Douglas S Lee1,2,3,4, Shihao Ma1,5,6, Anna Chu1,4, Chloe X Wang1, Xuesong Wang1, Peter C Austin1, Finlay A McAlister7,8,9, Sunil V Kalmady8, Moira K Kapral1,4,10, Padma Kaul8,9, Dennis T Ko1,4,11, Paula A Rochon1,4,12, Michael J Schull1,4,13, Barry B Rubin2,4,14, Bo Wang1,2,5,6,15. 1. ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Canada. 2. Peter Munk Cardiac Centre, University Health Network, Toronto, Canada. 3. Ted Rogers Centre for Heart Research, Toronto, Canada. 4. Faculty of Medicine, University of Toronto, Toronto, Canada. 5. Department of Computer Science, University of Toronto, Toronto, Canada. 6. Vector Institute of Artificial Intelligence, University of Toronto, Toronto, Canada. 7. Alberta SPOR Unit, University of Alberta, Edmonton, Canada. 8. Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada. 9. Department of Medicine, University of Alberta, Edmonton, Canada. 10. Division of General Internal Medicine, University of Toronto, Toronto, Canada. 11. Division of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Canada. 12. Women's College Hospital, Toronto, Canada. 13. Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada. 14. Division of Vascular Surgery, University Health Network, Toronto, Canada. 15. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.
Abstract
BACKGROUND: While individuals living in long-term care (LTC) homes have experienced adverse outcomes of SARS-CoV-2 infection, few studies have examined a broad range of predictors of 30-day mortality in this population. METHODS: We studied residents living in LTC homes in Ontario, Canada, who underwent PCR testing for SARS-CoV-2 infection from January 1 to August 31, 2020, and examined predictors of all-cause death within 30 days after a positive test for SARS-CoV-2. We examined a broad range of risk factor categories including demographics, comorbidities, functional status, laboratory tests, and characteristics of the LTC facility and surrounding community were examined. In total, 304 potential predictors were evaluated for their association with mortality using machine learning (Random Forest). RESULTS: A total of 64,733 residents of LTC, median age 86 (78, 91) years (31.8% men), underwent SARS-CoV-2 testing, of whom 5029 (7.8%) tested positive. Thirty-day mortality rates were 28.7% (1442 deaths) after a positive test. Of 59,702 residents who tested negative, 2652 (4.4%) died within 30 days of testing. Predictors of mortality after SARS-CoV-2 infection included age, functional status (e.g., activity of daily living score and pressure ulcer risk), male sex, undernutrition, dehydration risk, prior hospital contacts for respiratory illness, and duration of comorbidities (e.g., heart failure, COPD). Lower GFR, hemoglobin concentration, lymphocyte count, and serum albumin were associated with higher mortality. After combining all covariates to generate a risk index, mortality rate in the highest risk quartile was 48.3% compared with 7% in the first quartile (odds ratio 12.42, 95%CI: 6.67, 22.80, p < 0.001). Deaths continued to increase rapidly for 15 days after the positive test. CONCLUSIONS: LTC residents, particularly those with reduced functional status, comorbidities, and abnormalities on routine laboratory tests, are at high risk for mortality after SARS-CoV-2 infection. Recognizing high-risk residents in LTC may enhance institution of appropriate preventative measures.
BACKGROUND: While individuals living in long-term care (LTC) homes have experienced adverse outcomes of SARS-CoV-2 infection, few studies have examined a broad range of predictors of 30-day mortality in this population. METHODS: We studied residents living in LTC homes in Ontario, Canada, who underwent PCR testing for SARS-CoV-2 infection from January 1 to August 31, 2020, and examined predictors of all-cause death within 30 days after a positive test for SARS-CoV-2. We examined a broad range of risk factor categories including demographics, comorbidities, functional status, laboratory tests, and characteristics of the LTC facility and surrounding community were examined. In total, 304 potential predictors were evaluated for their association with mortality using machine learning (Random Forest). RESULTS: A total of 64,733 residents of LTC, median age 86 (78, 91) years (31.8% men), underwent SARS-CoV-2 testing, of whom 5029 (7.8%) tested positive. Thirty-day mortality rates were 28.7% (1442 deaths) after a positive test. Of 59,702 residents who tested negative, 2652 (4.4%) died within 30 days of testing. Predictors of mortality after SARS-CoV-2 infection included age, functional status (e.g., activity of daily living score and pressure ulcer risk), male sex, undernutrition, dehydration risk, prior hospital contacts for respiratory illness, and duration of comorbidities (e.g., heart failure, COPD). Lower GFR, hemoglobin concentration, lymphocyte count, and serum albumin were associated with higher mortality. After combining all covariates to generate a risk index, mortality rate in the highest risk quartile was 48.3% compared with 7% in the first quartile (odds ratio 12.42, 95%CI: 6.67, 22.80, p < 0.001). Deaths continued to increase rapidly for 15 days after the positive test. CONCLUSIONS: LTC residents, particularly those with reduced functional status, comorbidities, and abnormalities on routine laboratory tests, are at high risk for mortality after SARS-CoV-2 infection. Recognizing high-risk residents in LTC may enhance institution of appropriate preventative measures.
Authors: Douglas S Lee; Chloe X Wang; Finlay A McAlister; Shihao Ma; Anna Chu; Paula A Rochon; Padma Kaul; Peter C Austin; Xuesong Wang; Sunil V Kalmady; Jacob A Udell; Michael J Schull; Barry B Rubin; Bo Wang Journal: Lancet Reg Health Am Date: 2022-01-17
Authors: Adam H Dyer; Aoife Fallon; Claire Noonan; Helena Dolphin; Cliona O'Farrelly; Nollaig M Bourke; Desmond O'Neill; Sean P Kennelly Journal: J Am Med Dir Assoc Date: 2022-07-04 Impact factor: 7.802