Clinical course and risk factors for in-hospital mortality of 205 patients with SARS-CoV-2 pneumonia in Como, Lombardy Region, Italy (preprint)

ABSTRACT

ImportanceWith randomized clinical trials ongoing and vaccine still a long distance away, efforts to repurpose old medications used for other diseases provide hope for the treatment of COVID-19 ObjectivesTo examine the risk factors for in-hospital mortality and describe the effectiveness of different treatment strategies in a real-life setting of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. DesignReal-life single-center study during the Lombardy COVID-19 outbreak. SettingValduce Hospital in Como, Lombardy Region, Italy. Participants205 laboratory-confirmed patients presenting with SARS-Cov-2 pneumonia requiring hospitalization. InterventionsAll patients received best supportive care and, based on their clinical needs and comorbidities, specific interventions that included the main drugs being tested for repurposing to treat COVID-19, such as hydroxychloroquine, anticoagulation, antiviral drugs, steroids or interleukin-6 pathway inhibitors. Main outcomes and measuresClinical, laboratory and treatment characteristics were analyzed with univariate and multivariate logistic regression methods to explore their impact on in-hospital mortality and compared with current literature data. ResultsUnivariate analyses for clinical variables showed prognostic significance for age equal or greater than 70 years (estimated 28-days survival 21.4 vs 67.4%; p<0.0001), presence of 2 or more relevant comorbidities (35.3 vs 61.8%; p=0.0008), ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F) less than 200 at presentation (21-days survival 14.7 vs 52.4%;p<0.0001), high levels of lactate dehydrogenase (LDH) (26.4 vs 65.3%; p=0.0001), and elevated C-reactive protein (CRP) values (25.4 vs 74.9%; p=0.0001), while no statistical significance was found for all the other clinical variables tested. At univariate analysis for the different treatment scheduled, prognostic significance for survival was showed for intermediate or therapeutic-dose anticoagulation (estimated 28-days survival 37.1 vs 23.4%; p=0.0001), hydroxychloroquine (35.7 vs 27.3%; p=0.0029), early antiviral therapy with lopinavir/ritonavir (60.1 vs 22.4%; p<0.0001), late short-course of steroids (47.9 vs 18.2%; p<0.0001) or tocilizumab therapy (69.4 vs 29.4%; p=0.0059). Multivariable regression confirmed increasing odds of in-hospital death associated with age older than 70 years (odds ratio 3.26, 95% CI 1.81-5.86; p<0.0001) and showed a reduction in mortality for patients treated with anticoagulant (-0.37, 0.49-0.95; p=0.0273), antiviral (-1.22, 0.16-0.54; p<0.0001), or steroids (-0.59, 0.35-0.87; p=0.0117) therapy. Conclusions and RelevanceResults from this real-life single-center experience are in agreement and confirm actual literature data on SARS-CoV-2 pneumonia, both in terms of clinical risk factors for in-hospital mortality and as regards the effectiveness of the different therapies proposed for the management of COVID-19 disease. Waiting the results from randomized clinical trials, these data could help clinicians to identify patients with poor prognosis at an early stage and guide the choice between the different treatments implied in COVID-19 disease. KEY POINTSO_ST_ABSQuestionC_ST_ABSAmong the main drugs that have been tested for repurposing to treat COVID-19, what are the most effective medical treatments for SARS-CoV-2 pneumonia? FindingsResults from these real-life cohort of 205 patients confirm at multivariate regression model an increasing odds of in-hospital death associated with age older than 70 years (OR 3.26) and a reduction in mortality for patients treated with anticoagulant (OR -0.37), antiviral lopinavir/ritonavir (OR -1.22), or steroids therapy (OR -0.59). In contrast, hydroxychloroquine and tocilizumab have not been confirmed to have a significant effect in the treatment of SARS-CoV-2 pneumonia, in accordance with the latest data from the international literature. MeaningWaiting the results from randomized clinical trials, these data could help clinicians to identify patients with poor prognosis at an early stage and guide the choice between the different treatments implied in COVID-19 disease.