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Mortality in an Italian nursing home during COVID-19 pandemic: correlation with gender, age, ADL, vitamin D supplementation, and limitations of the diagnostic tests

Cangiano et al., Aging, doi:10.18632/aging.202307
Dec 2020  
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Mortality 73% Improvement Relative Risk HCQ for COVID-19  Cangiano et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 98 patients in Italy Lower mortality with HCQ (p=0.03) c19hcq.org Cangiano et al., Aging, December 2020 FavorsHCQ Favorscontrol 0 0.5 1 1.5 2+
HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
 
*, now with p < 0.00000000001 from 411 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,300+ studies for 75 treatments. c19hcq.org
73% lower mortality with HCQ. Analysis of 98 PCR+ nursing home residents in Italy, mean age 90, showing HCQ mortality RR 0.27, p = 0.03. Subject to confounding by contraindication. The paper provides the p value for regression but not the effect size.
Study covers vitamin D and HCQ.
risk of death, 73.4% lower, RR 0.27, p = 0.03, treatment 5 of 33 (15.2%), control 37 of 65 (56.9%), NNT 2.4.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Cangiano et al., 22 Dec 2020, retrospective, Italy, peer-reviewed, 14 authors.
This PaperHCQAll
Mortality in an Italian nursing home during COVID-19 pandemic: correlation with gender, age, ADL, vitamin D supplementation, and limitations of the diagnostic tests
Biagio Cangiano, Letizia Maria Fatti, Leila Danesi, Giacomo Gazzano, Marina Croci, Giovanni Vitale, Luisa Gilardini, Stefania Bonadonna, Iacopo Chiodini, Chiara Francesca Caparello, Antonio Conti, Luca Persani, Marco Stramba-Badiale, Marco Bonomi
Introduction: The COVID-19 pandemic caused an increased mortality in nursing homes due to its quick spread and the age-related high lethality. Results: We observed a two-month mortality of 40%, compared to 6.4% in the previous year. This increase was seen in both COVID-19 positive (43%) and negative (24%) residents, but 8 patients among those testing negative on the swab, tested positive on serological tests. Increased mortality was associated with male gender, older age, no previous vitamin D supplementation and worse "activities of daily living (ADL)" scores, such as Barthel index, Tinetti scale and S.OS.I.A. classification. Conclusion: Our data confirms a higher geriatric mortality due to COVID-19. Negative residents also had higher mortality, which we suspect is secondary to preanalytical error and a low sensitivity of the swab test in poorly compliant subjects. Male gender, older age and low scores on ADL scales (probably due to immobility) are risk factors for COVID-19 related mortality. Finally, mortality was inversely associated with vitamin D supplementation. Design: In this observational study, we described the two-month mortality among the 157 residents (age 60-100) of a nursing home after Sars-CoV-2 spreading, reporting the factors associated with the outcome. We also compared the diagnostic tests for Sars-CoV-2.
AUTHOR CONTRIBUTIONS
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' 'https://www.ats-milano.it/portale/epidemiologia/Valutazione-dellepidemia-COVID-19.'}, { 'key': '21', 'doi-asserted-by': 'publisher', 'first-page': '912', 'DOI': '10.1111/jgs.16445', 'article-title': 'Coronavirus disease 2019 in geriatrics and long-term care: the ABCDs of ' 'COVID-19.', 'volume': '6', 'author': 'Ouslander', 'year': '2020', 'journal-title': 'J Am Geriatr Soc'}, { 'key': '22', 'doi-asserted-by': 'publisher', 'first-page': '266', 'DOI': '10.1016/s0197-4572(03)00251-9', 'article-title': 'Experiencing SARS: perspectives of the elderly residents and health ' 'care professionals in a Hong Kong nursing home.', 'volume': '2', 'author': 'Benzie', 'year': '2003', 'journal-title': 'Geriatr Nurs'}, { 'key': '23', 'doi-asserted-by': 'publisher', 'first-page': '1653', 'DOI': '10.1111/jgs.16661', 'article-title': 'Characteristics of U.S. Nursing homes with COVID-19 cases.', 'volume': '6', 'author': 'Grabowski', 'year': '2020', 'journal-title': 'J Am Geriatr Soc'}, { 'key': '24', 'doi-asserted-by': 'publisher', 'first-page': '2052', 'DOI': '10.1001/jama.2020.6775', 'article-title': 'Presenting characteristics, comorbidities, and outcomes among 5700 ' 'patients hospitalized with COVID-19 in the New York city area.', 'volume': '32', 'author': 'Diefenbach', 'year': '2020', 'journal-title': 'JAMA'}, { 'key': '25', 'doi-asserted-by': 'publisher', 'DOI': '10.1111/jgs.16716', 'article-title': 'Frailty combined with loneliness or social isolation: an elevated risk ' 'for mortality in later life.', 'author': 'Andrew', 'year': '2020', 'journal-title': 'J Am Geriatr Soc'}, { 'key': '26', 'doi-asserted-by': 'publisher', 'first-page': '2249', 'DOI': '10.1001/jama.2020.8259', 'article-title': 'Interpreting diagnostic tests for SARS-CoV-2.', 'volume': '32', 'author': 'Ryo', 'year': '2020', 'journal-title': 'JAMA'}, { 'key': '27', 'doi-asserted-by': 'publisher', 'first-page': '269', 'DOI': '10.1038/s41577-020-0308-3', 'article-title': 'COVID-19: immunopathology and its implications for therapy.', 'volume': '2', 'author': 'Cao', 'year': '2020', 'journal-title': 'Nat Rev Immunol'}, { 'key': '28', 'doi-asserted-by': 'publisher', 'first-page': '379', 'DOI': '10.33549/physiolres.934492', 'article-title': 'COVID-19 and the immune system.', 'volume': '6', 'author': 'Cerny', 'year': '2020', 'journal-title': 'Physiol Res'}, { 'key': '29', 'doi-asserted-by': 'publisher', 'first-page': '844', 'DOI': '10.1111/jth.14768', 'article-title': 'Abnormal coagulation parameters are associated with poor prognosis in ' 'patients with novel coronavirus pneumonia.', 'volume': '1', 'author': 'Sun', 'year': '2020', 'journal-title': 'J Thromb Haemost'}, { 'key': '30', 'doi-asserted-by': 'publisher', 'first-page': '1094', 'DOI': '10.1111/jth.14817', 'article-title': 'Anticoagulant treatment is associated with decreased mortality in ' 'severe coronavirus disease 2019 patients with coagulopathy.', 'volume': '1', 'author': 'Sun', 'year': '2020', 'journal-title': 'J Thromb Haemost'}, { 'key': '31', 'doi-asserted-by': 'publisher', 'first-page': '1023', 'DOI': '10.1111/jth.14810', 'article-title': 'ISTH interim guidance on recognition and management of coagulopathy in ' 'COVID-19.', 'volume': '1', 'author': 'Iba', 'year': '2020', 'journal-title': 'J Thromb Haemost'}, { 'key': '32', 'doi-asserted-by': 'publisher', 'first-page': 'e438', 'DOI': '10.1016/S2352-3026(20)30145-9', 'article-title': 'Coagulation abnormalities and thrombosis in patients with COVID-19.', 'volume': '7', 'author': 'Levy', 'year': '2020', 'journal-title': 'Lancet Haematol'}, { 'key': '33', 'doi-asserted-by': 'publisher', 'first-page': '104950', 'DOI': '10.1016/j.phrs.2020.104950', 'article-title': 'Enhanced platelet inhibition treatment improves hypoxemia in patients ' 'with severe covid-19 and hypercoagulability. A case control, proof of ' 'concept study.', 'volume': '15', 'author': 'Santus', 'year': '2020', 'journal-title': 'Pharmacol Res'}, { 'key': '34', 'doi-asserted-by': 'publisher', 'DOI': '10.1002/dmrr.3319', 'article-title': 'Diabetes is a risk factor for the progression and prognosis of ' 'COVID-19.', 'author': 'Hu', 'year': '2020', 'journal-title': 'Diabetes Metab Res Rev'}, { 'key': '35', 'doi-asserted-by': 'publisher', 'first-page': '1025', 'DOI': '10.1097/CM9.0000000000000744', 'article-title': 'Clinical characteristics of novel coronavirus cases in tertiary ' 'hospitals in Hubei Province.', 'volume': '13', 'author': 'Liu', 'year': '2020', 'journal-title': 'Chin Med J (Engl)'}, { 'key': '36', 'doi-asserted-by': 'publisher', 'first-page': '1261', 'DOI': '10.1097/CM9.0000000000000824', 'article-title': 'Clinical characteristics of fatal and recovered cases of coronavirus ' 'disease 2019 in Wuhan, China: a retrospective study.', 'volume': '13', 'author': 'Liu', 'year': '2020', 'journal-title': 'Chin Med J (Engl)'}, { 'key': '37', 'doi-asserted-by': 'publisher', 'first-page': '1061', 'DOI': '10.1001/jama.2020.1585', 'article-title': 'Clinical characteristics of 138 hospitalized patients with 2019 novel ' 'coronavirus-infected pneumonia in Wuhan, China.', 'volume': '32', 'author': 'Peng', 'year': '2020', 'journal-title': 'JAMA'}, { 'key': '38', 'doi-asserted-by': 'publisher', 'first-page': '1372', 'DOI': '10.1164/rccm.202003-0543OC', 'article-title': 'Clinical features of 85 fatal cases of COVID-19 from Wuhan. A ' 'retrospective observational study.', 'volume': '20', 'author': 'Chang', 'year': '2020', 'journal-title': 'Am J Respir Crit Care Med'}, { 'key': '39', 'doi-asserted-by': 'publisher', 'first-page': '1054', 'DOI': '10.1016/S0140-6736(20)30566-3', 'article-title': 'Clinical course and risk factors for mortality of adult inpatients with ' 'COVID-19 in Wuhan, China: a retrospective cohort study.', 'volume': '39', 'author': 'Li', 'year': '2020', 'journal-title': 'Lancet'}, { 'key': '40', 'doi-asserted-by': 'publisher', 'first-page': '104371', 'DOI': '10.1016/j.jcv.2020.104371', 'article-title': 'Prevalence and severity of corona virus disease 2019 (COVID-19): a ' 'systematic review and meta-analysis.', 'volume': '12', 'author': 'Xu', 'year': '2020', 'journal-title': 'J Clin Virol'}, { 'key': '41', 'first-page': 'e35', 'article-title': 'Prevalence of underlying diseases in hospitalized patients with ' 'COVID-19: a systematic review and meta-analysis.', 'volume': '8', 'author': 'Akbari', 'year': '2020', 'journal-title': 'Arch Acad Emerg Med'}, { 'key': '42', 'doi-asserted-by': 'publisher', 'first-page': '101623', 'DOI': '10.1016/j.tmaid.2020.101623', 'article-title': 'Clinical, laboratory and imaging features of COVID-19: a systematic ' 'review and meta-analysis.', 'volume': '3', 'author': 'Ramírez-Vallejo', 'year': '2020', 'journal-title': 'Travel Med Infect Dis'}, { 'key': '43', 'doi-asserted-by': 'publisher', 'first-page': '1111', 'DOI': '10.1111/cen.14276', 'article-title': 'Low serum 25-hydroxyvitamin D (25[OH]D) levels in patients hospitalized ' 'with COVID-19 are associated with greater disease severity.', 'volume': '1', 'author': 'Quinton', 'year': '2020', 'journal-title': 'Clin Endocrinol (Oxf)'}, { 'key': '44', 'doi-asserted-by': 'publisher', 'first-page': '105771', 'DOI': '10.1016/j.jsbmb.2020.105771', 'article-title': 'Vitamin D and survival in COVID-19 patients: a quasi-experimental ' 'study.', 'volume': '20', 'author': 'Célarier', 'year': '2020', 'journal-title': 'J Steroid Biochem Mol Biol'}, { 'key': '45', 'doi-asserted-by': 'publisher', 'first-page': '606', 'DOI': '10.1016/j.arbres.2020.05.008', 'article-title': 'Hydroxychloroquine as prophylaxis for coronavirus SARS-CoV-2 infection: ' 'review of the ongoing clinical trials.', 'volume': '5', 'author': 'Velez', 'year': '2020', 'journal-title': 'Arch Bronconeumol'}, { 'key': '46', 'first-page': '61', 'article-title': 'Functional evaluation: the barthel index.', 'volume': '1', 'author': 'Barthel', 'year': '1965', 'journal-title': 'Md State Med J'}, { 'key': '47', 'doi-asserted-by': 'publisher', 'first-page': '119', 'DOI': '10.1111/j.1532-5415.1986.tb05480.x', 'article-title': 'Performance-oriented assessment of mobility problems in elderly ' 'patients.', 'volume': '3', 'author': 'Tinetti', 'year': '1986', 'journal-title': 'J Am Geriatr Soc'}, { 'key': '48', 'first-page': '439', 'article-title': '[SOSIA classification of the frail elderly in nursing homes of region ' 'of lombardy].', 'volume': '1', 'author': 'Fazzone', 'year': '2006', 'journal-title': 'Ann Ig'}], 'container-title': 'Aging', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://www.aging-us.com/lookup/doi/10.18632/aging.202307', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2021, 4, 6]], 'date-time': '2021-04-06T15:52:51Z', 'timestamp': 1617724371000}, 'score': 1, 'resource': {'primary': {'URL': 'https://www.aging-us.com/lookup/doi/10.18632/aging.202307'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2020, 12, 22]]}, 'references-count': 48, 'journal-issue': {'issue': '24', 'published-print': {'date-parts': [[2020, 12, 31]]}}, 'alternative-id': ['202307', '33353888'], 'URL': 'http://dx.doi.org/10.18632/aging.202307', 'relation': {}, 'ISSN': ['1945-4589'], 'subject': ['Cell Biology', 'Aging'], 'container-title-short': 'Aging', 'published': {'date-parts': [[2020, 12, 22]]}}
Late treatment
is less effective
Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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