Keywords
COVID-19; SARS-CoV-2; risk factors, mortality
Abstract
Introduction. The Coronavirus disease 2019 caused by a new Coronavirus (SARS-CoV-2) throughout the pandemic period has been characterised by a wide spectrum of clinical manifestations, courses, and outcomes. In particular, most patients with severe or critical symptoms re-quired hospitalization. The demographic and clinical characteristics of patients upon admission to the hospital, as well as pre-existing medical conditions, seem to have affected the clinical out-come. Predictive factors of inauspicious outcome in non-Intensive Care Unit hospitalized patients were investigated.
Methods. A retrospective, single-centre, observational study of 239 patients with confirmed COVID-19 disease admitted during the first waves of the pandemic to the Infectious Disease Operative Unit of a hospital in Southern Italy was conducted. Demographic characteristics, under-lying diseases, and clinical, laboratory, and radiological findings were collected from the patient’s medical records. Information about in-hospital medications, days of admission, and out-come were also considered. Inferential statistical analysis was performed to evaluate the association between patients' characteristics upon hospital admission and during in-hospital length of stay and death. Results. Mean age was 67.8 ± 15.8 years; 137/239 (57.3%) patients were males, and 176 (73.6%) had at least one comorbidity. More than half of patients (55.3%) suffered from hypertension. The length of stay in hospital was 16.5 ± 9.9 days and mortality rate of 12.55%. In multivariable logistic regression analysis, predictors of mortality of COVID-19 patients included age (OR, 1.09; CI, 1.04 - 1.15), Chronic Kidney Disease (OR, 4.04; CI,1.38 - 11.85), and need of High Flow Oxygen therapy (OR, 18.23; CI, 5.06 - 65.64).
Conclusions. Patients who died in the hospital had shorted length of stay than that of the surviving patients. Older age, pre-existent chronic renal disease and need of supplemental oxygen represented independent predictors of mortality in patients hospitalized in non-Intensive Care Unit with COVID-19. The determination of these factors allows retrospectively a greater understanding of the disease also in comparison with the successive epidemic waves.
References
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[22] Yamada T, Mikami T, Chopra N, Miyashita H, Chernyavsky S, Miyashita S. Patients with chronic kidney disease have a poorer prognosis of coronavirus disease 2019 (COVID-19): an experience in New York City. Int Urol Nephrol 2020;52(7):1405-6. https://doi.org/10.1007/s11255-020-02494-y.
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[24] Betjes MG. Immune cell dysfunction and inflammation in end-stage renal disease. Nat Rev Nephrol 2013;9(5):255-65. https://doi.org/10.1038/nrneph.2013.44.
[25] Heine GH, Ortiz A, Massy ZA, Lindholm B, Wiecek A, Martínez-Castelao A, Covic A, Goldsmith D, Süleymanlar G, London GM, Parati G, Sicari R, Zoccali C, Fliser D; European Renal and Cardiovascular Medicine (EURECA‑m) working group of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA). Monocyte subpopulations and cardiovascular risk in chronic kidney disease. Nat Rev Nephrol 2012;8(6):362-9. https://doi.org/10.1038/nrneph.2012.41.
[26] Santus P, Radovanovic D, Saderi L, Marino P, Cogliati C, De Filippis G, Rizzi M, Franceschi E, Pini S, Giuliani F, Del Medico M, Nucera G, Valenti V, Tursi F, Sotgiu G. Severity of respiratory failure at admission and in-hospital mortality in patients with COVID-19: a prospective observational multicentre study. BMJ Open 2020;10(10):e043651. https://doi.org/10.1136/bmjopen-2020-043651.
[27] Xie J, Covassin N, Fan Z, Singh P, Gao W, Li G, Kara T, Somers VK. Association Between Hypoxemia and Mortality in Patients With COVID-19. Mayo Clin Proc 2020;95(6):1138-47. https://doi.org/10.1016/j.mayocp.2020.04.006.
[28] Begum H, Neto AS, Alliegro P, Broadley T, Trapani T, Campbell LT, Cheng AC, Cheung W, Cooper DJ, Erickson SJ, French CJ, Litton E, McAllister R, Nichol A, Palermo A, Plummer MP, Rotherham H, Ramanan M, Reddi B, Reynolds C, Webb SA, Udy AA, Burrell A. People in intensive care with COVID-19: demographic and clinical features during the first, second, and third pandemic waves in Australia. Med J Aust 2022;217(7):352-60. https://doi.org/10.5694/mja2.51590.
[29] Carbonell R, Urgelés S, Rodríguez A, Bodí M, Martín-Loeches I, Solé-Violán J, Díaz E, Gómez J, Trefler S, Vallverdú M, Murcia J, Albaya A, Loza A, Socias L, Ballesteros JC, Papiol E, Viña L, Sancho S, Nieto M, Lorente MDC, Badallo O, Fraile V, Arméstar F, Estella A, Sanchez L, Sancho I, Margarit A, Moreno G; COVID-19 SEMICYUC Working Group. Mortality comparison between the first and second/third waves among 3,795 critical COVID-19 patients with pneumonia admitted to the ICU: A multicentre retrospective cohort study. Lancet Reg Health Eur 2021;11:100243. https://doi.org/10.1016/j.lanepe.2021.100243.