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Early predictors of clinical outcomes of COVID-19 outbreak in Milan, Italy.

ABSTRACT: BACKGROUND:National health-system hospitals of Lombardy faced a heavy burden of admissions for acute respiratory distress syndromes associated with coronavirus disease (COVID-19). Data on patients of European origin affected by COVID-19 are limited. METHODS:All consecutive patients aged ?18 years, coming from North-East of Milan's province and admitted at San Raffaele Hospital with COVID-19, between February 25th and March 24th, were reported, all patients were followed for at least one month. Clinical and radiological features at admission and predictors of clinical outcomes were evaluated. RESULTS:Of the 500 patients admitted to the Emergency Unit, 410 patients were hospitalized and analyzed: median age was 65 (IQR 56-75) years, and the majority of patients were males (72.9%). Median (IQR) days from COVID-19 symptoms onset was 8 (5-11) days. At hospital admission, fever (? 37.5 °C) was present in 67.5% of patients. Median oxygen saturation (SpO2) was 93% (range 60-99), with median PaO2/FiO2 ratio, 267 (IQR 184-314). Median Radiographic Assessment of Lung Edema (RALE) score was 9 (IQR 4-16). More than half of the patients (56.3%) had comorbidities, with hypertension, coronary heart disease, diabetes and chronic kidney failure being the most common. The probability of overall survival at day 28 was 66%. Multivariable analysis showed older age, coronary artery disease, cancer, low lymphocyte count and high RALE score as factors independently associated with an increased risk of mortality. CONCLUSION:In a large cohort of COVID-19 patients of European origin, main risk factors for mortality were older age, comorbidities, low lymphocyte count and high RALE.

SUBMITTER: Ciceri F

PROVIDER: S-EPMC7289745 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Early predictors of clinical outcomes of COVID-19 outbreak in Milan, Italy.

Ciceri Fabio F Castagna Antonella A Rovere-Querini Patrizia P De Cobelli Francesco F Ruggeri Annalisa A Galli Laura L Conte Caterina C De Lorenzo Rebecca R Poli Andrea A Ambrosio Alberto A Signorelli Carlo C Bossi Eleonora E Fazio Maria M Tresoldi Cristina C Colombo Sergio S Monti Giacomo G Fominskiy Efgeny E Franchini Stefano S Spessot Marzia M Martinenghi Carlo C Carlucci Michele M Beretta Luigi L Scandroglio Anna Maria AM Clementi Massimo M Locatelli Massimo M Tresoldi Moreno M Scarpellini Paolo P Martino Gianvito G Bosi Emanuele E Dagna Lorenzo L Lazzarin Adriano A Landoni Giovanni G Zangrillo Alberto A

Clinical immunology (Orlando, Fla.) 20200612

<h4>Background</h4>National health-system hospitals of Lombardy faced a heavy burden of admissions for acute respiratory distress syndromes associated with coronavirus disease (COVID-19). Data on patients of European origin affected by COVID-19 are limited.<h4>Methods</h4>All consecutive patients aged ≥18 years, coming from North-East of Milan's province and admitted at San Raffaele Hospital with COVID-19, between February 25th and March 24th, were reported, all patients were followed for at lea ...[more]

PMID: 32535188

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Project description:Introduction: Multiple risk factors of mortality have been identified in patients with COVID-19. Here, we sought to determine the effect of a history of neurological disorder and development of neurological manifestations on mortality in hospitalized patients with COVID-19. Methods: From March 20 to May 20, 2020, hospitalized patients with laboratory confirmed or highly suspected COVID-19 were identified at four hospitals in Ohio. Previous history of neurological disease was classified by severity (major or minor). Neurological manifestations during disease course were also grouped into major and minor manifestations. Encephalopathy, ischemic or hemorrhagic stroke, and seizures were defined as major manifestations, whereas minor neurological manifestations included headache, anosmia, dysgeusia, dizziness or vertigo, and myalgias. Multivariate logistic regression models were used to determine significant predictors of mortality in patients with COVID-19 infection. Results: 574/626 hospitalized patients were eligible for inclusion. Mean age of the 574 patients included in the analysis was 62.8 (SD 17.6), with 298 (51.9%) women. Of the cohort, 240(41.8%) patients had a prior history of neurological disease (HND), of which 204 (35.5%) had a major history of neurological disease (HND). Mortality rates were higher in patients with a major HND (30.9 vs. 15.4%; p = 0.00002), although this was not a significant predictor of death. Major neurological manifestations were recorded in 203/574 (35.4%) patients during disease course. The mortality rate in patients who had major neurological manifestations was 37.4% compared to 11.9% (p = 2 × 10-12) in those who did not. In multivariate analysis, major neurological manifestation (OR 2.1, CI 1.3-3.4; p = 0.002) was a predictor of death. Conclusions: In this retrospective study, history of pre-existing neurological disease in hospitalized COVID-19 patients did not impact mortality; however, development of major neurological manifestations during disease course was found to be an independent predictor of death. Larger studies are needed to validate our findings.

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Early predictors of clinical outcomes of COVID-19 outbreak in Milan, Italy.

Publications

Early predictors of clinical outcomes of COVID-19 outbreak in Milan, Italy.

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