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2.
Vaccines (Basel) ; 10(9)2022 Sep 16.
Article in English | MEDLINE | ID: covidwho-2044015

ABSTRACT

Some vaccinated individuals still develop severe COVID-19, and the underlying causes are not entirely understood. We aimed at identifying demographic, clinical, and coinfection characteristics of vaccinated patients who were hospitalized. We also hypothesized that coinfections might play a role in disease severity and mortality. We retrospectively collected data from our COVID-19 registry for whom vaccination data were available. Patients were split into groups based on the number of administered doses (zero, one, two, or three). Data were assessed with Chi-square and Kruskal-Wallis tests and multiple logistic regression analysis. We collected data from 1686 patients and found that intra-hospital mortality was not associated to the vaccination status (e.g., p = 0.2 with three doses), while older age, sepsis, and non-viral pneumonia were (p < 0.001). Unvaccinated patients needed mechanical ventilation more often (8.5%) than vaccinated patients, in whom the probability of mechanical ventilation decreased with increasing doses (8.7%, 2.8%, 0%). We did not find more coinfections in vaccinated people. We concluded that there is a lack of real-life data to adequately characterize the pathophysiology and risk factors of patients who develop severe COVID-19, but coinfections do not appear to play a role in disease severity.

3.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-334280

ABSTRACT

Background: the hyperinflammation phase of severe SARS-CoV-2 is characterized by complete blood count alterations. In this context, the neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) can be used as prognostic factors. We study NLR and PLR trends at different timepoints and compute optimal cutoffs to predict four outcomes: use of Continuous Positive Airways Pressure (CPAP), ICU admission, invasive ventilation and death. Methods: : we retrospectively included all adult patients with SARS-CoV-2 pneumonia admitted from 23 rd January 2020 to 18 th May 2021. Data were extracted using ICD9 codes and our Covid-19 registry. Analyses included descriptive statistics and non parametric tests to study the ability of NLR and PLR to distinguish the patients’ outcomes at each timepoint. ROC curves were built for NLR and PLR at each timepoint (minus discharge) in order to identify cutoffs to distinguish severe and non severe disease and their statistical significance was assessed with the Chi-square test. NLR and PLR were compared with DeLong’s test. Results: : we included 2169 patients. NLR and PLR were higher in severe Covid-19 at all the timepoints, with a difference that gets bigger and a trend that is steeper in more severe disease. Both ratios were able to distinguish the outcomes at each timepoint. For NLR, the areas under the curve (AUROC) ranged between 0.59 and 0.81, for PLR, between 0.53 and 0.67. From each ROC curve we computed an optimal cutoff value (e.g. NLR 7 for CPAP for males at admission). NLR performed better than PLR. Conclusion: our results are in line with other studies that computed NLR and PLR trends and values in disease, especially with those that distinguished between different grades of severity. Our study is retrospective and single centre, and is limited by selection bias, but includes more than 2000 patients, thus limiting the confounding factors and outliers. Our cutoffs do not only deal with severity and mortality but allow for a more tailored approach. Future prospect include validating our cutoffs in a prospective cohort and comparing their performance against other Covid19 scores.

4.
Heliyon ; 8(2): e08895, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1778151

ABSTRACT

COVID-19 tide had shattered on European countries with three distinct and tough waves, from March and April, 2020; October and November, 2020 and March and April, 2021 respectively. We observed a 50% reduction in the hazard of death during both wave II and III compared with wave I (HR 0.54, 95%CI 0.39-0.74 and HR 0.57, 95%CI 0.41-0.80, respectively). Sex and age were independent predictors of death. We compare in-hospital mortality of COVID-19 patients admitted at our Referral Hospital of Northern Italy during the different waves, discuss the reasons of the observed differences and suggest approaches to the challenges ahead.

5.
Front Psychol ; 12: 820074, 2021.
Article in English | MEDLINE | ID: covidwho-1731829

ABSTRACT

Burnout is a well-documented entity in Care Workers population, affecting up to 50% of physicians, just as it is equally well established that managing an infectious disease outbreaks, such as confirmed in the COVID-19 pandemic, increases Post-Traumatic Stress Disorder (PTSD) and the psychological burden. Mental health support, in the form of formal or remote sessions, has been shown to be helpful to health care staff, despite the organizational difficulties in an emergency. During the first emergence of COVID-19 in Italy, the Scientific Institute for Research, Hospitalization and Health Care Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo Foundation (Pavia, Lombardy), the Italian hospital that treated "patient 1," has activated an agreement with the Soleterre Foundation, an international Non-Governmental Organization (NGO) that manages health emergency projects, to provide psychological support. A task force of psychologists was created with the aim of designing and administering a Therapeutic Mental Health Assessment for COVID-19 Care Workers (TMHA COVID-19 CWs) to evaluate and support health care workers' mental health. The assessment battery was developed to evaluate symptoms and behaviors associated with trauma and the corresponding maladaptive behaviors (the National Stressful Events Survey for PTSD-Short Scale "NSESSS" and the Diagnostic and Statistical Manual of Mental Disorders "DSM-5" Self-Rated Level 1 transversal Symptom Measure-Adult). Once the TMHA COVID-19 CWs had been developed, the team of psychologists regularly visited healthcare staff in the ward to administer it. One hundred seven care workers (44 males, mean age 40 ± 15) across Intensive Care Units (ICUs), the emergency room and medical ward were administered the TMHA COVID-19 CWs. PTSD symptoms were reported as severe by 13% of the population. Depressive symptoms as severe for 7% and Anxiety symptoms as severe for 14%. Severe psychotic symptoms were experienced by 2% and severe suicidal thoughts by 1% of the population. The possibility of acting upon the results of the TMHA COVID-19 CWs allowed an early intervention through individual session beyond the cut-off level (moderate and severe symptoms) for PTSD in NSESSS. In fact, 280 individual support sessions were offered. Therefore, we considered our project a protective and support factor for healthcare workers' mental well-being and we recommend implementing a mental health screening program in ward involved in COVID-19 patients' care.

6.
EuropePMC;
Preprint in English | EuropePMC | ID: ppcovidwho-328806

ABSTRACT

Background: the hyperinflammation phase of severe SARS-CoV-2 is characterized by complete blood count alterations. In this context, the neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) can be used as prognostic factors. We study NLR and PLR trends at different timepoints and compute optimal cutoffs to predict four outcomes: use of Continuous Positive Airways Pressure (CPAP), ICU admission, invasive ventilation and death. Methods: we retrospectively included all adult patients with SARS-CoV-2 pneumonia admitted from 23 rd January 2020 to 18 th May 2021. Data were extracted using ICD9 codes and our Covid-19 registry. Analyses included descriptive statistics and non parametric tests to study the ability of NLR and PLR to distinguish the patients’ outcomes at each timepoint. ROC curves were built for NLR and PLR at each timepoint (minus discharge) in order to identify cutoffs to distinguish severe and non severe disease and their statistical significance was assessed with the Chi-square test. NLR and PLR were compared with DeLong’s test. Results: we included 2169 patients. NLR and PLR were higher in severe Covid-19 at all the timepoints, with a difference that gets bigger and a trend that is steeper in more severe disease. Both ratios were able to distinguish the outcomes at each timepoint. For NLR, the areas under the curve (AUROC) ranged between 0.59 and 0.81, for PLR, between 0.53 and 0.67. From each ROC curve we computed an optimal cutoff value (e.g. NLR 7 for CPAP for males at admission). NLR performed better than PLR. Conclusion: our results are in line with other studies that computed NLR and PLR trends and values in disease, especially with those that distinguished between different grades of severity. Our study is retrospective and single centre, and is limited by selection bias, but includes more than 2000 patients, thus limiting the confounding factors and outliers. Our cutoffs do not only deal with severity and mortality but allow for a more tailored approach. Future prospect include validating our cutoffs in a prospective cohort and comparing their performance against other Covid19 scores.

7.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-325523

ABSTRACT

Objectives: An accurate prediction of the clinical outcomes of European patients requiring hospitalisation for Coronavirus Disease 2019 (COVID-19) is lacking. The aim of the study is to identify predictors of in-hospital mortality and discharge in a cohort of Lombardy patients with COVID-19. Methods: All consecutive hospitalised patients from February 21 st to March 30 th , 2020, with confirmed COVID-19 from the IRCCS Policlinico San Matteo, Pavia, Lombardy, Italy, were included. In-hospital mortality and discharge were evaluated by competing risk analysis. The Fine and Gray model was fitted in order to estimate the effect of covariates on the cumulative incidence functions (CIFs) for in-hospital mortality and discharge. Results: 426 adult patients (median age 68 (IQR, 56 to 77 years) were admitted with confirmed COVID-19 over a 5-week period;292 (69%) were male. By 21 April 2020, 141 (33%) of these patients had died, 239 (56%) patients had been discharged and 46 (11%) were still hospitalised. Regression on the CIFs for in-hospital mortality showed that older age, male sex, number of comorbidities and hospital admission after March 4 th were independent risk factors associated with in-hospital mortality. Conclusions: Olderage, male sex and number of comorbidities definitively predicted in-hospital mortality in hospitalised patients with COVID-19

8.
iScience ; 25(2): 103743, 2022 Feb 18.
Article in English | MEDLINE | ID: covidwho-1611783

ABSTRACT

Information concerning the longevity of immunity to SARS-CoV-2 following natural infection may have considerable implications for durability of immunity induced by vaccines. Here, we monitored the SARS-CoV-2 specific immune response in COVID-19 patients followed up to 15 months after symptoms onset. Following a peak at day 15-28 postinfection, the IgG antibody response and plasma neutralizing titers gradually decreased over time but stabilized after 6 months. Compared to G614, plasma neutralizing titers were more than 8-fold lower against variants Beta, Gamma, and Delta. SARS-CoV-2-specific memory B and T cells persisted in the majority of patients up to 15 months although a significant decrease in specific T cells, but not B cells, was observed between 6 and 15 months. Antiviral specific immunity, especially memory B cells in COVID-19 convalescent patients, is long-lasting, but some variants of concern may at least partially escape the neutralizing activity of plasma antibodies.

9.
J Pers Med ; 11(8)2021 Jul 31.
Article in English | MEDLINE | ID: covidwho-1335139

ABSTRACT

Despite low rates of bacterial co-infections, most COVID-19 patients receive antibiotic therapy. We hypothesized that patients with positive pneumococcal urinary antigens (PUAs) would benefit from antibiotic therapy in terms of clinical outcomes (death, ICU admission, and length of stay). The San Matteo COVID-19 Registry (SMACORE) prospectively enrolls patients admitted for COVID-19 pneumonia at IRCCS Policlinico San Matteo, Pavia. We retrospectively extracted the data of patients tested for PUA from October to December 2020. Demographic, clinical, and laboratory data were recorded. Of 469 patients, 42 tested positive for PUA (8.95%), while 427 (91.05%) tested negative. A positive PUA result had no significant impact on death (HR 0.53 CI [0.22-1.28] p-value 0.16) or ICU admission (HR 0.8; CI [0.25-2.54] p-value 0.70) in the Cox regression model, nor on length of stay in linear regression (estimate 1.71; SE 2.37; p-value 0.47). After adjusting for age, we found no significant correlation between urinary antigen positivity and variations in the WHO ordinal scale and laboratory markers at admission and after 14 days. We found that a positive PUA result was not frequent and had no impact on clinical outcomes or clinical improvement. Our results did not support the routine use of PUA tests to select COVID-19 patients who will benefit from antibiotic therapy.

10.
Sci Rep ; 11(1): 1137, 2021 01 13.
Article in English | MEDLINE | ID: covidwho-1065934

ABSTRACT

An accurate prediction of the clinical outcomes of European patients requiring hospitalisation for Coronavirus Disease 2019 (COVID-19) is lacking. The aim of the study is to identify predictors of in-hospital mortality and discharge in a cohort of Lombardy patients with COVID-19. All consecutive hospitalised patients from February 21st to March 30th, 2020, with confirmed COVID-19 from the IRCCS Policlinico San Matteo, Pavia, Lombardy, Italy, were included. In-hospital mortality and discharge were evaluated by competing risk analysis. The Fine and Gray model was fitted in order to estimate the effect of covariates on the cumulative incidence functions (CIFs) for in-hospital mortality and discharge. 426 adult patients [median age 68 (IQR 56 to 77 years)] were admitted with confirmed COVID-19 over a 5-week period; 292 (69%) were male. By 21 April 2020, 141 (33%) of these patients had died, 239 (56%) patients had been discharged and 46 (11%) were still hospitalised. Among these 46 patients, updated as of 30 May, 2020, 5 (10.9%) had died, 8 (17.4%) were still in ICU, 12 (26.1%) were transferred to lower intensity care units and 21 (45.7%) were discharged. Regression on the CIFs for in-hospital mortality showed that older age, male sex, number of comorbidities and hospital admission after March 4th were independent risk factors associated with in-hospital mortality. Older age, male sex and number of comorbidities definitively predicted in-hospital mortality in hospitalised patients with COVID-19.


Subject(s)
COVID-19/mortality , Hospital Mortality , Registries/statistics & numerical data , Aged , Aged, 80 and over , COVID-19/epidemiology , Female , Humans , Italy/epidemiology , Male , Middle Aged , Risk Assessment
11.
N Engl J Med ; 382(24): 2327-2336, 2020 06 11.
Article in English | MEDLINE | ID: covidwho-47286

ABSTRACT

BACKGROUND: Remdesivir, a nucleotide analogue prodrug that inhibits viral RNA polymerases, has shown in vitro activity against SARS-CoV-2. METHODS: We provided remdesivir on a compassionate-use basis to patients hospitalized with Covid-19, the illness caused by infection with SARS-CoV-2. Patients were those with confirmed SARS-CoV-2 infection who had an oxygen saturation of 94% or less while they were breathing ambient air or who were receiving oxygen support. Patients received a 10-day course of remdesivir, consisting of 200 mg administered intravenously on day 1, followed by 100 mg daily for the remaining 9 days of treatment. This report is based on data from patients who received remdesivir during the period from January 25, 2020, through March 7, 2020, and have clinical data for at least 1 subsequent day. RESULTS: Of the 61 patients who received at least one dose of remdesivir, data from 8 could not be analyzed (including 7 patients with no post-treatment data and 1 with a dosing error). Of the 53 patients whose data were analyzed, 22 were in the United States, 22 in Europe or Canada, and 9 in Japan. At baseline, 30 patients (57%) were receiving mechanical ventilation and 4 (8%) were receiving extracorporeal membrane oxygenation. During a median follow-up of 18 days, 36 patients (68%) had an improvement in oxygen-support class, including 17 of 30 patients (57%) receiving mechanical ventilation who were extubated. A total of 25 patients (47%) were discharged, and 7 patients (13%) died; mortality was 18% (6 of 34) among patients receiving invasive ventilation and 5% (1 of 19) among those not receiving invasive ventilation. CONCLUSIONS: In this cohort of patients hospitalized for severe Covid-19 who were treated with compassionate-use remdesivir, clinical improvement was observed in 36 of 53 patients (68%). Measurement of efficacy will require ongoing randomized, placebo-controlled trials of remdesivir therapy. (Funded by Gilead Sciences.).


Subject(s)
Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , Antiviral Agents/therapeutic use , Compassionate Use Trials , Coronavirus Infections/drug therapy , Pneumonia, Viral/drug therapy , Adenosine Monophosphate/adverse effects , Adenosine Monophosphate/therapeutic use , Administration, Intravenous , Adult , Aged , Aged, 80 and over , Alanine/adverse effects , Alanine/therapeutic use , Antiviral Agents/adverse effects , Betacoronavirus , COVID-19 , Canada , Coronavirus Infections/mortality , Europe , Female , Humans , Japan , Male , Middle Aged , Pandemics , Pneumonia, Viral/mortality , Respiration, Artificial , SARS-CoV-2 , United States , Young Adult
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