Geriatric Department, AP-HP, Bichat and Beaujon University Hospitals, 46 rue Henri Huchard, Paris Cedex , 75877, France.
Paris Cité University, Paris, France.
BMC Geriatr. 2024 Aug 1;24(1):647. doi: 10.1186/s12877-024-05220-w.
BACKGROUND: During the first COVID-19 pandemic wave (1st CoPW), nursing homes (NHs) experienced a high rate of COVID-19 infection and death. Residents who survived the COVID-19 infection may have become frailer. This study aimed to determine the predictive value of having a COVID-19 infection during the 1st CoPW for 2-year mortality in NH residents. METHODS: This was a retrospective study conducted in three NHs. Residents who had survived the 1st CoPW (March to May 2020) were included. The diagnosis of COVID-19 was based on the results of a positive reverse transcriptase-polymerase chain reaction test. The collected data also included age, sex, length of residence in the NH, disability status, legal guardianship status, nutritional status, need for texture-modified food, hospitalization or Emergency Department visits during lockdown and SARS-COV2 vaccination status during the follow-up. Non-adjusted and adjusted Cox models were used to analyse factors associated with 2-year post-1st CoPW mortality. RESULTS: Among the 315 CoPW1 survivors (72% female, mean age 88 years, 48% with severe disability), 35% presented with COVID-19. Having a history of COVID-19 was not associated with 2-year mortality: hazard ratio (HR) [95% confidence interval] = 0.96 [0.81-1.13], p = 0.62. The factors independently associated with 2-year mortality were older age (for each additional year, HR = 1.05 [1.03-1.08], p < 0.01), severe disability vs. moderate or no disability (HR = 1.35 [1.12-1.63], p < 0.01) and severe malnutrition vs. no malnutrition (HR = 1.29 [1.04-1.60], p = 0.02). Considering that vaccination campaign started during the follow-up, mortality was associated with severe malnutrition before and severe disability after the start of the campaign. Vaccination was independently associated with better survival (HR 0.71 [0.55-0.93], p = 0.02). CONCLUSIONS: Having survived a COVID-19 infection during the 1st CoPW did not affect subsequent 2-year survival in older adults living in NHs. Severe malnutrition and disability remained strong predictor of mortality in this population, whereas vaccination was associated to better survival.
背景：在第一波 COVID-19 大流行期间（1st CoPW），养老院（NHs）的 COVID-19 感染率和死亡率很高。幸存 COVID-19 感染的居民可能会变得更加脆弱。本研究旨在确定在 1st CoPW 期间感染 COVID-19 对 NH 居民 2 年死亡率的预测价值。
方法：这是一项在三个 NH 中进行的回顾性研究。纳入了在第一波 COVID-19 大流行中幸存下来的居民（2020 年 3 月至 5 月）。COVID-19 的诊断基于逆转录酶-聚合酶链反应测试阳性结果。收集的数据还包括年龄、性别、在 NH 的居住时间、残疾状况、法定监护状况、营养状况、对质地改良食品的需求、封锁期间的住院或急诊就诊以及在随访期间的 SARS-COV2 疫苗接种状况。使用非调整和调整后的 Cox 模型分析与 1st CoPW 后 2 年死亡率相关的因素。
结果：在 315 名 CoPW1 幸存者中（72%为女性，平均年龄 88 岁，48%为重度残疾），35%出现 COVID-19。有 COVID-19 病史与 2 年死亡率无关：风险比（HR）[95%置信区间] = 0.96 [0.81-1.13]，p = 0.62。与 2 年死亡率独立相关的因素是年龄较大（每增加 1 岁，HR = 1.05 [1.03-1.08]，p < 0.01）、重度残疾与中度或无残疾（HR = 1.35 [1.12-1.63]，p < 0.01）和严重营养不良与无营养不良（HR = 1.29 [1.04-1.60]，p = 0.02）。考虑到疫苗接种运动在随访期间开始，死亡率与运动前的严重营养不良和运动后的严重残疾有关。疫苗接种与更好的生存独立相关（HR 0.71 [0.55-0.93]，p = 0.02）。
结论：在第一波 COVID-19 大流行期间幸存下来的 COVID-19 感染不会影响老年人在 NH 中随后 2 年的生存。在这一人群中，严重营养不良和残疾仍然是死亡的强烈预测因素，而疫苗接种与更好的生存有关。
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