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Panminerva Medica 2020 Nov 27

DOI: 10.23736/S0031-0808.20.04063-X

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

At the peak of Covid-19 age and disease severity but not comorbidities are predictors of mortality. Covid-19 burden in Bergamo, Italy

Luca NOVELLI 1, Federico RAIMONDI 1, 27, Arianna GHIRARDI 2, Dario PELLEGRINI 3, Davide CAPODANNO 4, Giovanni SOTGIU 5, Giulio GUAGLIUMI 3, Michele SENNI 3, Filippo M. RUSSO 6, 27, Ferdinando L. LORINI 6, Marco RIZZI 7, Tiziano BARBUI 2, Alessandro RAMBALDI 8, 27, Roberto COSENTINI 9, Lorenzo S. GRAZIOLI 6, Gianmariano MARCHESI 6, Giuseppe F. SFERRAZZA PAPA 10, 27, Simonetta CESA 11, Michele COLLEDAN 12, Roberta CIVILETTI 1, 28, Caterina CONTI 1, Monica CASATI 11, Francesco FERRI 6, Stefania CAMAGNI 12, Maria SESSA 13, Arianna MASCIULLI 2, Antonello GAVAZZI 2, Anna FALANGA 14, 29, Luigi F. DA POZZO 15, 29, Sabrina BUORO 16, Giuseppe REMUZZI 17, Piero RUGGENENTI 18, Annapaola CALLEGARO 19, Lorenzo D'ANTIGA 20, Luisa PASULO 21, Fabio PEZZOLI 22, Andrea GIANATTI 23, Piercarlo PARIGI 1, Claudio FARINA 19, Antonio BELLASI 24, Paolo SOLIDORO 25, Sandro SIRONI 26, 29, Fabiano DI MARCO 1, 27 , Stefano FAGIUOLI 21, on behalf of HPG23 Covid-19 Study Group

1 Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy; 2 FROM Research Foundation, Bergamo, Italy; 3 Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy; 4 Cardiology Unit, Ferrarotto Hospital, Università degli Studi di Catania, Catania, Italy; 5 Department of Medical, Surgical and Experimental Sciences, Università degli Studi di Sassari, Sassari, Italy; 6 Department of Emergency and Critical Care Area, ASST Papa Giovanni XXIII, Bergamo, Italy; 7 Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy; 8 Department of Oncology and Hematology, ASST Papa Giovanni, Bergamo, Italy; 9 Department of Emergency, ASST Papa Giovanni XXIII, Bergamo, Italy; 10 Department of Neurorehabilitation sciences, Casa di Cura del Policlinico, Milan, Italy; 11 Department of Health and Social Care Professions, ASST Papa Giovanni XXIII, Bergamo, Italy; 12 General Surgery 3 Unit, Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII; Bergamo, Italy; 13 Neurology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy; 14 Immunohematology and Transfusion Unit, ASST Papa Giovanni XXIII, Bergamo, Italy; 15 Urology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy; 16 Quality Management, ASST Papa Giovanni XXIII, Bergamo, Italy; 17 Mario Negri Institute for Pharmacological Research IRCCS, Anna Maria Astori Centre, Science and Technology Park Kilometro Rosso, Bergamo, Italy; 18 Nephrology and Dialysis Unit, ASST Papa Giovanni XXIII, Bergamo, Italy; 19 Department of Laboratory Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy; 20 Paediatric Hepatology Gastroenterology and Transplantation Unit, ASST Papa GiovannI XXIII, Bergamo, Italy; 21 Gastroenterology I, Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy; 22 Medical Direction, ASST Papa Giovanni XXIII, Bergamo, Italy; 23 Pathology Unit, Department of Laboratory Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy, 24 Department of Research, Innovation and Brand Reputation, ASST Papa Giovanni XXIII, Bergamo, Italy; 25 Pneumology Unit, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, Università degli Studi Torino, Turin, Italy; 26 Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy; 27 Università degli Studi di Milano, Milan, Italy; 28 Università degli Studi Federico II, Naples, Italy; 29 Università degli Studi di Milano-Bicocca, Milan, Italy



BACKGROUND: Findings from February, 2020, indicate that the clinical spectrum of Covid-19 can be heterogeneous, probably due to the infectious dose and viral load of SARS-CoV-2 within the first weeks of the outbreak. The aim of this study was to investigate predictors of overall 28-day mortality at the peak of the Italian outbreak.
METHODS: Retrospective observational study of all Covid-19 patients admitted to the main hospital of Bergamo, from February 23 to March, 14, 2020.
RESULTS: 508 patients were hospitalized , predominantly male (72.4%), mean age of 66±15 years; 49.2% were older than 70 years. Most of patients presented with severe respiratory failure (median value [IQR] of PaO2/FiO2 233 [149-281]). Mortality rate at 28 days resulted of 33.7% (N=171). 39.0% of patients were treated with continuous positive airway pressure (CPAP), 9.5% with non-invasive ventilation (NIV) and 13.6% with endotracheal intubation. 9.5% were admitted to semi-intensive respiratory care unit, and 18.9% to ICU. Risk factors independently associated with 28-day mortality were advanced age (≥78 years: odds ratio, OR, 95% confidence interval [CI] 38.91 [10.67-141.93], p<0.001; 70-77 years: 17.30 [5.40-55.38], p<0.001; 60-69 years: 3.20 [1.00-10.20], p=0.049), PaO2/FiO2 <200 at presentation (3.50 [1.70-7.20], p=0.001), need for CPAP/NIV in the first 24 hours (8.38 [3.63-19.35], p <0.001), and blood urea value at admission (1.01 [1.00-1.02], p=0.015).
CONCLUSIONS: At the peak of the outbreak, with a probable high infectious dose and viral load, older age, the severity of respiratory failure and renal impairment at presentation, but not comorbidities, are predictors of 28-day mortality in Covid-19.


KEY WORDS: Covid 19; SARS-CoV-2; Predictors of mortality

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