COVID-19 Incidence and Mortality in Pre-Dialysis Chronic Kidney Disease Patients (preprint)

Many studies reported a higher risk of COVID-19 disease among patients on dialysis or with kidney transplantation, and the poor outcome of COVID-19 in these patients. Patients in conservative management for chronic kidney disease (CKD) have received attention only recently, therefore less is known about how COVID-19 affects this population. The aim of this study was to provide evidence on COVID-19 incidence and mortality in CKD patients followed up in an integrated healthcare program and in the population living in the same catchment area.The study population included CKD patients in conservative management recruited in the Emilia-Romagna Prevention of Progressive Renal Insufficiency (PIRP) project, followed up in the 4 nephrology units (Ravenna, Forlì, Cesena and Rimini) of the Romagna Local Health Authority (Italy) and alive at 1.01.2020. We estimated the incidence of COVID-19, its related mortality and the excess mortality within the PIRP cohort as of 31.07.2020. COVID-19 incidence in CKD patients was 4.09% (193/4,716 patients), while in the general population it was 0.46% (5,195/1,125,574). The crude mortality rate among CKD patients with COVID-19 was 44.6% (86/193), compared to 4.7% (215/4,523) in CKD patients without COVID-19. The excess mortality of March-April 2020 was +69.8% than the average mortality of March-April 2015-19 in the PIRP cohort. In a cohort mostly including regularly followed up CKD patients, the incidence of COVID-19 disease and COVID-19 related mortality were about ten times higher than those of the general population. The incidence of COVID-19 among CKD patients was strongly related to the spread of the infection in the community, while its lethality is associated with the underlying kidney condition and comorbidities. For this reason, it is urgent to offer a direct protection to CKD patients by prioritizing their vaccination.

Non-COVID-19 patients in times of pandemic: decreased emergency department visits and increased out-of-hospital mortality in Northern Italy (preprint)

ObjectiveThe aim of this was to assess the short-term impact of the pandemic on non-COVID-19 patients living in a one-million inhabitants area in Northern Italy (Bologna Metropolitan Area-BMA), analyzing time trends of Emergency Department (ED) visits, hospitalizations and mortality. MethodsWe conducted a retrospective observational study using data extracted from BMA healthcare informative systems. Weekly trends of ED visits, hospitalizations, in- and out-of-hospital, all-cause and cause-specific mortality between December 1st, 2019 to May 31st, 2020, were compared with those of the same period of the previous year, using Joinpoint regression models and incidence rate ratios. ResultsNon-COVID-19 ED visits and hospitalizations showed a stable trend until the first Italian case of COVID-19 has been recorded, on February 19th, 2020, when they dropped simultaneously. The reduction of ED visits was observed in all age groups and across all severity and diagnosis groups. In the lockdown period a significant increase was found in overall out-of-hospital mortality (43.2%) and cause-specific out-of-hospital mortality related to neoplasms (76.7%), endocrine, nutritional and metabolic (79.5%) as well as cardiovascular (32.7%) diseases. ConclusionsThe pandemic caused a sudden drop of ED visits and hospitalizations of non-COVID-19 patients during the lockdown period, and a concurrent increase in out-of-hospital mortality mainly driven by deaths for neoplasms, cardiovascular and endocrine diseases. The findings of this study might be useful to understand both the population reaction and the healthcare system response at the early phases of the pandemic in terms of reduced demand of care and systems capability in intercepting it.

Non-COVID-19 Patients in Times of Pandemic: Decreased Emergency Department Visits and Increased Out-of-Hospital Mortality in Northern Italy (preprint)

Background: The COVID-19 pandemic forced healthcare services organization to adjust to healthcare needs of a mutating population. In this context, our aim was to assess the short-term impact of the pandemic on non-COVID-19 patients living in a one-million inhabitants area in Northern Italy (Bologna Metropolitan Area-BMA), analyzing time trends of ED visits, hospitalizations and mortality.Methods: We conducted a retrospective observational study using data extracted from BMA healthcare informative systems. Weekly trends of ED visits, hospitalizations, in- and out-of-hospital, all-cause and cause-specific mortality between December 1st, 2019 to May 31st, 2020, were compared with those of the same period of the previous year, using Joinpoint regression models and incidence rate ratios.Findings: Non-COVID-19 ED visits and hospitalizations showed a stable trend until the first Italian case hospitalized for COVID-19 has been recorded, on February 19th, 2020, when they dropped simultaneously with the growth of the SARS-CoV-2 curve. The marked reduction of ED visits was observed in all age groups and across all severity codes and diagnosis groups. In the lockdown period a significant increase was found in overall out-of-hospital mortality (43·2%) and cause-specific out-of-hospital mortality related to neoplasms (76·7%), endocrine, nutritional and metabolic (79·5%) as well as cardiovascular (32·7%) diseases.Interpretation: Our main finding is a sudden drop of ED visits and hospitalizations of non-COVID-19 patients during the pandemic and the concurrent increase in out-of-hospital mortality, particularly for neoplasms, cardiovascular and endocrine diseases. As a second phase of the COVID-19 pandemic is currently underway, the scenario described in this study might be useful to understand both the population reaction and the healthcare system response at the early phases of the pandemic in terms of reduced demand of care and systems capability in intercepting it.Fundings: This study received no specific funding.Declaration of Interests: All the authors declare no conflict of interests.Ethics Approval Statement: The study was approved by the Emilia Romagna Ethical Committee on August 3rd, 2020.

Covid-19 and low molecular weight heparin therapy: retrospective study of 257 patients. (preprint)

A hypercoagulability state with fatal thrombosis events seems to characterize the clinical worsening of COVID-19 pneumonia. The benefit and safety of anticoagulant doses of low molecular weight heparin (LMWH) in COVID-19 are still unknown. We evaluated in a retrospective cohort study 257 COVID-19 patients consecutively admitted to our COVID-Hospital from February 29, to April 7, 2020. We compared the in-hospital mortality between patients treated with prophylactic or therapeutic doses of LMWH. Of the 257 patients enrolled, 49 (19.1%) died during the hospitalization. Hospital mortality was significantly lower in patients treated with therapeutic doses of LMWH (enoxaparin 70-100 I.U./kg twice daily) (17/126, 13.5%), than in patients treated with prophylactic doses (60-90 I.U./kg once daily) (32/131, 24.4%; χ²=4.98, p = 0.02). In a stratified analysis by ventilation type, the only subgroup of patients who benefited from therapeutic LMWH was that requiring noninvasive mechanical ventilation (OR=0.099, 95% CI 0.028-0.354, p<0.001). No fatal bleedings were observed. In this retrospective study the treatment with therapeutic LMWH is safe and seems to reduce mortality in COVID-19 patients, especially among those who need noninvasive mechanical ventilation. Authors Daniela Aschieri and Marco Stabile contributed equally to this work.