Predictors of infection, symptoms development, and mortality in people with SARS-CoV-2 living in retirement nursing homes

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Abstract

Introduction

Since the start of the pandemic, millions of people have been infected, with thousands of deaths. Many foci worldwide have been identified in retirement nursing homes, with a high number of deaths. Our study aims were to evaluate the spread of SARS-CoV-2 in the retirement nursing homes, the predictors to develop symptoms, and death.

Methods and findings

We conducted a retrospective study enrolling all people living in retirement nursing homes (PLRNH), where at least one SARS-CoV-2 infected person was present. Medical and clinical data were collected. Variables were compared with Student’s t-test or Pearson chi-square test as appropriate. Uni- and multivariate analyses were conducted to evaluate variables’ influence on infection and symptoms development. Cox proportional-hazards model was used to evaluate 30 days mortality predictors, considering death as the dependent variable. We enrolled 382 subjects. The mean age was 81.15±10.97 years, and males were 140(36.7%). At the multivariate analysis, mental disorders, malignancies, and angiotensin II receptor blockers were predictors of SARS-CoV-2 infection while having a neurological syndrome was associated with a lower risk. Only half of the people with SARS-CoV-2 infection developed symptoms. Chronic obstructive pulmonary disease and neurological syndrome were correlated with an increased risk of developing SARS-CoV-2 related symptoms. Fifty-six (21.2%) people with SARS-CoV-2 infection died; of these, 53 died in the first 30 days after the swab’s positivity. Significant factors associated with 30-days mortality were male gender, hypokinetic disease, and the presence of fever and dyspnea. Patients’ autonomy and early heparin treatment were related to lower mortality risk.

Conclusions

We evidenced factors associated with infection’s risk and death in a setting with high mortality such as retirement nursing homes, that should be carefully considered in the management of PLRNH.

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Most cited references 53

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Clinical Characteristics of Coronavirus Disease 2019 in China

Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)

Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

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Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Fei Zhou, Ting Yu, Ronghui Du … (2020)

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

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Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention

Zunyou Wu, Jennifer M. McGoogan (2020)

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Author and article information

Contributors

Andrea De Vito:

ORCID: https://orcid.org/0000-0002-8265-5400

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: Writing – original draftRole: Writing – review & editing

Vito Fiore: Role: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing

Elija Princic: Role: ConceptualizationRole: Data curationRole: InvestigationRole: Writing – original draft

Nicholas Geremia:

ORCID: https://orcid.org/0000-0001-7988-5419

Role: ConceptualizationRole: Data curationRole: InvestigationRole: Writing – original draft

Catello Mario Panu Napodano:

ORCID: https://orcid.org/0000-0002-9450-786X

Role: Data curationRole: InvestigationRole: Writing – review & editing

Alberto Augusto Muredda:

ORCID: https://orcid.org/0000-0003-2258-0942

Role: Data curationRole: InvestigationRole: Writing – review & editing

Ivana Maida:

ORCID: https://orcid.org/0000-0003-4895-7576

Role: InvestigationRole: SupervisionRole: Writing – review & editing

Giordano Madeddu:

ORCID: https://orcid.org/0000-0001-6099-2273

Role: ConceptualizationRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing

Sergio Babudieri:

ORCID: https://orcid.org/0000-0001-7291-8687

Role: ConceptualizationRole: SupervisionRole: ValidationRole: Writing – review & editing

Andrea Calcagno: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS One

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 16 March 2021

Publication date Collection: 2021

Publication date PMC-release: 16 March 2021

Volume: 16

Issue: 3

Electronic Location Identifier: e0248009

Affiliations

[1 ] Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy

[2 ] Mediterranean Center for Disease Control, University of Sassari, Sassari, Italy

University of Torino, ITALY

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: andreadevitoaho@ 123456gmail.com

Author information

Andrea De Vito https://orcid.org/0000-0002-8265-5400

Nicholas Geremia https://orcid.org/0000-0001-7988-5419

Catello Mario Panu Napodano https://orcid.org/0000-0002-9450-786X

Alberto Augusto Muredda https://orcid.org/0000-0003-2258-0942

Ivana Maida https://orcid.org/0000-0003-4895-7576

Giordano Madeddu https://orcid.org/0000-0001-6099-2273

Sergio Babudieri https://orcid.org/0000-0001-7291-8687

Article

Publisher ID: PONE-D-20-34816

DOI: 10.1371/journal.pone.0248009

PMC ID: 7963051

PubMed ID: 33724987

SO-VID: c1844842-3621-47ec-a8bc-119d5b0e8386

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 13 November 2020

Date accepted : 17 February 2021

Page count

Figures: 3, Tables: 3, Pages: 14

Funding

The authors received no specific funding for this work.

Custom metadata

Data Availability All relevant data are within the paper and its Supporting Information files.

Outbreaks COVID-19

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