Asymptomatic COVID-19 in the elderly: dementia and viral clearance as risk factors for disease progression

Background:SARS-CoV-2 infected individuals ≥60 years old have the highest hospitalization rates and represent >80% fatalities. Within this population, those in long-term facilities represent >50% of the total COVID-19 related deaths per country. Among those without symptoms, the rate of pre-symptomatic illness is unclear, and potential predictors of progression for symptom development are unknown.Our objective was to delineate the natural evolution of asymptomatic SARS-CoV-2 infection in elders and identify determinants of progression.Methods:We established a medical surveillance team monitoring 63 geriatric institutions. When an index COVID-19 case emerged, we tested all other eligible asymptomatic elders ≥75 or >60 years old with at least 1 comorbidity. SARS-CoV-2 infected elders were followed for 28 days. Disease was diagnosed when any COVID-19 manifestation occurred. SARS-CoV-2 load at enrollment, shedding on day 15, and antibody responses were also studied.Results:After 28 days of follow-up, 74/113(65%) SARS-CoV-2-infected elders remained asymptomatic. 21/39(54%) pre-symptomatic patients developed hypoxemia and ten pre-symptomatic patients died(median day 13.5,IQR 12).Dementia was the only clinical risk factor associated with disease(OR 2.41(95%CI=1.08, 5.39). In a multivariable logistic regression model, dementia remained as a risk factor for COVID-19 severe disease. Furthermore, dementia status showed a statistically significant different trend when assessing the cumulative probability of developing COVID-19 symptoms(log-rank p=0.027).On day 15, SARS-CoV-2 was detectable in 30% of the asymptomatic group while in 61% of the pre-symptomatic(p=0.012).No differences were observed among groups in RT-PCR mean cycle threshold at enrollment(p=0.391) and in the rates of antibody seropositivity(IgM and IgG against SARS-CoV-2 nucleocapsid protein).Conclusions:In summary, 2/3 of our cohort of SARS-CoV-2 infected elders from vulnerable communities in Argentina remained asymptomatic after 28 days of follow-up with high mortality among those developing symptoms. Dementia and persistent SARS-CoV-2 shedding were associated with progression from asymptomatic to symptomatic infection.Fil: Esteban, Ignacio. Fundación para la Investigación en Infectología Infantil; ArgentinaFil: Bergero, Georgina. Fundación para la Investigación en Infectología Infantil; ArgentinaFil: Alves, Camila. Fundación para la Investigación en Infectología Infantil; ArgentinaFil: Bronstein, Micaela. Fundación para la Investigación en Infectología Infantil; ArgentinaFil: Ziegler, Valeria. Fundación para la Investigación en Infectología Infantil; ArgentinaFil: Wood, Cristian. Ministerio de Defensa. Ejército Argentino. Hospital Militar Central Cirujano Mayor "Dr. Cosme Argerich"; ArgentinaFil: Caballero, Mauricio Tomás. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación para la Investigación en Infectología Infantil; ArgentinaFil: Wappner, Diego. No especifíca;Fil: Libster, Romina Paula. Fundación para la Investigación en Infectología Infantil; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Perez Marc, Gonzalo. Ministerio de Defensa. Ejército Argentino. Hospital Militar Central Cirujano Mayor "Dr. Cosme Argerich"; ArgentinaFil: Polack, Fernando Pedro. Fundación para la Investigación en Infectología Infantil; Argentin

O paciente crítico em enfermaria de internação geral: análise descritiva dos fatores inerentes à transferência para unidade fechada: análise descritiva dos fatores inerentes à transferência para unidade fechada

Introduction: Unplanned transfers from the General Ward to Critical Care Units occur due to a deterioration in the patient\u27s clinical status. They are of great interest because of their negative impact, associated with longer hospital stays and higher mortality. Objectives: To report the frequency at which these transfers occur, characteristics of these patients and causes of the transfer. Identify shortcomings in the care process that may allow improvement strategies. Methodology: cross-sectional study. Cases were considered those who, during the first 24 hours of hospitalization in the General Ward, required transfer to the ICU between January - December 2022 in a high-complexity hospital in Buenos Aires. Results: Of 8317 admissions, 124 were transferred to the ICU, with a rate of 14 per 1000 and an average of 70 years. The most frequent comorbidities were high blood pressure, heart failure, cancer and overweight-obesity. The main causes of hospitalization were respiratory and gastrointestinal symptoms. 67% had non-alarming results in the NEWS score prior to transfer to the ICU. The most frequent causes were respiratory failure, hemodynamic instability and requirement for monitoring. Average hospital stay was 10 days and in-hospital mortality was 26%. Conclusions: Respiratory decompensation in elderly male patients was the most common cause of transfer to a Closed Unit. One of the shortcomings of the care process seems to be the NEWS score, where in 67% of cases it did not warn about the high requirement of patient monitoring.Introducción: Los traslados no programados, de Sala General a Unidades de Cuidados Críticos, se producen debido a un deterioro en el estado clínico del paciente. Son de gran interés debido a su impacto negativo, asociado con estadías hospitalarias más largas y mayor mortalidad. Objetivos: Reportar la frecuencia en la que ocurren estos traslados, las características de estos pacientes y las causas del pase. Identificar falencias del proceso asistencial que permitan generar estrategias de mejora. Metodología: estudio de corte transversal. Se consideraron casos quienes durante las primeras 24 horas de internación en Sala General requirieron traslado a UCI entre Enero - Diciembre 2022 en un hospital de alta complejidad en Buenos Aires. Resultados: De 8317 ingresos 124 fueron trasladados a UCI, con una tasa de 14 por 1000 y una media de 70 años. Las comorbilidades más frecuentes fueron hipertensión arterial, insuficiencia cardíaca, cáncer y sobrepeso-obesidad. Las principales causas de internación fueron cuadros respiratorios y gastrointestinales. Un 67% tuvieron resultados no alarmantes en el score NEWS previo al pase a UCI. Las causas más frecuentes fueron insuficiencia respiratoria, inestabilidad hemodinámica y requerimiento de monitoreo. La estadía hospitalaria media fue de 10 días y la mortalidad intrahospitalaria 26%. Conclusiones: Los descompensación respiratoria en pacientes añosos de sexo masculino fue la causa más común de pase a Unidad Cerrada.Una de las falencias del proceso asistencial pareciera ser el score NEWS, donde en un 67% de los casos no alertó sobre el alto requerimiento de monitoreo del paciente.Introdução: As transferências não programadas da Enfermaria Geral para Unidades de Cuidados Críticos ocorrem devido à deterioração do estado clínico do paciente. São de grande interesse devido ao seu impacto negativo, associado a internações hospitalares mais prolongadas e maior mortalidade. Objetivos: Relatar a frequência com que ocorrem essas transferências, as características desses pacientes e as causas da transferência. Identificar deficiências no processo de cuidado que permitam gerar estratégias de melhoria. Metodologia: estudo transversal. Foram considerados casos aqueles que, durante as primeiras 24 horas de internação na Enfermaria Geral, necessitaram de transferência para a UTI entre janeiro e dezembro de 2022 em um hospital de alta complexidade de Buenos Aires. Resultados: De 8.317 internações, 124 foram transferidas para UTI, com taxa de 14 por 1.000 e média de 70 anos. As comorbidades mais frequentes foram hipertensão arterial, insuficiência cardíaca, câncer e sobrepeso-obesidade. As principais causas de internação foram sintomas respiratórios e gastrointestinais. 67% tiveram resultados não alarmantes no escore NEWS antes da transferência para a UTI. As causas mais frequentes foram insuficiência respiratória, instabilidade hemodinâmica e necessidade de monitorização. A média de internação hospitalar foi de 10 dias e a mortalidade hospitalar foi de 26%. Conclusões: A descompensação respiratória em pacientes idosos do sexo masculino foi a causa mais comum de transferência para Unidade Fechada. Uma das deficiências do processo assistencial parece ser o escore NEWS, onde em 67% dos casos não alertou sobre a alta exigência de monitoramento do paciente