TY - JOUR
T1 - Clinical factors associated with death in 3044 COVID-19 patients managed in internal medicine wards in Italy: results from the SIMI-COVID-19 study of the Italian Society of Internal Medicine (SIMI)
AU - Corradini, Elena
AU - Ventura, Paolo
AU - Ageno, Walter
AU - Cogliati, Chiara Beatrice
AU - Muiesan, Maria Lorenza
AU - Girelli, Domenico
AU - Girelli, Davide Nicola
AU - Pirisi, Mario
AU - Gasbarrini, Antonio
AU - Angeli, Paolo
AU - Querini, Patrizia Rovere
AU - Bosi, Emanuele
AU - Tresoldi, Moreno
AU - Vettor, Roberto
AU - Cattaneo, Marco
AU - Piscaglia, Fabio
AU - Brucato, Antonio Luca
AU - Perlini, Stefano
AU - Martelletti, Paolo
AU - Pontremoli, Roberto
AU - Porta, Massimo
AU - Minuz, Pietro
AU - Olivieri, Oliviero
AU - Sesti, Giorgio
AU - Biolo, Gianni
AU - Rizzoni, Damiano
AU - Serviddio, Gaetano
AU - Cipollone, Francesco
AU - Grassi, Davide
AU - Manfredini, Roberto
AU - Moreo, Guido Luigi
AU - Pietrangelo, Antonello
AU - Teatini, Thomas
AU - Salvetti, Massimo
AU - Salvetti, Maria Cristina
AU - Crisafulli, Ernesto
AU - Sainaghi, Pier Paolo
AU - Zileri Dal Verme, Lorenzo
AU - Piano, Salvatore
AU - De Lorenzo, Rebecca
AU - Arcidiacono, Gaetano
AU - Podda, Marco
AU - Muratori, Luca
AU - Gabiati, Claudia
AU - Salinaro, Francesco
AU - Luciani, Michelangelo
AU - Luciani, Massimiliano
AU - Barnini, Cecilia
AU - Morra Di Cella, Stefania
AU - Dalbeni, Andrea
AU - Friso, Simonetta
AU - Luciani, Michelangelo
AU - Luciani, Massimiliano
AU - Mearelli, Filippo
AU - Malerba, Paolo
AU - Cavallone, Francesco
AU - D’Ardes, Damiano
AU - Notargiacomo, Serena
AU - De Giorgi, Alfredo
AU - Mansi, Marta
AU - Buzzetti, Elena
AU - Ricci, Andrea
AU - Martelli, Francesca
AU - Martelli, Franco
PY - 2021
Y1 - 2021
N2 - 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.
AB - 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.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - COVID-19
KW - Cohort Studies
KW - Comorbidity
KW - Critical Care
KW - Hospital Mortality
KW - Hospitalization
KW - Humans
KW - Internal Medicine
KW - Internal medicine
KW - Italy
KW - Middle Aged
KW - Mortality from COVID-19
KW - Polypharmacy
KW - Respiration, Artificial
KW - SARS-CoV-2
KW - Survival Rate
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - COVID-19
KW - Cohort Studies
KW - Comorbidity
KW - Critical Care
KW - Hospital Mortality
KW - Hospitalization
KW - Humans
KW - Internal Medicine
KW - Internal medicine
KW - Italy
KW - Middle Aged
KW - Mortality from COVID-19
KW - Polypharmacy
KW - Respiration, Artificial
KW - SARS-CoV-2
KW - Survival Rate
UR - http://hdl.handle.net/10807/203868
U2 - 10.1007/s11739-021-02742-8
DO - 10.1007/s11739-021-02742-8
M3 - Article
SN - 1828-0447
VL - 16
SP - 1005
EP - 1015
JO - Internal and Emergency Medicine
JF - Internal and Emergency Medicine
ER -