ABSTRACT
Background: Robust data on case fatality rate (CFR) among inpatients with COVID-19 are still lacking, and the role of patient characteristics in in-hospital deaths remains under-investigated. This study quantified the overall CFR and described its trend in a cohort of hospitalized patients with SARS-CoV-2 in Italy. Admission to ICU, death, or discharge were the secondary outcomes. Methods: This retrospective study is based on administrative health data and electronic case records of inpatients consecutively admitted to Niguarda Hospital between 21 February and 8 November 2020. Results: An overall CFR of 18% was observed. CFR was significantly reduced during the second wave of contagion (1 June to 30 September, 16%) compared with the first wave (21 February to 31 May, 21% p = 0.015). Such reduction was mainly observed among male inpatients between 40 and 80 years with limited comorbidities. Admission to ICU was associated with a high risk of mortality in both waves. The incidence of severe disease and the need for ICU admission were lower in the second wave. Conclusion: CFR in SARS-CoV-2 inpatients was demonstrated to decrease over time. This reduction may partly reflect the changes in hospital strategy and clinical practice. The reasons for this improvement should be further investigated to plan an exit strategy in case of future outbreaks. Key messages: What is already known on this topic Before the advent of anti-COVID-19 vaccines, a multi-wave pattern of contagion was observed, and this trend conditioned the inpatient case fatality rate (CFR), which varied over time accordingly to the waves of contagion.Only preliminary results on the in-hospital mortality trend are available, along with a partial analysis of its determinants. Consequently, robust data on CFR among inpatients with SARS-CoV-2 infection are still lacking, and the role of patient characteristics in in-hospital deaths remains under-investigated. What this study adds This study shows that the in-hospital mortality in patients with SARS-CoV-2 infection decreases over time.Such reduction was mainly observed among male inpatients between 40 and 80 years with limited comorbidities. Admission to ICU was invariably associated with a high risk of mortality during the whole study period (21 February to 8 November 2020), but the incidence of severe disease and the need for ICU admission were lower in the second wave of contagions (1 October to 8 November 2020). This reduction may partly reflect the impact of changes in hospital strategy and clinical practice. The reasons for this improvement should be further investigated to inform the response to future outbreaks and to plan exit strategy by prioritizing high-risk populations. Supplementary Information: The online version contains supplementary material available at 10.1007/s10389-021-01675-y.
ABSTRACT
Background: Coronavirus disease of 2019 (COVID-19) is associated with severe acute respiratory failure. Early identifcation of low-risk COVID-19 patients is crucial, discharging safely patients to home and optimizing the use of available resources. Methods: We aimed to external validate a simple score for the prediction of low-risk outcomes. A retrospective cohort study of patients hospitalized for COVID-19 was carried out by the Busto Hospital and Niguarda hospital. Epidemiological, clinical, laboratory, and treatment variables were collected at hospital admission. Variables included in this retrospective cohort were analized to validate the Busto COVID-19 score as a Clinical Risk Score able to individuate low risk COVID-19 patients. Among COVID-19 patients admitted to the hospital, severe outcome was defned as the composite of the admission to the Intensive Care Unit or death. Results: : The development cohort included 427 consecutive patients. The mean (SD) age of patients among the cohort was 60.5 years; 273 (63%) were men. As potential predictors, Busto COVID-19 score variables include: lung ultrasound abnormality, age, total white blood cells count , C-reactive protein value, pO2/FiO2 ratio, lactates value, arterial hypertension and fever from 5 days or more and resulted in the best performing score with an area under the curve in the derivation sample of 0.88 and 0.71 in the external sample. Conclusions: The proposed score can identify patients at low risk for severe outcome who can be safely managed in a low-intensity setting after hospital admission for COVID-19.