ABSTRACT
Objective: Coronavirus disease 2019 (COVID-19) represents a major clinical problem in terms of death and long-term sequelae. We conducted a retrospective cohort study at Montichiari Hospital (Brescia, Italy) to better understand different determinants of outcome in different COVID-19 outbreaks. Design and method: A total of 635 patients admitted from local emergency room with a confirmed diagnosis of SARS-CoV-2 infection and a moderate to severe COVID-19 were included in the present study. A group of 260 consecutive patients during SARS-CoV-2 first wave (from February to May 2020) and 375 consecutive patients during SARS-CoV-2 second/third wave (from October 2020 to May 2021) were considered. Demographic data, comorbidities, ongoing treatment and bio-humoral, respiratory and haemodynamic data were recorded and compared. Results: Main demographic data (Table 1) were not significantly different in the two considered time-lapses, except a lower prevalence of female sex during first wave. Mortality rate was significantly lower during the latter period (25% vs 11%;p < 0.001). Time from symptoms onset to hospital admission was longer during first wave (7.8 ± 5.6 vs 5.6 ± 4.3 days;p < 0.001) while hospital staying was significantly shorter (11 ± 10 vs 15 ± 12 days;p < 0.001). Other significant differences were a wider use of corticosteroids and low-molecular weight heparin (LMWH) as well less antibiotic prescription during the second wave (Table 2). Respiratory, bio-humoral and x-Ray score were significantly poorer at the time of admission in first-wave patients (Table 3). After a multivariate regression analysis, C-reactive protein and procalcitonin values, % fraction of inspired oxygen at admission, days after symptoms onset and duration of hospital staying were the strongest predictors of outcome in both periods. Concomitant anti-hypertensive treatment (including ACE-inhibitors and ARBs) did not affect outcome. Conclusions: Our preliminary data suggest that an earlier diagnosis, a timely hospital admission and a rational use of the therapeutic options allowed to reduce the rate of systemic inflammation response (of which CRP is a hallmark) and granted a better outcome during the second of the two time-lapses considered.
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Objective: Worldwide spread of SARS-CoV-2 caused a pandemic as never were seen in the last fifty years and represented a major clinical problem in Lombardy, one of the most affected Italian Regions, in terms of death toll and long-term sequelae. This is particularly true when elder people are considered;therefore, we conducted a retrospective cohort study in the General Medicine of our Hospital. Design and method: In the present study we recorded data of patients older than 65 years, admitted to a COVID-19 unit during 2020 and 2021;we compared the characteristics of in-patients admitted in the first (March-May 2020) and the second/ third pandemic waves (October 2020-May 2021) Results: A total of 407 patients 65 year-old and older were included, 185 during the first wave and 222 during second/third waves;63 (34%) of them died during the first and 36 (16%) during the second/third wave. No significant differences were found according to main comorbidities and chronic prescriptions between the two groups of patients, whereas those admitted during the second/third wave were slightly older. Number of in-hospital adverse events were similar in the two samples. Main differences between the two groups were: a lower mean number of days with symptoms before hospitalization, and a less severe laboratory, respiratory ed radiologic profile. Further, steroid treatment was highly implemented during the second/third wave. Conclusions: Older patients admitted to hospital since the beginning of the pandemic showed diverse clinical severity profile according to different waves;patient admitted during the first wave had worse respiratory, radiological and laboratory parameters than those admitted in the second/third wave;further difference was found in COVID-19 treatment during hospital stay as steroids were largely administered during the latter waves.
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Introduction and Aim Diagnosis of SARS-CoV-2 infection is mainly based on gene detection through polymerase chain reaction analysis on nasopharyngeal swab. The Allplex TM 2019-nCoV assay targets 3 different viral genes: RNA-dependent RNA polymerase, envelope, and nucleocapside. A coding system was developed based on different number of genes expressed: a nasopharyngeal swab was considered "positive" if all 3 genes tested underwent amplification, "mildly positive" if only 2 out of 3 genes were detected, "uncertain" if only 1 gene and "negative" if none resulted amplified from the test. Our aim was to assess whether this classification correlates with clinical outcome in a cohort of COVID-19 patients. Methods This is a retrospective study including patients admitted with diagnosis of SARS-CoV-2 infection to a medical ward at the Montichiari Hospital, Brescia, Italy, from February 28 to April 30, 2020. All patients underwent the nasopharyngeal swab upon admission. Results A total of 204 patients were included in this study. Patients with full positive nasopharyngeal swab showed higher values of C-reactive protein and neutrophiles/lymphocytes ratio compared with patients with mildly positive or uncertain nasopharyngeal swab. Mortality did not differ between the 2 groups. A Cox multivariate analysis showed that age, male sex, and CRP values are independent predictors of in-hospital mortality. Conclusions Our study demonstrated that patients with a complete SARS-CoV-2 gene detection nasopharyngeal swab show a higher inflammatory profile, and this can be an indirect measurement of viral load in COVID-19 patients.
ABSTRACT
The real estimate of the infection fatality rate of SARS-CoV-2 is a pivotal aspect of the COVID-19 pandemic. However, this number is still debated, since both the numerator and the denominator are uncertain. Data analysis from the most affected areas in the world minimizes computational errors and represents a unique approach for estimating infection fatality rate. We first extracted data from PubMed/Medline, Google, traditional media and social media to obtain the rate of SARS-CoV-2 antibodies seroprevalence in the most affected and best-studied areas in the world: Val Seriana (Italy), Ischgl (Austria) and Manaus (Brasil). We then searched mortality data from national institutes of statistics and calculated excess mortality. We estimated the infection fatality rate considering several scenarios according to the mortality attributable to COVID-19 and the proportion of the population infected with the virus. We found that the seropositivity was surprisingly close to 40% in all the considered areas. We calculated the SARS-CoV-2 infection fatality rate for Val Seriana, using from half to the entire excess mortality (1208 deaths) and considering from 40% to 80% of the population as being infected with SARS-CoV-2. In the most conservative scenario, infection fatality rate was as low as 0.55%, while in the worst-case one it was 2.2%. We found that the seroconversion rate in the most affected areas worldwide is about 40%. We consequently estimated the infection fatality rate to be between 0.55% and 2.2% in an area with a relatively elderly population. © 2021 The Author(s). Published by MRE Press.
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Objective: Patients affected by novel pandemic SARS-CoV-2 may develop COVID-19 related pneumonia, which is potentially fatal. To date, the role of ongoing treatments for different conditions (such as hypertension) has been clarified in terms of their impact on survival and there is no established specific therapy for the disease, although many molecules are under investigation. Aim of the present study was testing those two issues in a population of 258 consecutive patients admitted from 29 February to 30 April 2020 to General Medicine ward of the Hospital of Montichiari (Brixia). Design and method: A group of 258 patients (173 males and 85 females, aged 71 ± 14) was enrolled. Their medical record and ongoing treatment were assessed. Patients were treated according to emerging information with oxygen, anti-malarian agents, anti-viral drugs, different antibiotics (azithromycin and others), tocilizumab and low molecular weight heparin (LMWH) at different doses. As of June 10th, 65 deaths had been observed. Survival curves were calculated according to Kaplan-Meier method. Comparison between groups was performed with Breslow and Mantel-Cox test Results: Ongoing therapy with ACE-inhibitors at the time of admission was associated with a worse prognosis (p=0.004), while no difference in survival was observed in patients under treatment with ARBs (p=0.68). Ongoing treatment with statins (p<0.001), low-dose aspirin (p<0.001) and steroids (p<0.001) was associated with a poorer outcome as well Administration during hospitalization of LMWH (p<0.001), steroids (p<0.001), anti-viral drugs (p=0.002), anti-malarian drugs (p<0.001) and tocilizumab (p<0.001), improved prognosis, while antibiotics (azithromycin and other) didn't have any impact. Conclusions: our experience confirms most findings in ongoing trials. Surprisingly, treatment with ACE-inhibitors seems to impact negatively on survival in patients affected by SARS-CoV-2 pneumonia. A possible explanation may be that patients treated with certain drugs are more comorbid and due to this, more fragile.
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Objective: COVID-19 is a new disease caused by pandemic SARS-CoV-2, that involves multiple organs and can cause a potentially fatal respiratory distress syndrome. Accumulating evidence point out that an “endothelitis” due to a cytokines storm causes intravascular thrombosis, especially in the lungs, and is related to the poor outcome. We tested possible relationships between anticoagulant treatment and/or administration of low molecular weight heparin (LMWH) at different doses and outcome in a population of 258 COVID-19 patients admitted from February 28th to April 30th, 2020 to General Medicine ward of the Hospital of Montichiari (Brixia, Italy). Design and method: A group of 258 consecutive patients (174 males and 84 females, mean age 71 years +/-14) was included in the present study. In 168 patients, high-flow oxygen was required (Venturi mask), 6 patients needed orotracheal intubation and 20 were given continuous positive pressure oxygen therapy (CPAP). Patient were treated (unless a pulmonary embolism was detected) with different doses of prophylactic LMWH, according to emerging evidence during pandemic period. As of June 10th, 65 deaths had been observed. Survival curves were calculated according to Kaplan-Meier method. Comparison between groups was performed with Breslow and Mantel-Cox test. Results: LMWH at standard dose (4000 IU once daily) didn't reduce mortality compared to no treatment (p=ns), while LMWH at a higher dose than usual prophylactic dose (enoxaparin 6000 IU once daily or 4000 IU bid) was associated with better outcome (p<0.001 vs untreated and treated with standard dose). Significance was confirmed adding patients treated with oral anti-coagulant (OAC)for any reason. None of the patients treated with LMWH at higher doses or OAC died. Conclusions: The administration of subcutaneous LMWH at a higher dose than indicated for deep vein thrombosis prophylaxis is associated with a better outcome in patients with SARS-CoV-2 pneumonia, confirming some emerging evidence.
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Objective: Emerging data show that hypertension as well as other cardiovascular risk factors may have a major role on outcome in terms of death on patients with COVID-19. We analysed a population of 258 consecutive patients admitted to General Medicine ward of the Hospital of Montichiari (Brixia, Italy) from 29 February to 30 April 2020. Design and method: A group of 258 consecutive patients (173 males and 85 females, aged 71 ± 14) was enrolled. In 168 patients, high-flow oxygen was required (Venturi mask), 20 patients needed orotracheal intubation and 11 were given continuous positive pressure oxygen therapy (CPAP). Patients were treated with the best approach according to available evidence during pandemic period: anti-malaria agents, anti-viral drugs, antibiotics (azithromycin and others), tocilizumab and low molecular weight heparin (LMWH). As of June 10th, 65 deaths had been observed. Survival curves were calculated according to Kaplan-Meier method. Comparison between groups was performed with Breslow and Mantel-Cox test. Results: As shown in the table, a significant raise in mortality was observed in patients older than 65 years (p<0.001), of male sex (p<0.001), hypertensives (p<0.001) as well as in patients with heart disease (picture 1;p<0.001), COPD (picture 2;p=0.004), diabetes (p<0.001) and neoplasms (p=0.03) compared with patients with no comorbidities or different diseases, both at discharge and at standard follow-up. The number of comorbidities impacted on survival as well. Conclusions: Hypertension, heart disease and cardiovascular risk factors play a significant role as a negative prognostic factor in patients affected by SARSCoV-2 pneumonia. This confirms previous observations (Pol Arch Intern Med 2020;130(4):304-309) and outlines the importance of prevention of contagion in population with cardiovascular risk factors or established cardiovascular disease.