Clinical features and risk factors for mortality among long-term care facility residents hospitalized due to COVID-19 in Spain

Ramos-Rincón, José-Manuel; Bernabeu-Whittel, Máximo; Fiteni-Mera, Isabel; López-Sampalo, Almudena; López-Ríos, Carmen; García-Andreu, María-Del-Mar; Mancebo-Sevilla, Juan-José; Jiménez-Juan, Carlos; Matía-Sanz, Marta; López-Quirantes, Pablo; Rubio-Rivas, Manuel; Paredes-Ruiz, Diana; González-San-Narciso, Candela; González-Vega, Rocío; Sanz-Espinosa, Pablo; Hernández-Milián, Almudena; Gonzalez-Noya, Amara; Gil-Sánchez, Ricardo; Boixeda, Ramon; Alcalá-Pedrajas, José-Nicolás; Palop-Cervera, Marta; Cortés-Rodríguez, Begoña; Guisado-Espartero, María-Esther; Mella-Pérez, Carmen; Gómez-Huelgas, Ricardo

BACKGROUND: COVID-19 severely impacted older adults and long-term care facility (LTCF) residents. Our primary aim was to describe differences in clinical and epidemiological variables, in-hospital management, and outcomes between LTCF residents and community-dwelling older adults hospitalized with COVID-19. The secondary aim was to identify risk factors for mortality due to COVID-19 in hospitalized LTCF residents. METHODS: This is a cross-sectional analysis within a retrospective cohort of hospitalized patients≥75 years with confirmed COVID-19 admitted to 160 Spanish hospitals. Differences between groups and factors associated with mortality among LTCF residents were assessed through comparisons and logistic regression analysis. RESULTS: Of 6,189 patients≥75 years, 1,185 (19.1%) were LTCF residents and 4,548 (73.5%) were community-dwelling. LTCF residents were older (median: 87.4 vs. 82.1 years), mostly female (61.6% vs. 43.2%), had more severe functional dependence (47.0% vs 7.8%), more comorbidities (Charlson Comorbidity Index: 6 vs 5), had dementia more often (59.1% vs. 14.4%), and had shorter duration of symptoms (median: 3 vs 6 days) than community-dwelling patients (all, p<.001). Mortality risk factors in LTCF residents were severe functional dependence (aOR:1.79;95%CI:1.13-2.83;p=.012), dyspnea (1.66;1.16-2.39;p=.004), SatO2<94% (1.73;1.27-2.37;p=.001), temperature≥37.8ºC (1.62;1.11-2.38; p=.013); qSOFA index≥2 (1.62;1.11-2.38;p=.013), bilateral infiltrates (1.98;1.24-2.98;p<.001), and high C-reactive protein (1.005;1.003-1.007;p<.001). In-hospital mortality was initially higher among LTCF residents (43.3% vs 39.7%), but lower after adjusting for sex, age, functional dependence, and comorbidities (aOR:0.74,95%CI:0.62-0.87;p<.001). CONCLUSION: Basal functional status and COVID-19 severity are risk factors of mortality in LTCF residents. The lower adjusted mortality rate in LTCF residents may be explained by earlier identification, treatment, and hospitalization for COVID-19.