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Background: Little is known about the long-term re-hospitalization of patients with confirmed infection by SARS CoV 2 discharged from hospital. Aim: The aim of our retrospective cohort study was to identify death and re-hospitalization outcomes in a 16-month follow-up in a population of subjects already hospitalized for Covid-19. Materials and Methods: The study was conducted in the metropolitan area of Bari (population: 472,385 inhabitants) by examining the patients hospitalized from 17/03/2020 to 28/05/2021 at the Covid Unit of the F. Miulli hospital in Acquaviva delle Fonti. Results: 1238 patients (754 males, 60.9%, median 70 years) were hospitalized in Covid Unit: 1060 (85.6%) (M 60.1% median 71 years) were hospitalized in non-intensive wards, while 178 (14.4%) (M 65.7%, median 69 aa), passed through the IT. At follow-up, 922 subjects were still alive;66 deceased (7.2% of the total, 37.8% males, median 80 years). Analyzing only the data of patients residing in the metropolitan area, where the hospital is the reference, 780 patients discharged alive were examined. Of these, 11.2% were rehospitalized at least once, 30 died (4.3%). Mortality on re-admission to hospital was 17.2%. A third of the re-admissions were unrelated to Covid. Infections, pneumonia and cardiovascular disease were the most represented reason for hospitalization. Conclusions: Data show that at a follow-up of 16 months 92.8% of the subjects were still alive, while 7.2% had died, mainly elderly women. 11.2% of those discharged from the Covid ward have been re-admitted to the hospital at least once.
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Background and Aim:We currently do not have a specific therapy for SARS-CoV-2 infection;experimental therapies have been improved with various drugs such as lopinavir/ritonavir, hydroxychloroquine, tocilizumab with controversial data about efficacy. The aim of the study is to highlight any gender differences in the response to the aforementioned therapies. Materials and Methods: Retrospective analysis of 234 patients, 96 F and 138 M, referring to our CoViD UNIT from March 2020 to April 2021, divided into groups based on the administered drug. Results: Lopinavir/ritonavir: in the overall cohort (M+F) the drug reduces the risk of death/ICU admission (p=0.01);this impact on the outcome is not significant in the individual groups M and F when analyzed separately. On the other hand, considering mortality alone, in the collective group this was lower in treated patients, an efficacy figure that does not differ in the two sexes after stratification by gender. Hydroxychloroquine: considering the whole cohort there is a reduced mortality in the treated (p <0.001). The impact of the drug on the risk of death/intensive care admission is comparable in the two sexes. Tocilizumab: the drug does not change the risk of death/ICU admission in the overall group;the subgroup analysis is lacking due to the small number of samples. Conclusions: The gender difference does not show a significant impact on the efficacy of the drugs considered. New studies, on larger cohorts, are needed to confirm or refute these preliminary data.
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Background and Aim: Vaccination against SARS-CoV-2 started in Italy in January 2021. First, healthcare personnel were vaccinated. Immunization of subjects should lead to a reduction in the clinical manifestations of the disease. Aim of the study was to evaluate the antibody response after the administration of two doses of the BNT162b2 SARS-CoV-2 mRNA vaccine. Materials and Methods: We determined antibody levels at baseline (before second dose of vaccine) and 3 weeks after the second dose of the BNT162b2 SARS-CoV-2 mRNA vaccine in 92 (middle age 44±12 ) health care workers (35 male 38%, and 57 female). Written informed consent was obtained for all study participants. Results: Antibody responses was of 452 U/mL±2744 (median 36, interquartile range 9-99) vs 3154±4389 (median 1957, interquartile range 1242-3238) p<0.001 (average increase of 2702±2554). Excluding 3 cases with baseline value>1000 the response was 63±92 (median 35, interquartile range 8-78) vs 2693±2410 (median 1912, interquartile range 1241-3136) p<0.001 (average increase of 2630±2369). According to multivariate regression analysis: baseline is inversely associated with age (p <0.001) but not with sex (p=0.393);post sampling is inversely associated with age (p=0.003) but not with sex (p=0.653). Conclusions: Our data demonstrate that the antibody response after the administration of two doses of the BNT162b2 SARS-CoV-2 mRNA vaccine was obtained in 100% of the subjects studied. In particular, there is a relationship with age: younger subjects show a more robust response. Gender does not influence extent of response.
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Background and Aim: The CoViD-19 pandemic experienced two main waves: February-June 2020 and October 2020-February 2021 respectively. The F. Miulli Hospital has activated intensive and semi-intensive care, pulmonology and infectious disease departments, for a total of 240 beds. Aim of the study was to evaluate differences between the two waves, in relation to the length of hospitalization and mortality. Materials and Methods: We collected data from 1005 subjects (619 men). Age, gender, length of hospital stay, and deaths were analyzed. Results: In the second wave we found a higher percentage of deaths (25.8 vs 19.4%;p=0.043) and among these a higher prevalence of males (66 vs 44.7%;p=0.007);furthermore, in the subjects hospitalized during the second wave, we observed a lower average age of the deceased (78±13 vs 82±8 years;p=0.019) and a shorter duration of hospitalization (18±13 vs 21±14 days;p=0.004). No significant difference was observed in the prevalence of males, however most affected (62.4% second wave vs 59.1% first wave), and in mean age (69±15 seconds vs 68±18 first wave). Conclusions: The second wave showed greater lethality especially for males and younger subjects. Despite this, the duration of hospitalization was shorter, a condition probably linked to the experience acquired by the health professionals involved in the assistance and to a wider network of local structures capable of welcoming CoViD patients. The impact of the variants on the severity of the disease remains to be assessed.
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Background and Aim of the study: Data on the recent SARS-Cov-2 pandemic show that women have a lower incidence of infectionsand more favorable outcomes. It is not clear whether the sex disparities occur in all age groups and whether it may depend on adifferent immune response. The aim of the study was to verify thedifferences between males (M) and females (F), comparing theimmune response and the outcomes in the two groups.Methods: We studied all SARS-Cov-2 infected patients hospitalized from the 10th of March to 31th of May 2020. At the time ofadmission, in addition to the common laboratory tests and inflammatory parameters (IL6, CRP), we evaluated B and T cells (CD3),helper/suppressor ratio (CD4/CD8), and NK cells (CD56). Results: 152 patients, 91 M (59.8%) were analyzed. The averageage was 68±17 years;the F group was older (76±14 vs 63±16;p <0.001), with a higher percentage of subjects >75 years: 59%vs 27.9% (p <0.001). A higher CD4/CD8 ratio was found in subjects >75 years of age compared to those aged 60-75 (2.3±1.2vs 1.9±1.4;p<0.05) and in F group (2.8±2.3 vs 2.2±1.4;p<0.05). Interestingly, an inverse correlation between IL6 and CD3was found in both sexes, but highly significant in the M group(p<0.001;r-0.48). Finally, a higher number of in-hospital deathswere found in the F group: 23.9% vs 9.9% (p <0.03).Conclusions: SARS-Cov-2 infection affects mainly M subjects,that show an inverse correlation between IL6 and CD3 cells. TheF group over 75 years has a higher CD4 / CD8 ratio and highermortality.
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Introduction and Aim of the study: Hydroxychloroquine has beenauthorized in the therapy of patients with COVID-19. Many publications have not clarified the real efficacy of the drug. Really, thedrug was widely used during the pandemic. A single-center observational cohort study was conducted to evaluate the effectiveness of hydroxychloroquine therapy in a group of subjects admittedin the sub-intensive therapy of the COVID Unit Hospital F. Miulli(Acquaviva delle Fonti, Bari, Italy) from 17 march to 17 may 2020.Materials and Methods: The data contained in the medicalrecords were studied. The sample was divided into two groups withrespect to therapy with or without hydroxychloroquine'. Clinicaland laboratory data were analyzed.Results: A total of 174 patients hospitalized (60.4% males),mean age 68 yrs, with diagnosis of SARS-CoV2, were analyzed.118 patients were treated with hydroxychloroquine. The treatment group consisted of 66.1% males, mean age 63 years. Thetwo groups were homogeneous in comorbidity and in the severityof clinical presentation of SARS-CoV2 infection. The death ratewas significantly higher in the group of untreated than in thosereceiving hydroxychloroquine, 40% vs 2.6% respectively. Therewere no significant differences on QTc prolongation between thetwo groups (467+47 ms control group, 446 + 35 ms, treatmentgroup).Discussion and Conclusions: The data of our study, although referring to a reduced sample, show the effectiveness of hydroxychloroquine in reducing mortality in subjects suffering fromSARS-CoV2 infection.
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Background and Aim of the study: Several studies show that microbial co-infection increases the risk of disease severity in humans, but there is limited knowledge on co-infection amongpatients with coronavirus disease 2019 (COVID-19). The aim ofthe study was to evaluate co-infections with other pathogensamong COVID-19 cases. Methods: In this study, we analyzed the laboratory-confirmedCOVID-19 consecutive patients admitted at Miulli General Hospitalfrom the 17th of March to the 31th of May 2020. We included patients in all settings, either in Covid wards and in ICU. We soughtto define the prevalence of patients with bacterial and fungal coinfections.Results: Overall, 233 patients (M 59%;age 67±18 years) were examined;52 (22.3%) of them were co-infected with one or morepathogens;in total 27 respiratory pathogens were found. Copathogens included different bacteria such as Staphylococcus aureus, Klebsiella pneumoniae, Mycoplasma, Chlamydia and Candidaspecies. In addition, 7.7% of patients had pathogens with resistancegenes. Most co-infections occurred within 5 days of onset of COVID-19 disease. A higher prevalence of ICU patients had bacterial coinfections than patients in a mixed ward (72.7% vs 17.1%;p<0.001), and the fungal co-infections and bacterial-fungal co-infections were more prevalent in severe COVID-19 cases.Conclusions: A low proportion of COVID-19 patients have a bacterial co-infection;while in ICU the prevalence increases. These results suggest that routine antibiotics might not be indicated inpatients with COVID-19.
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Background and Aim of the study: As of 17 June 2020, Italy had237.828 cases of SARS-CoV-2 infections, with about 35.000deaths;median age of cases 61 years, median age of deceased81 years. A single-center observational cohort study was conducted to evaluate clinical features, laboratory characteristicscomparing two groups of subjects by age (>75 and <75 years)admitted in the sub-intensive therapy of the COVID Unit HospitalF. Miulli (Acquaviva delle Fonti, Bari, Italy) from 17 march to 17may 2020.Materials and Methods: The data contained in the medicalrecords were studied.Results: A total of 174 patients hospitalized (60.4% males),mean age 68 yrs, with diagnosis of SARS-CoV2, were analyzed;they were divided into two groups >75 years and <75 years (110pts and 64 pts respectively). The group of older subjects had ahigher prevalence of comorbility (heart, kidney failure, COPD);mortality was more significant in subjects >75 years (37.3% vs 0.9%)compared to young people. No difference was observed in thelength of stay (21 days on average), while the younger subjectswere treated with hydroxychloroquine more than the elderly(83.6% vs 40.6% respectively) as well as with lopinavir / ritonavir(39.4% vs 14.5%).Conclusions: Our data, although referring to a small sample ofsubjects, show that patients over 75 years of age are more fragile(die more), have better comorbidities and have been under treatedcompared to younger subjects.
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Background and Aim: As of 22 June 2020, Italy had 238.499cases of Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2) infections, with about 35.000 deaths. A single-center observational cohort study was conducted to evaluate epidemiological, demographic, clinical and laboratory data of SARS-CoV-2patients who were admitted to the sub-intensive therapy unit ofthe COVID Unit Hospital F. Miulli (Acquaviva delle Fonti, Bari, Italy),from Mar 17, 2020 to May 17, 2020.Materials and Methods: Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes wereall collected and analysed. Results: A total of 143 SARS-CoV-2 patients, 60.4% males, meanage 68 yrs , were included. Twenty-seven patients (19%) had clinical signs of severe pneumonia and 6.3% had an ARDS, ICU admissions were 2.9%. The most represented comorbidities were:chronic heart failure (10.3%), diabetes (15.5%), chronic obstructive pulmonary disease (17.8%), cancer (13.2%), kidney chronicfailure (28.2%). The used drugs have been distributed as follows:lopinavir/ritonavir (30.4%), hydroxychloroquine (67.8%), steroid(21.2%), tocilizumab (4%). Length of stay was 21 days and theaverage negative time of the second nasopharyngeal swab was18 days. In our study, a total of 20 patients (13.9%) died, withmean age 86 yrs .Conclusions: Our findings show that SARS-CoV-2 infection maybe severe, requiring intensive care admission, expecially in olderpatients and in those with comorbidities.
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Background and Aim of the study: The SARS-CoV 2 pandemicinvolved about 230.00 people in Italy with about 35.000 deaths.In China the lethality rate of confirmed cases is 4.7% in men compared to 2.8% in women. In Italy women represent 34.0% of thetotal and are older than men (respectively 83 years vs 79). A single-center observational cohort study was conducted to evaluategender differences in clinical features, laboratory, length of stayand mortality in patients admitted in sub-intensive COVID Unit ofF. Miulli Hospital (Acquaviva delle Fonti, Bari, Italy) from 17 marchto 17 may 2020.Materials and Methods: The data contained in the medicalrecords were studied.Results: A total of 174 patients were analyzed. Females accountfor 39.6%. The average age was 66 yrs and 70 yrs respectively inmales and females. No difference was observed with respect to themain inflammation markers (IL6, d-Dimer, CRP);the length of hospital stay was similar, 20 days in females and 21 days in males.Chronic heart failure, COPD, diabetes, chronic renal failure, wereequally represented in the two groups. Disease severity and mortalitywere similar. The only significant difference (p <0.02) was in the useof hydroxychloroquine, prevalent in the group of male subjects.Discussion and Conclusions: The data of our study, although witha limited sample of subjects, do not show significant differencesbetween males and females. Length of stay and mortality are notinfluenced by gender. We could conclude that when women getsick they feel the disease in the same way as men.
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Background and Aim of the study: After the outbreak in China,Italy was the first country facing COVID-19 pandemic. The earliestidentified cases in Lombardy at mid-February, 2020 have promptlygiven the idea of a dramatic infection. During the first decade ofMarch the Italian Government introduced drastic measures of social isolation to contain the spread of contagion, to prevent thecollapse of healthcare system, and to reduce deaths. We evaluatedthe geographic differences in COVID-19 cases, hospitalizations,and deaths as well as compared to the initial stage of diffusionacross Italian regions.Materials and Methods: We assessed data daily released by Italian Civil Protection Department since February to May, 2020. Wecompared six geographic repartitions of similar population sizeafter the first 1000 cases in each macro-area. Results: Out 227364 patients infected by COVID-19, 32330(14.2%) dead. Time to double infections was initially very short.The northern regions nearest to the epicenter showed the majorpercentage of cases, hospitalizations and fatal events. Conclusions: The COVID 19 infection represents an unexpectedhealth-care challenge. Although the spatial heterogeneity ofCOVID-19 diffusion through Italy, prompt containment measureshave produced positive results, in particular for southern regions.This aspect is due to holographic isolation, delay in spreading thevirus and social restrictions. The adopted strategies by the ItalianGovernment have been relevant to control the unpredictable andpotential fatal evolution of infection in our regions.