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2.
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.

3.
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.

4.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-323427

ABSTRACT

Background: The pandemic surge of Coronavirus disease 2019 (COVID-19) is posing the unprecedent challenge of rapidly identifying and isolating probable cases and diagnosing the main respiratory complications. We aimed to describe the application of a lung ultrasound (LUS)-based diagnostic approach, combining the LUS likelihood of COVID-19 pneumonia with patient’s symptoms and clinical history.Methods: This is an international multicenter prospective observational study on patients suspected for COVID-19, presenting to 22 different US and European hospitals. Patients underwent LUS and reverse transcription-polymerase chain reaction (RT-PCR) swab test. We identified 3 different clinical phenotypes based on pre-existing chronic cardiac or respiratory diseases (mixed phenotype), and on the presence (severe phenotype) or absence (mild phenotype) of signs and/or symptoms of respiratory failure at presentation. We defined the LUS likelihood of COVID-19 pneumonia according to 4 different patterns, characterized by the presence and distribution of typical and atypical LUS signs: high (HPLUS), intermediate (IPLUS), alternative (APLUS) and low (LPLUS) probability patterns. The association between the combination of patterns and phenotypes with RT-PCR results was described and analyzed.Findings: We studied 1462 patients, classified in mild (n=400), severe (n=727) and mixed (n=335) phenotypes. In the overall population, the HPLUS corresponded to a positive RT-PCR in 92.6% of cases, with similarly high percentages in all clinical phenotypes ranging from 87.5% (mild) to 90.3% (mixed) and 96.5% (severe). The IPLUS yielded a lower match with positive RT-PCR (65.7%). In patients with respiratory failure, the LPLUS predicted a negative RT-PCR in 100% of cases. In the overall population, the APLUS indicated an alternative pulmonary condition in 81.1% of patients. At multivariate analysis the HPLUS strongly predicted RT-PCR positivity (odds ratio 4.173, interquartile range 2.595-6.712, p<0.0001), independently from age, low oxygen saturation and dyspnea.Interpretation: Combining LUS patterns of probability for interstitial pneumonia with clinical phenotypes at presentation could facilitate the early diagnosis of COVID-19 or suggest an alternative pulmonary condition. This approach may be useful to rapidly guide and support patient’s allocation for a wiser use of hospital resources during a pandemic surge.Funding: None.Conflict of Interest: The authors declare no conflicts of interest. Ethical Approval: The local Ethical Committee Boards of each center approved the study, and the study was conducted following the ethical standards of the 1964 Helsinki declaration and its later amendments and with local guidelines for good clinical practice.

5.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-320843

ABSTRACT

Objective: to analyze the most frequent radiographic features of COVID-19 pneumonia and assess the effectiveness of CXR in detecting pulmonary alterations. Materials: and Methods : CXR of 240 symptomatic patients (70% male, mean age 65±16 years), with SARS-CoV-2 infection confirmed by RT-PCR were retrospectively evaluated. Patients were clustered in four groups based on the number of days between symptom onset and CXR: A (0-2 days) 49 patients, B (3-5) 75 patients, C (6- 9) 85 patients and D (>9) 31 patients. Alteration’s type (reticular/opacification/consolidation) and distribution (bilateral/unilateral, upper/middle/lower fields, peripheral/central) were noted. Statistical significance was tested using chi-squared test. Results: among 240 CXR, 60 (25%) were negative (A 36.7%, B 28%, C 18.8%, D 16.1%). Opacification was observed in 124/180 (68.8%), reticular alteration in 113/180 (62.7%), consolidation in 71/180 (39.4%). Consolidation was significantly less frequent (p<0.01). Distribution among groups was: reticular alteration (A 70.9%, B 72.2%, C 57.9%, D 46.1%), opacification (A 67.7%, B 62.9%, C 71%, D 76.9%), consolidation (A 35.5%, B 31.4%, C 47.8%, D 38.5%). Alterations were bilateral in 73.3%. Upper, middle and lower fields were involved in 36.7%, 79.4%, 87.8%. Lesions were peripheral in 49.4%, central in 11.1% or both in 39.4%. Upper fields and central zones were significantly less involved (p<0.01). Conclusions: the most frequent lesions in COVID-19 patients were opacification (intermediate/late phase) and reticular alteration (early phase) while consolidation gradually increased over time. The most frequent distribution was bilateral, peripheral, with middle/lower predominance. Overall rate of negative CXR is 25%, progressively decreased over time.

6.
J Cardiovasc Med (Hagerstown) ; 22(11): 828-831, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1406806

ABSTRACT

AIMS: Controversial data have been published regarding the prognostic role of cardiac troponins in patients who need hospitalization because of coronavirus disease 2019 (COVID-19). The aim of the study was to assess the role of high-sensitivity troponin plasma levels and of respiratory function at admission on all-cause deaths in unselected patients hospitalized because of COVID-19. METHODS: We pooled individual patient data from observational studies that assessed all-cause mortality of unselected patients hospitalized for COVID-19. The individual data of 722 patients were included. The ratio of partial pressure arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) and high-sensitivity troponins was reported at admission in all patients. This meta-analysis was registered on PROSPERO (CRD42020213209). RESULTS: After a median follow-up of 14 days, 180 deaths were observed. At multivariable regression analysis, age [hazard ratio (HR) 1.083, 95% confidence interval (CI) 1.061-1.105, P < 0.0001], male sex (HR 2.049, 95% CI 1.319-3.184, P = 0.0014), moderate-severe renal dysfunction (estimated glomerular filtration rate  < 30 mL/min/m2) (HR 2.108, 95% CI 1.237-3.594, P = 0.0061) and lower PaO2/FiO2 (HR 0.901, 95% CI 0.829-0.978, P = 0.0133) were the independent predictors of death. A linear increase in the HR was associated with decreasing values of PaO2/FiO2 below the normality threshold. On the contrary, the HR curve for troponin plasma levels was near-flat with large CI for values above the normality thresholds. CONCLUSION: In unselected patients hospitalized for COVID-19, mortality is mainly driven by male gender, older age and respiratory failure. Elevated plasma levels of high-sensitivity troponins are not an independent predictor of worse survival when respiratory function is accounted for.


Subject(s)
COVID-19 , Oxygen/analysis , Respiratory Function Tests/methods , Troponin/blood , Age Factors , Biomarkers/analysis , Biomarkers/blood , Blood Gas Analysis/methods , Breath Tests/methods , COVID-19/blood , COVID-19/diagnosis , COVID-19/mortality , Humans , Prognosis , Risk Assessment/methods , SARS-CoV-2 , Sex Factors
8.
Comput Biol Med ; 136: 104742, 2021 09.
Article in English | MEDLINE | ID: covidwho-1347560

ABSTRACT

The Covid-19 European outbreak in February 2020 has challenged the world's health systems, eliciting an urgent need for effective and highly reliable diagnostic instruments to help medical personnel. Deep learning (DL) has been demonstrated to be useful for diagnosis using both computed tomography (CT) scans and chest X-rays (CXR), whereby the former typically yields more accurate results. However, the pivoting function of a CT scan during the pandemic presents several drawbacks, including high cost and cross-contamination problems. Radiation-free lung ultrasound (LUS) imaging, which requires high expertise and is thus being underutilised, has demonstrated a strong correlation with CT scan results and a high reliability in pneumonia detection even in the early stages. In this study, we developed a system based on modern DL methodologies in close collaboration with Fondazione IRCCS Policlinico San Matteo's Emergency Department (ED) of Pavia. Using a reliable dataset comprising ultrasound clips originating from linear and convex probes in 2908 frames from 450 hospitalised patients, we conducted an investigation into detecting Covid-19 patterns and ranking them considering two severity scales. This study differs from other research projects by its novel approach involving four and seven classes. Patients admitted to the ED underwent 12 LUS examinations in different chest parts, each evaluated according to standardised severity scales. We adopted residual convolutional neural networks (CNNs), transfer learning, and data augmentation techniques. Hence, employing methodological hyperparameter tuning, we produced state-of-the-art results meeting F1 score levels, averaged over the number of classes considered, exceeding 98%, and thereby manifesting stable measurements over precision and recall.


Subject(s)
COVID-19 , Deep Learning , Pneumonia , Humans , Lung/diagnostic imaging , Pneumonia/diagnostic imaging , Reproducibility of Results , SARS-CoV-2
10.
J Healthc Eng ; 2021: 5556207, 2021.
Article in English | MEDLINE | ID: covidwho-1314165

ABSTRACT

The efficacy of hydroxychloroquine (HCQ) in treating SARS-CoV-2 infection is harshly debated, with observational and experimental studies reporting contrasting results. To clarify the role of HCQ in Covid-19 patients, we carried out a retrospective observational study of 4,396 unselected patients hospitalized for Covid-19 in Italy (February-May 2020). Patients' characteristics were collected at entry, including age, sex, obesity, smoking status, blood parameters, history of diabetes, cancer, cardiovascular and chronic pulmonary diseases, and medications in use. These were used to identify subtypes of patients with similar characteristics through hierarchical clustering based on Gower distance. Using multivariable Cox regressions, these clusters were then tested for association with mortality and modification of effect by treatment with HCQ. We identified two clusters, one of 3,913 younger patients with lower circulating inflammation levels and better renal function, and one of 483 generally older and more comorbid subjects, more prevalently men and smokers. The latter group was at increased death risk adjusted by HCQ (HR[CI95%] = 3.80[3.08-4.67]), while HCQ showed an independent inverse association (0.51[0.43-0.61]), as well as a significant influence of cluster∗HCQ interaction (p < 0.001). This was driven by a differential association of HCQ with mortality between the high (0.89[0.65-1.22]) and the low risk cluster (0.46[0.39-0.54]). These effects survived adjustments for additional medications in use and were concordant with associations with disease severity and outcome. These findings suggest a particularly beneficial effect of HCQ within low risk Covid-19 patients and may contribute to clarifying the current controversy on HCQ efficacy in Covid-19 treatment.


Subject(s)
Antimalarials/adverse effects , Antimalarials/therapeutic use , COVID-19/drug therapy , COVID-19/mortality , Hospital Mortality , Hydroxychloroquine/adverse effects , Hydroxychloroquine/therapeutic use , Aged , Aged, 80 and over , COVID-19/physiopathology , Cluster Analysis , Female , Humans , Italy , Male , Middle Aged , Retrospective Studies , SARS-CoV-2/drug effects , Severity of Illness Index , Treatment Outcome
11.
Front Med (Lausanne) ; 8: 639970, 2021.
Article in English | MEDLINE | ID: covidwho-1285307

ABSTRACT

Background: Protease inhibitors have been considered as possible therapeutic agents for COVID-19 patients. Objectives: To describe the association between lopinavir/ritonavir (LPV/r) or darunavir/cobicistat (DRV/c) use and in-hospital mortality in COVID-19 patients. Study Design: Multicenter observational study of COVID-19 patients admitted in 33 Italian hospitals. Medications, preexisting conditions, clinical measures, and outcomes were extracted from medical records. Patients were retrospectively divided in three groups, according to use of LPV/r, DRV/c or none of them. Primary outcome in a time-to event analysis was death. We used Cox proportional-hazards models with inverse probability of treatment weighting by multinomial propensity scores. Results: Out of 3,451 patients, 33.3% LPV/r and 13.9% received DRV/c. Patients receiving LPV/r or DRV/c were more likely younger, men, had higher C-reactive protein levels while less likely had hypertension, cardiovascular, pulmonary or kidney disease. After adjustment for propensity scores, LPV/r use was not associated with mortality (HR = 0.94, 95% CI 0.78 to 1.13), whereas treatment with DRV/c was associated with a higher death risk (HR = 1.89, 1.53 to 2.34, E-value = 2.43). This increased risk was more marked in women, in elderly, in patients with higher severity of COVID-19 and in patients receiving other COVID-19 drugs. Conclusions: In a large cohort of Italian patients hospitalized for COVID-19 in a real-life setting, the use of LPV/r treatment did not change death rate, while DRV/c was associated with increased mortality. Within the limits of an observational study, these data do not support the use of LPV/r or DRV/c in COVID-19 patients.

12.
J Ultrasound Med ; 41(3): 543-545, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1239992

ABSTRACT

Lung ultrasound (LUS) has proven to be a helpful diagnostic tool for evaluating lung involvement in respiratory pathologies. The usage of this imaging technique became even more widespread during the SARS-CoV-2 pandemic. The latest generation ultrasound scanners are conveniently portable and this permits ultrasound examinations to be performed even in extreme environments where no other diagnostic tool is available. Our team has developed the first guide that assists the clinician while operating in low-resource settings, in managing a SARS-CoV-2 patient based on the clinical examination and the LUS findings.


Subject(s)
COVID-19 , SARS-CoV-2 , Humans , Lung/diagnostic imaging , Pandemics , Ultrasonography
13.
Intern Emerg Med ; 16(4): 1005-1015, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1202836

ABSTRACT

During the COVID-19 2020 outbreak, a large body of data has been provided on general management and outcomes of hospitalized COVID-19 patients. Yet, relatively little is known on characteristics and outcome of patients managed in Internal Medicine Units (IMU). To address this gap, the Italian Society of Internal Medicine has conducted a nationwide cohort multicentre study on death outcome in adult COVID-19 patients admitted and managed in IMU. This study assessed 3044 COVID-19 patients at 41 referral hospitals across Italy from February 3rd to May 8th 2020. Demographics, comorbidities, organ dysfunction, treatment, and outcomes including death were assessed. During the study period, 697 patients (22.9%) were transferred to intensive care units, and 351 died in IMU (death rate 14.9%). At admission, factors independently associated with in-hospital mortality were age (OR 2.46, p = 0.000), productive cough (OR 2.04, p = 0.000), pre-existing chronic heart failure (OR 1.58, p = 0.017) and chronic obstructive pulmonary disease (OR 1.17, p = 0.048), the number of comorbidities (OR 1.34, p = 0.000) and polypharmacy (OR 1.20, p = 0.000). Of note, up to 40% of elderly patients did not report fever at admission. Decreasing PaO2/FiO2 ratio at admission was strongly inversely associated with survival. The use of conventional oxygen supplementation increased with the number of pre-existing comorbidities, but it did not associate with better survival in patients with PaO2/FiO2 ratio < 100. The latter, significantly benefited by the early use of non-invasive mechanical ventilation. Our study identified PaO2/FiO2 ratio at admission and comorbidity as the main alert signs to inform clinical decisions and resource allocation in non-critically ill COVID-19 patients admitted to IMU.


Subject(s)
COVID-19/mortality , COVID-19/therapy , Hospitalization , Internal Medicine , Adult , Aged , Aged, 80 and over , COVID-19/complications , Cohort Studies , Critical Care , Hospital Mortality , Humans , Italy , Middle Aged , Respiration, Artificial , Survival Rate
14.
Diagnostics (Basel) ; 11(5)2021 Apr 23.
Article in English | MEDLINE | ID: covidwho-1201154

ABSTRACT

BACKGROUND: COVID-19 is an emerging infectious disease, that is heavily challenging health systems worldwide. Admission Arterial Blood Gas (ABG) and Lung Ultrasound (LUS) can be of great help in clinical decision making, especially during the current pandemic and the consequent overcrowding of the Emergency Department (ED). The aim of the study was to demonstrate the capability of alveolar-to-arterial oxygen difference (AaDO2) in predicting the need for subsequent oxygen support and survival in patients with COVID-19 infection, especially in the presence of baseline normal PaO2/FiO2 ratio (P/F) values. METHODS: A cohort of 223 swab-confirmed COVID-19 patients underwent clinical evaluation, blood tests, ABG and LUS in the ED. LUS score was derived from 12 ultrasound lung windows. AaDO2 was derived as AaDO2 = ((FiO2) (Atmospheric pressure - H2O pressure) - (PaCO2/R)) - PaO2. Endpoints were subsequent oxygen support need and survival. RESULTS: A close relationship between AaDO2 and P/F and between AaDO2 and LUS score was observed (R2 = 0.88 and R2 = 0.67, respectively; p < 0.001 for both). In the subgroup of patients with P/F between 300 and 400, 94.7% (n = 107) had high AaDO2 values, and 51.4% (n = 55) received oxygen support, with 2 ICU admissions and 10 deaths. According to ROC analysis, AaDO2 > 39.4 had 83.6% sensitivity and 90.5% specificity (AUC 0.936; p < 0.001) in predicting subsequent oxygen support, whereas a LUS score > 6 showed 89.7% sensitivity and 75.0% specificity (AUC 0.896; p < 0.001). Kaplan-Meier curves showed different mortality in the AaDO2 subgroups (p = 0.0025). CONCLUSIONS: LUS and AaDO2 are easy and effective tools, which allow bedside risk stratification in patients with COVID-19, especially when P/F values, signs, and symptoms are not indicative of severe lung dysfunction.

15.
Intensive Care Med ; 47(4): 444-454, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1141400

ABSTRACT

PURPOSE: To analyze the application of a lung ultrasound (LUS)-based diagnostic approach to patients suspected of COVID-19, combining the LUS likelihood of COVID-19 pneumonia with patient's symptoms and clinical history. METHODS: This is an international multicenter observational study in 20 US and European hospitals. Patients suspected of COVID-19 were tested with reverse transcription-polymerase chain reaction (RT-PCR) swab test and had an LUS examination. We identified three clinical phenotypes based on pre-existing chronic diseases (mixed phenotype), and on the presence (severe phenotype) or absence (mild phenotype) of signs and/or symptoms of respiratory failure at presentation. We defined the LUS likelihood of COVID-19 pneumonia according to four different patterns: high (HighLUS), intermediate (IntLUS), alternative (AltLUS), and low (LowLUS) probability. The combination of patterns and phenotypes with RT-PCR results was described and analyzed. RESULTS: We studied 1462 patients, classified in mild (n = 400), severe (n = 727), and mixed (n = 335) phenotypes. HighLUS and IntLUS showed an overall sensitivity of 90.2% (95% CI 88.23-91.97%) in identifying patients with positive RT-PCR, with higher values in the mixed (94.7%) and severe phenotype (97.1%), and even higher in those patients with objective respiratory failure (99.3%). The HighLUS showed a specificity of 88.8% (CI 85.55-91.65%) that was higher in the mild phenotype (94.4%; CI 90.0-97.0%). At multivariate analysis, the HighLUS was a strong independent predictor of RT-PCR positivity (odds ratio 4.2, confidence interval 2.6-6.7, p < 0.0001). CONCLUSION: Combining LUS patterns of probability with clinical phenotypes at presentation can rapidly identify those patients with or without COVID-19 pneumonia at bedside. This approach could support and expedite patients' management during a pandemic surge.


Subject(s)
COVID-19/diagnostic imaging , Lung/diagnostic imaging , Ultrasonography , Adult , Aged , Early Diagnosis , Humans , Middle Aged
16.
J Hypertens ; 39(2): 376-380, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-1114884

ABSTRACT

OBJECTIVE: The burst of COVID-19 epidemics in Italy prompted the Italian Society of Hypertension to start an observational study to explore the characteristics of the hospitalized victims of the disease. The current analysis aimed to investigate the predictors of healing among Italian COVID-19 patients. We also assessed the effect of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers on the outcome. METHODS: We designed a cross-sectional, observational, multicenter, nationwide survey in Italy to explore the demographic and clinical characteristics of patients with confirmed COVID-19 infection. We analyzed information from 2446 charts of Italian patients admitted for certified COVID-19 in 27 hospitals. Healing from COVID-19 infection, defined as two consecutive negative swabs, was reported in 544 patients (22.2%), 95% of them were hospitalized. RESULTS: Age and Charlson Comorbidity Index were significantly lower in healing compared with nonhealing patients (63 ±â€Š15 vs. 69 ±â€Š15 and 2 ±â€Š2 vs. 3 ±â€Š2, both P < 0.05). In multivariable regression model, predictors of healing were younger age (OR: 0.99; 95% CI 0.98-0.99, P = 0.0001), absence of chronic kidney disease (OR: 0.35; 95% CI 0.17-0.70, P = 0.003) or heart failure (OR: 0.44; 95% CI, 0.28-0.70, P = 0.001). In the subgroup of patients suffering from hypertension and/or heart failure (n = 1498), no differences were observed in the use of ACE inhibitors and angiotensin receptor blockers. CONCLUSION: Our study demonstrated that younger age and absence of comorbidities play a major role in determining healing in patients with COVID-19. No effects of ACE inhibitors and angiotensin receptor blockers on the outcome was reported.


Subject(s)
Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , COVID-19/complications , Heart Failure/complications , Renal Insufficiency, Chronic/complications , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Analysis of Variance , Angiotensin Receptor Antagonists/adverse effects , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Antihypertensive Agents/therapeutic use , Chronic Disease , Comorbidity , Cross-Sectional Studies , Female , Heart Failure/epidemiology , Hospitalization , Humans , Hypertension/epidemiology , Italy/epidemiology , Male , Middle Aged , Renal Insufficiency, Chronic/epidemiology , Renin-Angiotensin System/drug effects , SARS-CoV-2 , Surveys and Questionnaires , Young Adult
17.
Intern Emerg Med ; 16(5): 1317-1327, 2021 08.
Article in English | MEDLINE | ID: covidwho-1107866

ABSTRACT

Bedside lung ultrasound (LUS) can play a role in the setting of the SarsCoV2 pneumonia pandemic. To evaluate the clinical and LUS features of COVID-19 in the ED and their potential prognostic role, a cohort of laboratory-confirmed COVID-19 patients underwent LUS upon admission in the ED. LUS score was derived from 12 fields. A prevalent LUS pattern was assigned depending on the presence of interstitial syndrome only (Interstitial Pattern), or evidence of subpleural consolidations in at least two fields (Consolidation Pattern). The endpoint was 30-day mortality. The relationship between hemogasanalysis parameters and LUS score was also evaluated. Out of 312 patients, only 36 (11.5%) did not present lung involvment, as defined by LUS score < 1. The majority of patients were admitted either in a general ward (53.8%) or in intensive care unit (9.6%), whereas 106 patients (33.9%) were discharged from the ED. In-hospital mortality was 25.3%, and 30-day survival was 67.6%. A LUS score > 13 had a 77.2% sensitivity and a 71.5% specificity (AUC 0.814; p < 0.001) in predicting mortality. LUS alterations were more frequent (64%) in the posterior lower fields. LUS score was related with P/F (R2 0.68; p < 0.0001) and P/F at FiO2 = 21% (R2 0.59; p < 0.0001). The correlation between LUS score and P/F was not influenced by the prevalent ultrasound pattern. LUS represents an effective tool in both defining diagnosis and stratifying prognosis of COVID-19 pneumonia. The correlation between LUS and hemogasanalysis parameters underscores its role in evaluating lung structure and function.


Subject(s)
COVID-19 , Humans , Lung/diagnostic imaging , Phenotype , RNA, Viral , SARS-CoV-2 , Ultrasonography
20.
J Hypertens ; 39(2): 376-380, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-927007

ABSTRACT

OBJECTIVE: The burst of COVID-19 epidemics in Italy prompted the Italian Society of Hypertension to start an observational study to explore the characteristics of the hospitalized victims of the disease. The current analysis aimed to investigate the predictors of healing among Italian COVID-19 patients. We also assessed the effect of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers on the outcome. METHODS: We designed a cross-sectional, observational, multicenter, nationwide survey in Italy to explore the demographic and clinical characteristics of patients with confirmed COVID-19 infection. We analyzed information from 2446 charts of Italian patients admitted for certified COVID-19 in 27 hospitals. Healing from COVID-19 infection, defined as two consecutive negative swabs, was reported in 544 patients (22.2%), 95% of them were hospitalized. RESULTS: Age and Charlson Comorbidity Index were significantly lower in healing compared with nonhealing patients (63 ±â€Š15 vs. 69 ±â€Š15 and 2 ±â€Š2 vs. 3 ±â€Š2, both P < 0.05). In multivariable regression model, predictors of healing were younger age (OR: 0.99; 95% CI 0.98-0.99, P = 0.0001), absence of chronic kidney disease (OR: 0.35; 95% CI 0.17-0.70, P = 0.003) or heart failure (OR: 0.44; 95% CI, 0.28-0.70, P = 0.001). In the subgroup of patients suffering from hypertension and/or heart failure (n = 1498), no differences were observed in the use of ACE inhibitors and angiotensin receptor blockers. CONCLUSION: Our study demonstrated that younger age and absence of comorbidities play a major role in determining healing in patients with COVID-19. No effects of ACE inhibitors and angiotensin receptor blockers on the outcome was reported.


Subject(s)
Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , COVID-19/complications , Heart Failure/complications , Renal Insufficiency, Chronic/complications , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Analysis of Variance , Angiotensin Receptor Antagonists/adverse effects , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Antihypertensive Agents/therapeutic use , Chronic Disease , Comorbidity , Cross-Sectional Studies , Female , Heart Failure/epidemiology , Hospitalization , Humans , Hypertension/epidemiology , Italy/epidemiology , Male , Middle Aged , Renal Insufficiency, Chronic/epidemiology , Renin-Angiotensin System/drug effects , SARS-CoV-2 , Surveys and Questionnaires , Young Adult
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