RESUMO
Multicentre, retrospective cohort study with multivariable Cox proportional-hazards modelling and survival-time inverse-probability-weighting, evaluating the impact of different treatments on survival of proven COVID-19 patients admitted to two Hospitals in the province of Piacenza, Italy. Use of tocilizumab and of high doses of low molecular weight heparin, but not of antivirals (either alone or in combination), azithromycin, and any corticosteroid, was independently associated with lower mortality. Our results support further clinical evaluation of high doses of low molecular weight heparin and tocilizumab as COVID-19 therapeutics.
Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Antivirais/administração & dosagem , Tratamento Farmacológico da COVID-19 , COVID-19/epidemiologia , Heparina/administração & dosagem , Corticosteroides/administração & dosagem , Idoso , Azitromicina/administração & dosagem , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Probabilidade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , SARS-CoV-2 , Resultado do TratamentoRESUMO
BACKGROUND: Piacenza is the closest city to the first coronavirus disease 2019 (COVID-19) cluster in Italy and has the highest national COVID-19 death rates per population. The objective of this study is to present characteristics and outcomes of patients admitted to medical departments of the Hospital of Piacenza during the first wave of the epidemic. METHODS: A total of 218 patients with confirmed or suspect COVID-19 and severe pneumonia were included from February 21st to May 15th, 2020. Routinely-collected clinical and laboratory data were retrospectively retrieved from electronic medical files. A Cox proportional-hazards model was fit to assess the association of treatment and other variables with death. RESULTS: Median age of patients was 68 years; 150 patients (69%) had comorbidities, mainly hypertension (107, 49%). Overall, 185 (85%) patients had acute respiratory distress syndrome (ARDS) on admission, including 103 (47%) with moderate or severe ARDS. Chest computed tomography scan showed bilateral disease in 201 (98%) and extensive lung involvement in 79 (50%) patients. Most patients received antiviral treatment (187, 86%) and corticosteroids (134, 61%). All patients received respiratory support and 64 (29%) were admitted to intensive care unit. As of June 30th, 100 patients (46%) died, 109 patients (50%) were discharged, and 9 patients (4%) were still hospitalized. In multivariable Cox analysis, age above 65 years, having more than one comorbidity, severe ARDS, low platelet counts, and high LDH levels at admission were associated with mortality, while having diarrhea at admission was associated with survival. The use of antivirals or corticosteroids was not associated with survival. CONCLUSIONS: Overall case fatality rates were high and associated with comorbidities, extensive lung involvement, ARDS at admission, and advanced age. The use of antivirals was not associated with increased survival.
Assuntos
COVID-19/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/fisiopatologia , Comorbidade , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Adulto JovemRESUMO
In the last ten years the number of asylum seekers has increased in all of Europe. Our Migrants Health Unit in Piacenza, Emilia Romagna, Italy, is designated to provide primary health care for migrants without a regular permit of stay and, since 2015, is the reference center for asylum-seekers in our Province. Aim of this study is to describe the results of the screening for infectious diseases performed in asylum seekers from January 2015 to December 2015. For any asylum seekers referred to our Centre, we recorded demographical data and we offered screening for HIV, HBV, HCV, syphilis and active tuberculosis (TB). Descriptive statistics were used to analyze the characteristics of the cohort. In 2015, 316 asylum seekers accessed to our Centre. Of them, the majority were men (N= 275; 87,03%). Africa was the most represented geographical area (221, 69,94%), followed from Asia (95, 30.06%). The median age was 25,4 years. 301 patients underwent chest X-Ray, that resulted negative in 262 cases (87%). HBsAg testing proved to be positive in 17 (5,3%) cases. The screening test for HCV, HIV and syphilis resulted respectively positive in 1.9%, 0.3% and 1.6%.
Assuntos
Programas de Rastreamento , Refugiados , Adulto , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Hepatite B/diagnóstico , Hepatite B/epidemiologia , Hepatite C/diagnóstico , Hepatite C/epidemiologia , Humanos , Itália , Masculino , Atenção Primária à Saúde , Sífilis/diagnóstico , Sífilis/epidemiologia , Tuberculose/diagnóstico , Tuberculose/epidemiologiaRESUMO
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infects humans through the angiotensin converting enzyme-2 (ACE-2) receptor expressed on many cells, including lymphocytes. In Covid-19 patients IL-6 is overexpressed, and hyperactivated plasmacytoid lymphocytes are detected in peripheral blood film. We hypothesize that, due to the unpredictable interaction between the new virus and the B cell lineage of infected patients, a cascade of out of control events can ensue, capable of determining unexpected pathologic disorders involving such lineage. Here we report two cases of autoimmune hemolytic anemia (AIHA) and two cases of B-cell hematological malignancies developed or reactivated during acute SARS-CoV-2 infection. The temporal relationship of the events may suggest a potential causal relationship between SARS-CoV-2 infection and the hematopoietic disorders. We suggest that special attention should be paid to COVID-19 patients with underlining B cell lineage disorders.