亡率为 21.75%（86%集中在发病后 28 天内）。多变量逻辑回归分析显示，某些变量（如年龄、肺炎、发热、呼吸困难、昏迷、拒绝口服摄入和痴呆）对死亡率有阳性预测值（所有变量均为 p<0.01）。结果表明，护理院的密度并不能解释设施内感染发生率的差异。这项研究提供了对 2020 年 3 月至 5 月加泰罗尼亚地区第一波大流行期间居住在长期护理院的高依赖度老年人的疾病自然史的深入了解，并表明一些合并症和症状对死亡率具有很强的预测价值。
