Outcomes of Nursing Home COVID-19 Patients by Initial Symptoms and Comorbidity: Results of Universal Testing of 1970 Residents.
J Am Med Dir Assoc
; 21(12): 1767-1773.e1, 2020 12.
Article
en En
| MEDLINE
| ID: mdl-33153910
ABSTRACT
OBJECTIVE:
Clinical implications of asymptomatic cases of the novel coronavirus disease 2019 (COVID-19) in nursing homes remain poorly understood. We assessed the association of symptom status and medical comorbidities on mortality and hospitalization risk associated with COVID-19 in residents across 15 nursing homes in Maryland.DESIGN:
Retrospective cohort study. SETTING ANDPARTICIPANTS:
1970 residents from 15 nursing home facilities with universal COVID-19 testing in Maryland.METHODS:
We used descriptive statistics to compare baseline characteristics, logistic regression to assess the association of comorbidities with COVID-19, and Cox regression to assess the association of asymptomatic and symptomatic COVID-19 with mortality and hospitalization. We assessed the association of comorbidities with mortality and hospitalization risk. Symptom status was assessed at the time of the first test. Maximum follow-up was 94 days.RESULTS:
Among the 1970 residents (mean age 73.8, 57% female, 68% black), 752 (38.2%) were positive on their first test. Residents who were positive for COVID-19 and had multiple symptoms at the time of testing had the highest risk of mortality [hazard ratio (HR) 4.44, 95% confidence interval (CI) 2.97, 6.65) and hospitalization (subhazard ratio 2.38, 95% CI 1.70, 3.33), even after accounting for comorbidity burden. Cases who were asymptomatic at testing had a higher risk of mortality (HR 2.92, 95% CI 1.95, 4.35) but not hospitalization (HR 1.06, 95% CI 0.82, 1.38) compared with those who were negative for COVID-19. Of 52 SARS-CoV-2-positive residents who were asymptomatic at the time of testing and were closely monitored for 14 days at one facility, only 6 (11.6%) developed symptoms. CONCLUSIONS AND IMPLICATIONS Asymptomatic infection with SARS-CoV-2 in the nursing home setting was associated with increased risk of death, suggesting a need for closer monitoring of these residents, particularly those with underlying cardiovascular and respiratory comorbidities.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Comorbilidad
/
Prueba de COVID-19
/
COVID-19
/
Casas de Salud
Tipo de estudio:
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
/
Middle aged
País/Región como asunto:
America do norte
Idioma:
En
Revista:
J Am Med Dir Assoc
Asunto de la revista:
HISTORIA DA MEDICINA
/
MEDICINA
Año:
2020
Tipo del documento:
Article
País de afiliación:
Estados Unidos
Pais de publicación:
EEUU
/
ESTADOS UNIDOS
/
ESTADOS UNIDOS DA AMERICA
/
EUA
/
UNITED STATES
/
UNITED STATES OF AMERICA
/
US
/
USA