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1. Negative prognostic impact of electrolyte disorders in patients hospitalized for Covid-19 in a large multicenter study.

Author

Genovesi S, Regolisti G, Rebora P, Occhino G, Belli M, Molon G, Citerio G, Beltrame A, Maloberti A, Generali E, Giannattasio C, Epis OM, Rossetti C, Bellelli G, De Nalda AL, Capua I, and Valsecchi MG

Subjects
Adult, Humans, Prognosis, Hospital Mortality, Sodium, Potassium, Electrolytes, Hyponatremia, COVID-19 complications
Abstract

Background: The prognostic impact of electrolyte disorders in hospitalized COVID-19 patients is unclear., Methods: The study included all adult patients hospitalized for COVID-19 in four hospitals in Northern Italy between January 2020 and May 2021 with at least one serum potassium and sodium measurement performed within 3 days since admission. Primary outcome was in-hospital death; secondary outcome was Intensive Care Unit (ICU) admission. A cause-specific Cox proportional-hazards regression model was used for investigating the association between potassium and sodium (as either categorical or continuous variables) and mortality or admission to ICU., Results: Analyses included 3,418 adult hospitalized COVID-19 patients. At multivariable analysis, both hyperkalemia (Hazard Ratio, [HR] 1.833, 95% Confidence Interval [CI] 1.371-2.450) and sK above the median (K 5.1 vs 4.1 mmol/L: HR 1.523, 95% CI 1.295-1.798), and hypernatremia (HR 2.313, 95%CI 1.772-3.018) and sNa above the median (Na 149 vs 139 mmol/L: HR 1.442, 95% CI 1.234-1.686), were associated with in-hospital death, whereas hypokalemia and hyponatremia were not. Hyponatremia was associated with increased hazard of ICU admission (HR 1.884, 95%CI 1.389-2.556)., Conclusions: Electrolyte disorders detected at hospital admission may allow early identification of COVID-19 patients at increased risk of adverse outcomes., (© 2022. The Author(s) under exclusive licence to Italian Society of Nephrology.)

Published
2023
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2. Prevalence and Death Rate of COVID-19 in Autoimmune Systemic Diseases in the First Three Pandemic Waves. Relationship with Disease Subgroups and Ongoing Therapies.

Author

Ferri C, Raimondo V, Gragnani L, Giuggioli D, Dagna L, Tavoni A, Ursini F, L'Andolina M, Caso F, Ruscitti P, Caminiti M, Foti R, Riccieri V, Guiducci S, Pellegrini R, Zanatta E, Varcasia G, Olivo D, Gigliotti P, Cuomo G, Murdaca G, Cecchetti R, De Angelis R, Romeo N, Ingegnoli F, Cozzi F, Codullo V, Cavazzana I, Colaci M, Abignano G, De Santis M, Lubrano E, Fusaro E, Spinella A, Lumetti F, De Luca G, Bellando-Randone S, Visalli E, Bosco YD, Amato G, Giannini D, Bilia S, Masini F, Pellegrino G, Pigatto E, Generali E, Mariano GP, Pettiti G, Zanframundo G, Brittelli R, Aiello V, Caminiti R, Scorpiniti D, Ferrari T, Campochiaro C, Brusi V, Fredi M, Moschetti L, Cacciapaglia F, Paparo SR, Ragusa F, Mazzi V, Elia G, Ferrari SM, Di Cola I, Vadacca M, Lorusso S, Monti M, Lorini S, Aprile ML, Tasso M, Miccoli M, Bosello S, D'Angelo S, Doria A, Franceschini F, Meliconi R, Matucci-Cerinic M, Iannone F, Giacomelli R, Salvarani C, Zignego AL, Fallahi P, and Antonelli A

Subjects
Aged, Humans, Male, Middle Aged, Pandemics, Prevalence, Prospective Studies, Antirheumatic Agents therapeutic use, Autoimmune Diseases drug therapy, Autoimmune Diseases epidemiology, COVID-19 epidemiology, Lung Diseases, Interstitial drug therapy, Lung Diseases, Interstitial epidemiology, Scleroderma, Systemic, COVID-19 Drug Treatment
Abstract

Objective: Autoimmune systemic diseases (ASD) represent a predisposing condition to COVID-19. Our prospective, observational multicenter telephone survey study aimed to investigate the prevalence, prognostic factors, and outcomes of COVID-19 in Italian ASD patients., Methods: The study included 3,918 ASD pts (815 M, 3103 F; mean age 59±12SD years) consecutively recruited between March 2020 and May 2021 at the 36 referral centers of COVID-19 and ASD Italian Study Group. The possible development of COVID-19 was recorded by means of a telephone survey using a standardized symptom assessment questionnaire., Results: ASD patients showed a significantly higher prevalence of COVID-19 (8.37% vs. 6.49%; p<0.0001) but a death rate statistically comparable to the Italian general population (3.65% vs. 2.95%). Among the 328 ASD patients developing COVID-19, 17% needed hospitalization, while mild-moderate manifestations were observed in 83% of cases. Moreover, 12/57 hospitalized patients died due to severe interstitial pneumonia and/or cardiovascular events; systemic sclerosis (SSc) patients showed a significantly higher COVID-19-related death rate compared to the general population (6.29% vs. 2.95%; p=0.018). Major adverse prognostic factors to develop COVID-19 were: older age, male gender, SSc, pre-existing ASD-related interstitial lung involvement, and long-term steroid treatment. Of note, patients treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) showed a significantly lower prevalence of COVID-19 compared to those without (3.58% vs. 46.99%; p=0.000), as well as the SSc patients treated with low dose aspirin (with 5.57% vs. without 27.84%; p=0.000)., Conclusion: During the first three pandemic waves, ASD patients showed a death rate comparable to the general population despite the significantly higher prevalence of COVID-19. A significantly increased COVID-19- related mortality was recorded in only SSc patients' subgroup, possibly favored by preexisting lung fibrosis. Moreover, ongoing long-term treatment with csDMARDs in ASD might usefully contribute to the generally positive outcomes of this frail patients' population., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Published
2022
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3. Covid-19 And Rheumatic Autoimmune Systemic Diseases: Role of Pre-Existing Lung Involvement and Ongoing Treatments.

Author

Ferri C, Giuggioli D, Raimondo V, L'Andolina M, Dagna L, Tavoni A, Caso F, Ursini F, Ruscitti P, Caminiti M, Foti R, Riccieri V, Guiducci S, Pellegrini R, Zanatta E, Varcasia G, Olivo D, Gigliotti P, Cuomo G, Murdaca G, Cecchetti R, De Angelis R, Romeo N, Ingegnoli F, Cozzi F, Codullo V, Cavazzana I, Colaci M, Abignano G, De Santis M, Lubrano E, Fusaro E, Rossa AD, Spinella A, Lumetti F, De Luca G, Bellando-Randone S, Visalli E, Dal Bosco Y, Amato G, Giannini D, Bilia S, Masini F, Pellegrino G, Pigatto E, Generali E, Mariano GP, Pettiti G, Zanframundo G, Brittelli R, Aiello V, Caminiti R, Scorpiniti D, Ferrari T, Campochiaro C, Brusi V, Fredi M, Moschetti L, Cacciapaglia F, Gragnani L, Monti M, Lorini S, Paparo SR, Ragusa F, Mazzi V, Elia G, Ferrari SM, Di Cola I, Vadacca M, Lorusso S, Barsotti S, Aprile ML, Marco T, Miccoli M, Bosello S, Matucci-Cerinic M, D'Angelo S, Doria A, Franceschini F, Meliconi R, Iannone F, Giacomelli R, Zignego AL, Fallahi P, and Antonelli A

Subjects
Humans, Lung, Pandemics, SARS-CoV-2, Autoimmune Diseases drug therapy, Autoimmune Diseases epidemiology, COVID-19, Rheumatic Diseases drug therapy, Rheumatic Diseases epidemiology
Abstract

Background: The Covid-19 pandemic may have a deleterious impact on patients with autoimmune systemic diseases (ASD) due to their deep immune-system alterations., Objective: This study aims to investigate the prevalence of symptomatic Covid-19 and its correlations with both organ involvement and ongoing treatments in a large series of Italian ASD patients during the first wave of pandemic., Methods: Our multicenter telephone 6-week survey included 3,029 unselected ASD patients enrolled at 36 tertiary referral centers of northern, central, and southern Italian macro-areas with different diffusion of the pandemic. Symptomatic SARS-CoV-2 infection was classified as definite Covid-19 (presence of symptoms plus positive oral/nasopharyngeal swabs) or highly suspected Covid-19 (highly suggestive symptoms, in the absence of a swab testing)., Results: A significantly higher prevalence of definite plus highly suspected Covid-19 compared to the Italian general population was detected in the whole ASD series (p=.000), as well as in patients from the three macro-areas (p=.000 in all). Statistically higher prevalence of Covid-19 was also found in connective tissue diseases compared to chronic arthritis subgroup (p=.000) and in ASD patients with pre-existing interstitial lung involvement (p=.000). Patients treated with either conventional disease-modifying anti-rheumatic drugs (DMARDs) and/or biological DMARDs showed a significantly lower prevalence of Covid-19 (p=.000 in both). Finally, scleroderma patients undergoing low-dose aspirin showed a significantly lower rate of Covid-19 compared to those without (p=0.003)., Conclusion: The higher prevalence of Covid-19 in ASD patients, along with the significant correlations with important clinical features and therapeutic regimens, suggests the need to develop targeted prevention/management strategies during the current pandemic wave., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Published
2021
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4. High mortality in COVID‐19 patients with mild respiratory disease.

Author

Masetti, Chiara, Generali, Elena, Colapietro, Francesca, Voza, Antonio, Cecconi, Maurizio, Messina, Antonio, Omodei, Paolo, Angelini, Claudio, Ciccarelli, Michele, Badalamenti, Salvatore, Canonica, G. Walter, Lleo, Ana, and Aghemo, Alessio

Subjects
*COVID-19, *RESPIRATORY diseases, *PULMONARY fibrosis, *HOSPITAL mortality, *SYMPTOMS
Abstract

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has infected 189 000 people in Italy, with more than 25 000 deaths. Several predictive factors of mortality have been identified; however, none has been validated in patients presenting with mild disease. Methods: Patients with a diagnosis of interstitial pneumonia caused by SARS‐CoV‐2, presenting with mild symptoms, and requiring hospitalization in a non‐intensive care unit with known discharge status were prospectively collected and retrospectively analysed. Demographical, clinical and biochemical parameters were recorded, as need for non‐invasive mechanical ventilation and admission in intensive care unit. Univariate and multivariate logistic regression analyses were used to identify independent predictors of death. Results: Between 28 February and 10 April 2020, 229 consecutive patients were included in the study cohort; the majority were males with a mean age of 60 years. 54% of patients had at least one comorbidity, with hypertension being the most commonly represented, followed by diabetes mellitus. 196 patients were discharged after a mean of 9 days, while 14.4% died during hospitalization because of respiratory failure. Age higher than 75 years, low platelet count (<150 × 103/mm3) and higher ferritin levels (>750 ng/mL) were independent predictors of death. Comorbidities were not independently associated with in‐hospital mortality. Conclusions: In‐hospital mortality of patients with COVID‐19 presenting with mild symptoms is high and is associated with older age, platelet count and ferritin levels. Identifying early predictors of outcome can be useful in the clinical practice to better stratify and manage patients with COVID‐19. [ABSTRACT FROM AUTHOR]

Published
2020
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5. Covid-19 And Rheumatic Autoimmune Systemic Diseases: Role of Pre-Existing Lung Involvement and Ongoing Treatments

Author

M. L. Aprile, Rosario Foti, Ruscitti Piero, Giuseppe Varcasia, Ilaria Cavazzana, Nicoletta Romeo, Riccardo Meliconi, Serena Lorini, Serena Guiducci, Amelia Spinella, Roberto Giacomelli, Vincenzo Aiello, Alessandra Della Rossa, Giorgio Amato, Daiana Giannini, Vincenzo Raimondo, Francesco Caso, Ennio Lubrano, Silvia Bosello, Maurizio Caminiti, Monica Monti, Tasso Marco, Francesca Ingegnoli, Giorgio Pettiti, Massimo L'Andolina, Salvatore D'Angelo, Francesca Ragusa, Elisabetta Zanatta, Giacomo De Luca, Riccardo Cecchetti, Franco Franceschini, Greta Pellegrino, Silvia Bellando-Randone, Silvia Martina Ferrari, Micaela Fredi, Veronica Brusi, Lorenzo Dagna, Giusy Elia, Fabio Cacciapaglia, Francesco Ursini, Giuseppina Abignano, Sebastiano Lorusso, Clodoveo Ferri, Anna Linda Zignego, Rodolfo Caminiti, Sabrina Rosaria Paparo, Raffaele Brittelli, Liala Moschetti, Elena Generali, Marco Matucci-Cerinic, Roberta Pellegrini, Ylenia Dal Bosco, Giovanni Zanframundo, Domenico Olivo, Tommaso Ferrari, Alessandro Antonelli, M. Vadacca, Andrea Doria, Pietro Gigliotti, Poupak Varcasia, Enrico Fusaro, Elisa Visalli, Simone Barsotti, Giuseppa Pagano Mariano, Giovanna Cuomo, Florenzo Iannone, Maria De Santis, Valeria Mazzi, Giuseppe Murdaca, Michele Colaci, Silvia Bilia, Franco Cozzi, Dilia Giuggioli, Corrado Campochiaro, Valeria Riccieri, Erika Pigatto, Laura Gragnani, Ilenia Di Cola, Daniela Scorpiniti, Mario Miccoli, Francesco Masini, Veronica Codullo, Rossella De Angelis, Federica Lumetti, Antonio Tavoni, Ferri, Clodoveo, Giuggioli, Dilia, Raimondo, Vincenzo, L’Andolina, Massimo, Dagna, Lorenzo, Tavoni, Antonio, Caso, Francesco, Ursini, Francesco, Piero, Ruscitti, Caminiti, Maurizio, Foti, Rosario, Riccieri, Valeria, Guiducci, Serena, Pellegrini, Roberta, Zanatta, Elisabetta, Varcasia, Giuseppe, Olivo, Domenico, Gigliotti, Pietro, Cuomo, Giovanna, Murdaca, Giuseppe, Cecchetti, Riccardo, De Angelis, Rossella, Romeo, Nicoletta, Ingegnoli, Francesca, Cozzi, Franco, Codullo, Veronica, Cavazzana, Ilaria, Colaci, Michele, Abignano, Giuseppina, De Santis, Maria, Lubrano, Ennio, Fusaro, Enrico, Rossa, Alessandra Della, Spinella, Amelia, Lumetti, Federica, De Luca, Giacomo, Bellando-Randone, Silvia, Visalli, Elisa, Dal Bosco, Ylenia, Amato, Giorgio, Giannini, Daiana, Bilia, Silvia, Masini, Francesco, Pellegrino, Greta, Pigatto, Erika, Generali, Elena, Mariano, Giuseppa Pagano, Pettiti, Giorgio, Zanframundo, Giovanni, Brittelli, Raffaele, Aiello, Vincenzo, Caminiti, Rodolfo, Scorpiniti, Daniela, Ferrari, Tommaso, Campochiaro, Corrado, Brusi, Veronica, Fredi, Micaela, Moschetti, Liala, Cacciapaglia, Fabio, Gragnani, Laura, Monti, Monica, Lorini, Serena, Paparo, Sabrina Rosaria, Ragusa, Francesca, Mazzi, Valeria, Elia, Giusy, Ferrari, Silvia Martina, Di Cola, Ilenia, Vadacca, Marta, Lorusso, Sebastiano, Barsotti, Simone, Aprile, Maria Letizia, Marco, Tasso, Miccoli, Mario, Bosello, Silvia, Matucci-Cerinic, Marco, D'Angelo, Salvatore, Doria, Andrea, Franceschini, Franco, Meliconi, Riccardo, Iannone, Florenzo, Giacomelli, Roberto, Zignego, Anna Linda, Varcasia, Poupak, Antonelli, Alessandro, L'Andolina, Massimo, Della Rossa, Alessandra, Pagano Mariano, Giuseppa, Rosaria Paparo, Sabrina, Martina Ferrari, Silvia, Letizia Aprile, Maria, Linda Zignego, Anna, Ferri C., Giuggioli D., Raimondo V., L'andolina M., Dagna L., Tavoni A., Caso F., Ursini F., Ruscitti P., Caminiti M., Foti R., Riccieri V., Guiducci S., Pellegrini R., Zanatta E., Varcasia G., Olivo D., Gigliotti P., Cuomo G., Murdaca G., Cecchetti R., De Angelis R., Romeo N., Ingegnoli F., Cozzi F., Codullo V., Cavazzana I., Colaci M., Abignano G., De Santis M., Lubrano E., Fusaro E., Della Rossa A., Spinella A., Lumetti F., De Luca G., Bellando-Randone S., Visalli E., Dal Bosco Y., Amato G., Giannini D., Bilia S., Masini F., Pellegrino G., Pigatto E., Generali E., Mariano G.P., Pettiti G., Zanframundo G., Brittelli R., Aiello V., Caminiti R., Scorpiniti D., Ferrari T., Campochiaro C., Brusi V., Fredi M., Moschetti L., Cacciapaglia F., Gragnani L., Monti M., Lorini S., Paparo S.R., Ragusa F., Mazzi V., Elia G., Ferrari S.M., Di Cola I., Vadacca M., Lorusso S., Barsotti S., Aprile M.L., Marco T., Miccoli M., Bosello S., Matucci-Cerinic M., D'angelo S., Doria A., Franceschini F., Meliconi R., Iannone F., Giacomelli R., Zignego A.L., Fallahi P., and Antonelli A.

Subjects
medicine.medical_specialty, Settore MED/16 - REUMATOLOGIA, Referral, Coronavirus disease 2019 (COVID-19), autoimmune systemic disease, systemic sclerosis, Population, COVID-19, SARS-CoV-2, arthritis, autoimmune systemic diseases, connective tissue diseases, interstitial lung disease, rheumatic diseases, Arthritis, Keywords: COVID-19, Scleroderma, Autoimmune Diseases, Covid-19, Autoimmune systemic diseases, Connective tissue diseases, Interstitial lung disease, Rheumatic diseases, Systemic sclerosis, Internal medicine, Rheumatic Diseases, Drug Discovery, Pandemic, medicine, Humans, education, rheumatic disease, Lung, Pandemics, Pharmacology, education.field_of_study, Aspirin, business.industry, covid 19, medicine.disease, arthriti, connective tissue disease, business, medicine.drug
Abstract

Background: The Covid-19 pandemic may have a deleterious impact on patients with autoimmune systemic diseases (ASD) due to their deep immune-system alterations. Objective: This study aims to investigate the prevalence of symptomatic Covid-19 and its correlations with both organ involvement and ongoing treatments in a large series of Italian ASD patients during the first wave of pandemic. Methods: Our multicenter telephone 6-week survey included 3,029 unselected ASD patients enrolled at 36 tertiary referral centers of northern, central, and southern Italian macro-areas with different diffusion of the pandemic. Symptomatic SARS-CoV-2 infection was classified as definite Covid-19 (presence of symptoms plus positive oral/nasopharyngeal swabs) or highly suspected Covid-19 (highly suggestive symptoms, in the absence of a swab testing). Results: A significantly higher prevalence of definite plus highly suspected Covid-19 compared to the Italian general population was detected in the whole ASD series (p=.000), as well as in patients from the three macro-areas (p=.000 in all). Statistically higher prevalence of Covid-19 was also found in connective tissue diseases compared to chronic arthritis subgroup (p=.000) and in ASD patients with pre-existing interstitial lung involvement (p=.000). Patients treated with either conventional disease-modifying anti-rheumatic drugs (DMARDs) and/or biological DMARDs showed a significantly lower prevalence of Covid-19 (p=.000 in both). Finally, scleroderma patients undergoing low-dose aspirin showed a significantly lower rate of Covid-19 compared to those without (p=0.003). Conclusion: The higher prevalence of Covid-19 in ASD patients, along with the significant correlations with important clinical features and therapeutic regimens, suggests the need to develop targeted prevention/management strategies during the current pandemic wave.

Published
2021

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