Risk Factors Associated with the Mortality of COVID-19 Patients Aged ≥60 Years Neither Intubated nor Treated with Mechanical Ventilation: A Multicentre Retrospective Cohort Study during the First Wave in Spain

Background: To determine risk factors of death in diagnosed patients with COVID-19 who were aged ≥60 years and could not benefit from intubation and mechanical ventilation. Methods: Retrospective multicentre study including all patients with COVID-19 admitted to four medium-stay centres in Catalonia (March-June 2020). At the multivariate level, we calculated hazard ratios (HR) with 95% confidence intervals (CI) to determine risk factors associated with mortality. Results: 683 patients were included, of whom 227 died (case fatality rate of 33%, reaching 42% in patients of more than 90 years). Mean survival was 21.92 (20.98–22.86) days. Factors associated with death were fever (HR:1.5 (1.06–2.13)), malaise (HR:1.4 (1.04–1.99)), dyspnoea (HR:1.98 (1.41–2.79)) and atrial fibrillation (HR:1.45 (1.03–2.05)), while coughing (HR: 0.66 (0.46–0.94)), diarrhoea (HR:0.46 (0.23–0.92)), dyslipidaemia (HR:0.47 (0.28–0.82)), and receiving antithrombotic treatment (HR:0.56 (0.40–0.78)) had a protective effect. The analysis by age group showed that other factors were uniquely associated with each age group, such as chronic obstructive pulmonary disease at 60–74 years and polypharmacy at 75–90 years, among other factors. Conclusions: Case fatality in COVID-19 patients who could not benefit from intubation and mechanical ventilation was exceptional. Clinical manifestations such as fever, malaise, dyspnoea and atrial fibrillation helped to identify patients at higher risk of mortality, while antithrombotic treatment had a protective effect. Although some symptoms are very general regarding COVID-19, in the context of the first wave without vaccination, when not much was known about the disease, such symptoms could be useful.

Impact of the COVID-19 pandemic on contact tracing of patients with pulmonary tuberculosis.

BACKGROUND: The COVID-19 pandemic could have negative effects on tuberculosis (TB) control. The objective was to assess the impact of the pandemic in contact tracing, TB and latent tuberculosis infection (LTBI) in contacts of patients with pulmonary TB in Catalonia (Spain). METHODS: Contact tracing was carried out in cases of pulmonary TB detected during 14 months in the pre-pandemic period (1 January 2019 to 28 February 2020) and 14 months in the pandemic period (1 March 2020 to 30 April 2021). Contacts received the tuberculin skin test and/or interferon gamma release assay and it was determined whether they had TB or LTBI. Variables associated with TB or LTBI in contacts (study period and sociodemographic variables) were analyzed using adjusted odds ratio (aOR) and the 95% confidence intervals (95% CI). RESULTS: The pre-pandemic and pandemic periods showed, respectively: 503 and 255 pulmonary TB reported cases (reduction of 50.7%); and 4676 and 1687 contacts studied (reduction of 36.1%). In these periods, the proportion of TB cases among the contacts was 1.9% (84/4307) and 2.2% (30/1381) (P = 0.608); and the proportion of LTBI was 25.3% (1090/4307) and 29.2% (403/1381) (P < 0.001). The pandemic period was associated to higher LTBI proportion (aOR = 1.3; 95% CI 1.1-1.5), taking into account the effect on LTBI of the other variables studied as sex, age, household contact and migrant status. CONCLUSIONS: COVID-19 is affecting TB control due to less exhaustive TB and LTBI case detection. An increase in LTBI was observed during the pandemic period. Efforts should be made to improve detection of TB and LTBI among contacts of TB cases.

Diabetes and tuberculosis: A syndemic complicated by COVID-19.

Tuberculosis (TB) is the leading cause of infectious mortality in the world, affecting mainly developing countries (DC), while diabetes (DM) is one of the most prevalent chronic diseases. This review analyzes the fact that diabetes is currently an important risk factor for developing TB, also presenting more complicated TB, more relapses and higher mortality. The DCs and the fourth world of the large cities are those with the highest incidence of TB and an increase in DM, which will make it difficult to control tuberculosis disease. At the same time, the COVID-19 pandemic is complicating the management of both diseases due to the difficulty of access to control and treatment and the worsening of socioeconomic inequalities. It is necessary to establish a bidirectional screening for TB and DM and promote recommendations for the joint management of both diseases.

La tuberculosis (TB) era la primera causa de mortalidad infecciosa mundial hasta la pandemia de COVID-19. Afecta sobre todo a los países en vías de desarrollo (PVD), mientras que la diabetes mellitus (DM) es una de las enfermedades crónicas más prevalentes.En esta revisión se objetiva que la DM constituye actualmente un importante factor de riesgo para desarrollar TB, presentando además TB más complicadas, más recaídas y mayor letalidad. Los PVD y el cuarto mundo de las grandes ciudades son los que presentan mayor incidencia de TB y un incremento de la DM, lo que dificultará el control de la enfermedad tuberculosa. Paralelamente, la pandemia por COVID-19 está complicando el manejo de ambas enfermedades por la dificultad de acceso al control y tratamiento y por el empeoramiento de desigualdades socioeconómicas. Es necesario establecer un cribado bidireccional de TB y DM e impulsar recomendaciones para el manejo conjunto de ambas enfermedades.

Diabetes and tuberculosis: a syndemic complicated by COVID-19. / Diabetes y tuberculosis: una sindemia complicada por la COVID-19.

Tuberculosis (TB) is the leading cause of infectious mortality in the world, affecting mainly developing countries (DC), while diabetes (DM) is one of the most prevalent chronic diseases. This review analyzes the fact that diabetes is currently an important risk factor for developing TB, also presenting more complicated TB, more relapses and higher mortality. The DCs and the fourth world of the large cities are those with the highest incidence of TB and an increase in DM, which will make it difficult to control tuberculosis disease. At the same time, the COVID-19 pandemic is complicating the management of both diseases due to the difficulty of access to control and treatment and the worsening of socioeconomic inequalities. It is necessary to establish a bidirectional screening for TB and DM and promote recommendations for the joint management of both diseases.