De Zorggroep, Region Venlo (EBC), Venlo, the Netherlands.
Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
J Am Med Dir Assoc. 2022 Aug;23(8):1274-1278. doi: 10.1016/j.jamda.2022.06.005. Epub 2022 Jun 20.
To assess short- and long-term mortality and risk factors in nursing home patients with COVID-19 infection.
Retrospective 2-center cohort study.
Dutch nursing home patients with clinically suspected COVID-19 infection confirmed by reverse transcription-polymerase chain reaction testing.
Data were gathered between March 2020 and November 2020 using electronic medical records, including demographic characteristics, comorbidities, medical management, and symptoms on the first day of suspected COVID-19 infection. Mortality at 30 days and 6 months was assessed using multivariate logistic regression models and Kaplan-Meier analysis. At 6 months, a subgroup analysis was performed to estimate the mortality risk between COVID-negative patients and patients who survived COVID-19. Risk factors for mortality were assessed through multivariate logistic regression models.
A total of 321 patients with suspected COVID-19 infection were included, of whom 134 tested positive. Sixty-two patients in the positive group died at 30 days, with a short-term mortality rate of 2.9 (95% CI 1.7-5.3). Risk factors were fatigue (OR 2.6, 95% CI 1.3-6.2) and deoxygenation (OR 2.9, 95% CI 1.3-7.6). At 6 months, the mortality risk was 2.1 (95% CI 1.3-3.7). Risk factors for 6-month mortality were shortness of breath (OR 2.7, 95% CI 1.3-7.0), deoxygenation (OR 2.5, 95% CI 1.1-6.5) and medical management (OR 4.5, 95% CI 1.7-25.8). However, among patients who survived COVID-19 infection, the long-term mortality risk was not sustained (OR 1.0, 95% CI 0.4-2.7).
Overall, COVID-19 infection increases short- and long-term mortality risk among nursing home patients. However, this study shows that surviving COVID-19 infection does not lead to increased mortality in the long term within this population. Therefore, advanced care planning should focus on quality of life among nursing home patients after COVID-19 infection.
评估养老院 COVID-19 感染患者的短期和长期死亡率及相关风险因素。
回顾性 2 中心队列研究。
荷兰养老院 COVID-19 感染疑似患者，通过逆转录聚合酶链反应（RT-PCR）检测确诊。
使用电子病历于 2020 年 3 月至 11 月间收集数据，包括人口统计学特征、合并症、医疗管理以及疑似 COVID-19 感染第一天的症状。采用多变量逻辑回归模型和 Kaplan-Meier 分析评估 30 天和 6 个月时的死亡率。在 6 个月时进行亚组分析，以评估 COVID-19 阴性患者和 COVID-19 存活患者之间的死亡率风险。采用多变量逻辑回归模型评估死亡率的风险因素。
共纳入 321 例 COVID-19 疑似感染患者，其中 134 例 RT-PCR 检测阳性。阳性组中 62 例患者在 30 天内死亡，短期死亡率为 2.9（95%置信区间 1.7-5.3）。风险因素为疲劳（比值比 2.6，95%置信区间 1.3-6.2）和低氧血症（比值比 2.9，95%置信区间 1.3-7.6）。6 个月时，死亡率风险为 2.1（95%置信区间 1.3-3.7）。6 个月时死亡率的风险因素为呼吸急促（比值比 2.7，95%置信区间 1.3-7.0）、低氧血症（比值比 2.5，95%置信区间 1.1-6.5）和医疗管理（比值比 4.5，95%置信区间 1.7-25.8）。然而，在 COVID-19 感染存活的患者中，长期死亡率风险并不持续（比值比 1.0，95%置信区间 0.4-2.7）。
总体而言，COVID-19 感染增加了养老院患者的短期和长期死亡率风险。然而，本研究表明，在该人群中，COVID-19 感染存活后并不会导致长期死亡率增加。因此，在 COVID-19 感染后，高级护理计划应侧重于养老院患者的生活质量。
