Risk Factors Associated With All-Cause 30-Day Mortality in Nursing Home Residents With COVID-19
Risk Factors Associated With All-Cause 30-Day Mortality in Nursing Home Residents With COVID-19
复制标题
DOI：
10.1001/jamainternmed.2020.7968
复制
发表时间：
2021-01-04
影响因子：
39
通讯作者：
Mor, Vincent
中科院分区：
文献类型：
--
作者：
Panagiotou, Orestis A.;Kosar, Cyrus M.;Mor, Vincent
2019冠状病毒病（COVID-19）疫情严重影响疗养院。脆弱的养老院居民是在高风险的不良后果，但需要提高认识，以确定风险因素的死亡率在养老院residents. ObjectiveTo确定风险因素的30天全因死亡率在美国养老院居民与COVID-19。设计，设置，这项队列研究在351家美国养老院进行，共有5256名患有COVID-19相关症状的养老院居民，他们患有严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染，在2020年3月16日至9月15日期间通过聚合酶链反应检测确认。主要结果和指标在首次SARS-CoV阳性后30天内因任何原因死亡，2检验结果。结果本研究共纳入5256名养老院居民（3185名女性[61%];中位年龄，79岁[四分位距，69-88岁];和3741名白色居民[71%]，909名黑人居民[17%]和586名其他种族/民族[11%]）。与75岁至79岁的居民相比，（95% CI，1.14-1.86）倍，80 - 84岁居民，1.59 85 ~ 89岁的居民高2.14倍（95%CI，1.25-2.03），90岁以上的居民高2.14倍（95%CI，1.70-2.69）。女性30天死亡率的风险低于男性（比值比[OR]，0.69 [95%CI，0.60-0.80]）。两种合并症与死亡率相关：糖尿病（OR，1.21 [95% CI，1.05-1.40]）和慢性肾脏疾病（OR，1.33 [95%，1.11-1.61]）。发烧（OR，1.66 [95% CI，1.41-1.96]），呼吸短促（OR，2.52 [95% CI，2.00-3.16]），心动过速（OR，1.31 [95% CI，1.04-1.64]）和缺氧（OR，2.05 [95% CI，1.68-2.50]）也与30天死亡率风险增加相关。与认知功能正常的居民相比，中度认知功能障碍的居民死亡几率高2.09倍（95%CI，1.68-2.59），重度认知功能障碍的居民死亡几率高2.79倍（95%CI，2.14-3.66）。与无或轻度身体功能损害的居民相比，中度身体功能损害的居民的死亡几率为1.49（95%CI，1.18-1.88）倍，重度损伤居民的死亡几率为1.64（95%CI，1.30-2.08）倍。结论和相关性在这项对美国养老院COVID-19患者的队列研究中，年龄增加，男性，认知和身体功能受损与死亡率独立相关。了解这些危险因素可以帮助开发该人群死亡率的临床预测模型。
IMPORTANCE The coronavirus disease 2019 (COVID-19) pandemic has severely affected nursing homes. Vulnerable nursing home residents are at high risk for adverse outcomes, but improved understanding is needed to identify risk factors for mortality among nursing home residents.OBJECTIVE To identify risk factors for 30-day all-cause mortality among US nursing home residents with COVID-19.DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted at 351 US nursing homes among 5256 nursing home residents with COVID-19-related symptoms who had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection confirmed by polymerase chain reaction testing between March 16 and September 15, 2020.EXPOSURES Resident-level characteristics, including age, sex, race/ethnicity, symptoms, chronic conditions, and physical and cognitive function.MAIN OUTCOMES AND MEASURES Death due to any cause within 30 days of the first positive SARS-CoV-2 test result.RESULTS The study included 5256 nursing home residents (3185 women [61%]; median age, 79 years [interquartile range, 69-88 years]; and 3741 White residents [71%], 909 Black residents [17%], and 586 individuals of other races/ethnicities [11%]) with COVID-19. Compared with residents aged 75 to 79 years, the odds of death were 1.46 (95% CI, 1.14-1.86) times higher for residents aged 80 to 84 years, 1.59 (95% CI, 1.25-2.03) times higher for residents aged 85 to 89 years, and 2.14 (95% CI, 1.70-2.69) times higher for residents aged 90 years or older. Women had lower risk for 30-day mortality than men (odds ratio [OR], 0.69 [95% CI, 0.60-0.80]). Two comorbidities were associated with mortality: diabetes (OR, 1.21 [95% CI, 1.05-1.40]) and chronic kidney disease (OR, 1.33 [95%, 1.11-1.61]). Fever (OR, 1.66 [95% CI, 1.41-1.96]), shortness of breath (OR, 2.52 [95% CI, 2.00-3.16]), tachycardia (OR, 1.31 [95% CI, 1.04-1.64]), and hypoxia (OR, 2.05 [95% CI, 1.68-2.50]) were also associated with increased risk of 30-day mortality. Compared with cognitively intact residents, the odds of death among residents with moderate cognitive impairment were 2.09 (95% CI, 1.68-2.59) times higher, and the odds of death among residents with severe cognitive impairment were 2.79 (95% CI, 2.14-3.66) times higher. Compared with residents with no or limited impairment in physical function, the odds of death among residents with moderate impairment were 1.49 (95% CI, 1.18-1.88) times higher, and the odds of death among residents with severe impairment were 1.64 (95% CI, 1.30-2.08) times higher.CONCLUSIONS AND RELEVANCE In this cohort study of US nursing home residents with COVID-19, increased age, male sex, and impaired cognitive and physical function were independently associated with mortality. Understanding these risk factors can aid in the development of clinical prediction models of mortality in this population.