Clinical characteristics and predictors of mortality associated with COVID-19 in elderly patients from a long-term care facility

  1. Enrico Maria Trecarichi
  2. Maria Mazzitelli
  3. Francesca Serapide
  4. Maria Chiara Pelle
  5. Bruno Tassone
  6. Eugenio Arrighi
  7. Graziella Perri
  8. Paolo Fusco
  9. Vincenzo Scaglione
  10. Chiara Davoli
  11. Rosaria Lionello
  12. Valentina La Gamba
  13. Giuseppina Marrazzo
  14. Maria Teresa Busceti
  15. Amerigo Giudice
  16. Marco Ricchio
  17. Anna Cancelliere
  18. Elena Lio
  19. Giada Procopio
  20. Francesco Saverio Costanzo
  21. Daniela Patrizia Foti
  22. Giovanni Matera
  23. Carlo Torti
  24. IDTM UMG COVID-19 Group
  25. Domenico Laganà
  26. Maria Petullà
  27. Bernardo Bertucci
  28. Angela Quirino
  29. Giorgio Settimo Barreca
  30. Aida Giancotti
  31. Luigia Gallo
  32. Angelo Lamberti
  33. Maria Carla Liberto
  34. Nadia Marascio
  35. Adele Emanuela De Francesco

Reviewed by

Read the full article See related articles

Discuss this preprint

Start a discussion What are Sciety discussions?

Listed in

Log in to save this article

Abstract

Since December 2019, coronavirus disease 2019 (COVID-19) pandemic has spread from China all over the world and many COVID-19 outbreaks have been reported in long-term care facilities (LCTF). However, data on clinical characteristics and prognostic factors in such settings are scarce. We conducted a retrospective, observational cohort study to assess clinical characteristics and baseline predictors of mortality of COVID-19 patients hospitalized after an outbreak of SARS-CoV-2 infection in a LTCF. A total of 50 patients were included. Mean age was 80 years (SD, 12 years), and 24/50 (57.1%) patients were males. The overall in-hospital mortality rate was 32%. At Cox regression analysis, significant predictors of in-hospital mortality were: hypernatremia (HR 9.12), lymphocyte count < 1000 cells/µL (HR 7.45), cardiovascular diseases other than hypertension (HR 6.41), and higher levels of serum interleukin-6 (IL-6, pg/mL) (HR 1.005). Our study shows a high in-hospital mortality rate in a cohort of elderly patients with COVID-19 and hypernatremia, lymphopenia, CVD other than hypertension, and higher IL-6 serum levels were identified as independent predictors of in-hospital mortality. Given the small population size as major limitation of our study, further investigations are necessary to better understand and confirm our findings in elderly patients.

Article activity feed

  1. Version published to 10.1038/s41598-020-77641-7
  2. ScreenIT

    SciScore for 10.1101/2020.06.30.20143701: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: This study was notified to the Ethics Committee of the Calabria Region on May 13th, 2020 and conducted in in accordance with the declaration of Helsinki.
    Consent: The need for written informed consent was waived for patients owing to the retrospective nature of the study.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study has major limitations, including its retrospective nature and the small population size. By contrast, the main strength is that patients were all infected in a limited period of time, so this is an incident cohort, and analysis of outcome predictors could be more reliable. To the best of our knowledge, the present is the first study investigating clinical characteristics, mortality and prognostic factors of a complete cohort of patients during a SARS-CoV-2 outbreak in a LTCF. We found that in-hospital mortality was 32%, in line with fatality rates reported in elderly patients in Italy. Importantly, hypernatremia, lymphopenia, CVD other than hypertension, and higher IL-6 serum level appeared to be independent predictors of in-hospital mortality. Further larger studies are necessary to better understand and confirm our findings, in order to rapidly identify characteristics associated with an adverse outcome among elderly suffering from COVID-19 and provide a more aggressive monitoring and care.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.06.30.20143701 on medRxiv