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1. Progressive right ventricular dysfunction and exercise impairment in patients with heart failure and diabetes mellitus: insights from the T.O.S.CA. Registry

Author

Salzano, A, D'Assante, R, Iacoviello, M, Triggiani, V, Rengo, G, Cacciatore, F, Maiello, C, Limongelli, G, Masarone, D, Sciacqua, A, Perrone Filardi, P, Mancini, A, Volterrani, M, Vriz, O, Castello, R, Passantino, A, Campo, M, Modesti, Pa, De Giorgi, A, Arcopinto, M, Gargiulo, P, Perticone, M, Colao, A, Milano, S, Garavaglia, A, Napoli, R, Suzuki, T, Bossone, E, Marra, Am, Cittadini, A, Saccà, L, Monti, Mg, Matarazzo, M, Stagnaro, Fm, Piccioli, L, Lombardi, A, Panicara, V, Flora, M, Golia, L, Faga, V, Ruocco, A, Della Polla, D, Franco, R, Schiavo, A, Gigante, A, Spina, E, Sicuranza, M, Monaco, F, Apicella, M, Miele, C, Campanino, Ag, Mazza, L, Abete, R, Farro, A, Luciano, F, Polizzi, R, Ferrillo, G, De Luca, M, Crisci, G, Giardino, F, Barbato, M, Ranieri, B, Ferrara, F, Russo, V, Malinconico, M, Citro, R, Guastalamacchia, E, Leone, M, Giagulli, Va, Amarelli, C, Mattucci, I, Calabrò, P, Calabrò, R, D'Andrea, A, Maddaloni, V, Pacileo, G, Scarafile, R, Belfiore, A, Cimellaro, A, Casaretti, L, Paolillo, S, Favuzzi, Amr, Di Segni, C, Bruno, C, Vergani, E, Massaro, R, Grimaldi, F, Frigo, A, Sorrentino, Mr, Malandrino, D, Manfredini, R, Fabbian, F, Puzzo, A, Ragusa, L, Caliendo, L, Carbone, L, Frigiola, A, Generali, T, Giacomazzi, F, De Vincentiis, C, Ballotta, A, Garofalo, P, Malizia, G, Misiano, G, Israr, Mz, Bernieh, D, Cassambai, S, Yazaki, Y, Heaney, Lm, Eagle, Ka, Ventura, Ho, Bruzzese, D, Salzano, Andrea, D'Assante, Roberta, Iacoviello, Massimo, Triggiani, Vincenzo, Rengo, Giuseppe, Cacciatore, Francesco, Maiello, Ciro, Limongelli, Giuseppe, Masarone, Daniele, Sciacqua, Angela, Filardi, Pasquale Perrone, Mancini, Antonio, Volterrani, Maurizio, Vriz, Olga, Castello, Roberto, Passantino, Andrea, Campo, Michela, Modesti, Pietro A, De Giorgi, Alfredo, Arcopinto, Michele, Gargiulo, Paola, Perticone, Maria, Colao, Annamaria, Milano, Salvatore, Garavaglia, Agnese, Napoli, Raffaele, Suzuki, Toru, Bossone, Eduardo, Marra, Alberto M, Cittadini, Antonio, and Misiano, Gabriella

Subjects
Registrie, Heart Failure, Endocrinology, Diabetes and Metabolism, Ventricular Dysfunction, Right, Diabetes, Insulins, Socio-culturale, Stroke Volume, Insulin resistance, Diabete, Cardiopulmonary exercise test, Chronic heart failure, Diabetes, Insulin resistance, Right ventricle, TOSCA Registry, Chronic heart failure, Diabetes Mellitus, Type 2, TOSCA Registry, Exercise Test, Ventricular Function, Right, Humans, Insulin, Right ventricle, Registries, Cardiology and Cardiovascular Medicine, Cardiopulmonary exercise test, TOSCA, Human, LS4_7
Abstract

Background Findings from the T.O.S.CA. Registry recently reported that patients with concomitant chronic heart failure (CHF) and impairment of insulin axis (either insulin resistance—IR or diabetes mellitus—T2D) display increased morbidity and mortality. However, little information is available on the relative impact of IR and T2D on cardiac structure and function, cardiopulmonary performance, and their longitudinal changes in CHF. Methods Patients enrolled in the T.O.S.CA. Registry performed echocardiography and cardiopulmonary exercise test at baseline and at a patient-average follow-up of 36 months. Patients were divided into three groups based on the degree of insulin impairment: euglycemic without IR (EU), euglycemic with IR (IR), and T2D. Results Compared with EU and IR, T2D was associated with increased filling pressures (E/e′ratio: 15.9 ± 8.9, 12.0 ± 6.5, and 14.5 ± 8.1 respectively, p 2) in TD2 vs EU and IR patients was recorded (respectively, 15.8 ± 3.8 ml/Kg/min, 18.4 ± 4.3 ml/Kg/min and 16.5 ± 4.3 ml/Kg/min, p 2 in the T2D group (+ 13% increase in RV dimension, − 21% decline in TAPSE/PAPS ratio and − 20% decrease in peak VO2). Conclusion The higher risk of death and CV hospitalizations exhibited by HF-T2D patients in the T.O.S.CA. Registry is associated with progressive RV ventricular dysfunction and exercise impairment when compared to euglycemic CHF patients, supporting the pivotal importance of hyperglycaemia and right chambers in HF prognosis. Trial registration ClinicalTrials.gov identifier: NCT023358017

Published
2022

2. Clinical Characteristics and Predictors of In-Hospital Mortality among Older Patients with Acute Heart Failure

Author

De Matteis, Giuseppe, Covino, Marcello, Burzo, M. L., Della Polla, D. A., Franceschi, Francesco, Mebazaa, A., Gambassi, Giovanni, De Matteis G., Covino M. (ORCID:0000-0002-6709-2531), Franceschi F. (ORCID:0000-0001-6266-445X), Gambassi G. (ORCID:0000-0002-7030-9359), De Matteis, Giuseppe, Covino, Marcello, Burzo, M. L., Della Polla, D. A., Franceschi, Francesco, Mebazaa, A., Gambassi, Giovanni, De Matteis G., Covino M. (ORCID:0000-0002-6709-2531), Franceschi F. (ORCID:0000-0001-6266-445X), and Gambassi G. (ORCID:0000-0002-7030-9359)

Abstract

Acute Heart Failure (AHF)-related hospitalizations and mortality are still high in western countries, especially among older patients. This study aimed to describe the clinical characteristics and predictors of in-hospital mortality of older patients hospitalized with AHF. We conducted a retrospective study including all consecutive patients ≥65 years who were admitted for AHF at a single academic medical center between 1 January 2008 and 31 December 2018. The primary outcome was all-cause, in-hospital mortality. We also analyzed deaths due to cardiovascular (CV) and non-CV causes and compared early in-hospital events. The study included 6930 patients, mean age 81 years, 51% females. The overall mortality rate was 13%. Patients ≥85 years had higher mortality and early death rate than younger patients. Infections were the most common condition precipitating AHF in our cohort, and pneumonia was the most frequent of these. About half of all hospital deaths were due to non-CV causes. After adjusting for confounding factors other than NYHA class at admission, infections were associated with an almost two-fold increased risk of mortality, HR 1.74, 95% CI 1.10–2.71 in patients 65–74 years (p = 0.014); HR 1.83, 95% CI 1.34–2.49 in patients 75–84 years (p = 0.001); HR 1.74, 95% CI 1.24–2.19 in patients ≥85 years (p = 0.001). In conclusion, among older patients with AHF, in-hospital mortality rates increased with increasing age, and infections were associated with an increased risk of in-hospital mortality. In contemporary patients with AHF, along with the treatment of the CV conditions, management should be focused on timely diagnosis and appropriate treatment of non-CV factors, especially pulmonary infections.

Published
2022

3. Frailty in Elderly Patients with Covid-19: A Narrative Review

Author

Salini, S., Russo, Andrea, De Matteis, Giuseppe, Piccioni, Andrea, Della Polla, D., Carbone, Luigi, Barillaro, Christian, Landi, Francesco, Franceschi, Francesco, Covino, Marcello, Russo A., De Matteis G., Piccioni A., Carbone L., Barillaro C., Landi F. (ORCID:0000-0002-3472-1389), Franceschi F. (ORCID:0000-0001-6266-445X), Covino M. (ORCID:0000-0002-6709-2531), Salini, S., Russo, Andrea, De Matteis, Giuseppe, Piccioni, Andrea, Della Polla, D., Carbone, Luigi, Barillaro, Christian, Landi, Francesco, Franceschi, Francesco, Covino, Marcello, Russo A., De Matteis G., Piccioni A., Carbone L., Barillaro C., Landi F. (ORCID:0000-0002-3472-1389), Franceschi F. (ORCID:0000-0001-6266-445X), and Covino M. (ORCID:0000-0002-6709-2531)

Abstract

Introduction: The SARS CoV-2 pandemic still generates a very high number of affected patients and a significant mortality rate. It is essential to establish objective criteria to stratify COVID-19 death risk. Frailty has been identified as a potential determinant of increased vulnerability in older adults affected by COVID-19, because it may suggest alterations of physical performance and functional autonomy. Methods: We have conducted a narrative review of the literature on the evidences regarding COVID-19 and the frailty condition. Thirteen observational studies were included. Conclusion: Data emerging from the studies indicate that older COVID-19 patients with a frailty condition have an increased risk of mortality compared with non-frail patients, and this association is independent of other clinical and demographic factors. A frailty evaluation is required to help clinicians to better stratify the overall risk of death for older patients with COVID-19.

Published
2022

4. Characteristic of IgA and IgG antibody response to SARS-CoV-2 infection in an Italian referral COVID-19 Hospital

Author

Carnicelli, A., Fiori, B., Ricci, Rosalba, Piano, A., Bonadia, N., Taddei, Eleonora, Fantoni, Massimo, Murri, Rita, Cingolani, Antonella, Barillaro, Christian, Cutuli, S. L., Marchesini, Debora, Della Polla, D. A., Forte, E., Fuorlo, M., Di Maurizio, L., Amorini, Paola, Cattani, P., Franceschi, Francesco, Sanguinetti, Maurizio, Ricci R., Taddei E., Fantoni M. (ORCID:0000-0001-6913-8460), Murri R. (ORCID:0000-0003-4263-7854), Cingolani A. (ORCID:0000-0002-3793-2755), Barillaro C., Marchesini D., Amorini P., Franceschi F. (ORCID:0000-0001-6266-445X), Sanguinetti M. (ORCID:0000-0002-9780-7059), Carnicelli, A., Fiori, B., Ricci, Rosalba, Piano, A., Bonadia, N., Taddei, Eleonora, Fantoni, Massimo, Murri, Rita, Cingolani, Antonella, Barillaro, Christian, Cutuli, S. L., Marchesini, Debora, Della Polla, D. A., Forte, E., Fuorlo, M., Di Maurizio, L., Amorini, Paola, Cattani, P., Franceschi, Francesco, Sanguinetti, Maurizio, Ricci R., Taddei E., Fantoni M. (ORCID:0000-0001-6913-8460), Murri R. (ORCID:0000-0003-4263-7854), Cingolani A. (ORCID:0000-0002-3793-2755), Barillaro C., Marchesini D., Amorini P., Franceschi F. (ORCID:0000-0001-6266-445X), and Sanguinetti M. (ORCID:0000-0002-9780-7059)

Abstract

Introduction: Antibody response plays a fundamental role in the natural history of infectious disease. A better understanding of the immune response in patients with SARS-CoV-2 infection could be important for identifying patients at greater risk of developing a more severe form of disease and with a worse prognosis. Methods: We performed a cross-sectional analysis to determine the presence and the levels of both anti-SARS-CoV-2 IgG and IgA in a cohort of hospitalized patients with confirmed infection at different times in the natural history of the disease. Patients enrolled when admitted at the emergency department were prospectively followed up during hospital stay. Results: Overall, 131 patients were considered with a total of 237 samples processed. Cross-sectional analysis showed that seroconversion for IgA seems to occur between days 6 and 15, while IgG response seems to occur slightly later, peaking at day 20 after symptoms onset. Both IgA and IgG were maintained beyond 2 months. Severe patients showed a higher IgA response compared with mild patients when analyzing optical density (8.3 versus 5.6, p < 0.001). Prospective analysis conducted on 55 patients confirmed that IgA appear slightly earlier than IgG. After stratifying for the severity of disease, both the IgA and IgG responses were more vigorous in severe cases. Moreover, while IgG tended to stabilize, there was a relevant decline after the first month of IgA levels in mild cases. Conclusion: IgA and IgG antibody response is closely related, although seroconversion for IgA occurs earlier. Both IgA and IgG are maintained beyond 2 months. Severe patients showed a more vigorous IgA and IgG response. IgA levels seem to decline after 1 month since the onset of symptoms in mild cases. Our results should be interpreted with cautions due to several limitations in our study, mainly the small number of cases, lack of data on viral load and clinical setting.

Published
2022

5. Multiple hormonal and metabolic deficiency syndrome predicts outcome in heart failure: the T.O.S.CA. Registry

Author

Cittadini A., Salzano A., Iacoviello M., Triggiani V., Rengo G., Cacciatore F., Maiello C., Limongelli G., Masarone D., Perticone F., Cimellaro A., Filardi P. P., Paolillo S., Mancini A., Volterrani M., Vriz O., Castello R., Passantino A., Campo M., Modesti P. A., de Giorgi A., Monte I. P., Puzzo A., Ballotta A., D'Assante R., Arcopinto M., Gargiulo P., Sciacqua A., Bruzzese D., Colao A., Napoli R., Suzuki T., Eagle K. A., Ventura H. O., Marra A. M., Bossone E., Sacca L., Monti M. G., Matarazzo M., Stagnaro F. M., Piccioli L., Lombardi A., Panicara V., Flora M., Golia L., Faga V., Ruocco A., della Polla D., Franco R., Schiavo A., Gigante A., Spina E., Sicuranza M., Monaco F., Apicella M., Miele C., Campanino A. G., Mazza L., Abete R., Farro A., Luciano F., Polizzi R., Ferrillo G., de Luca M., Crisci G., Giardino F., Barbato M., Ranieri B., Ferrara F., Russo V., Malinconico M., Citro R., Guastalamacchia E., Leone M., Giagulli V. A., Amarelli C., Mattucci I., Calabro P., Calabro R., D'Andrea A., Maddaloni V., Pacileo G., Scarafile R., Belfiore A., Casaretti L., Favuzzi A. M. R., Di Segni C., Bruno C., Vergani E., Massaro R., Grimaldi F., Frigo A., Campo M. R., Sorrentino M. R., Malandrino D., Manfredini R., Fabbian F., Ragusa L., Caliendo L., Carbone L., Frigiola A., Generali T., Giacomazzi F., de Vincentiis C., Garofalo P., Malizia G., Milano S., Misiano G., Israr M. Z., Bernieh D., Cassambai S., Yazaki Y., Heaney L. M., Cittadini, Antonio, Salzano, Andrea, Iacoviello, Massimo, Triggiani, Vincenzo, Rengo, Giuseppe, Cacciatore, Francesco, Maiello, Ciro, Limongelli, Giuseppe, Masarone, Daniele, Perticone, Francesco, Cimellaro, Antonio, Perrone Filardi, Pasquale, Paolillo, Stefania, Mancini, Antonio, Volterrani, Maurizio, Vriz, Olga, Castello, Roberto, Passantino, Andrea, Campo, Michela, Modesti, Pietro A, De Giorgi, Alfredo, Monte, Ines P, Puzzo, Alfonso, Ballotta, Andrea, D'Assante, Roberta, Arcopinto, Michele, Gargiulo, Paola, Sciacqua, Angela, Bruzzese, Dario, Colao, Annamaria, Napoli, Raffaele, Suzuki, Toru, Eagle, Kim A, Ventura, Hector O, Marra, Alberto M, Bossone, Eduardo, Cittadini, A., Salzano, A., Iacoviello, M., Triggiani, V., Rengo, G., Cacciatore, F., Maiello, C., Limongelli, G., Masarone, D., Perticone, F., Cimellaro, A., Filardi, P. P., Paolillo, S., Mancini, A., Volterrani, M., Vriz, O., Castello, R., Passantino, A., Campo, M., Modesti, P. A., de Giorgi, A., Monte, I. P., Puzzo, A., Ballotta, A., D'Assante, R., Arcopinto, M., Gargiulo, P., Sciacqua, A., Bruzzese, D., Colao, A., Napoli, R., Suzuki, T., Eagle, K. A., Ventura, H. O., Marra, A. M., Bossone, E., Sacca, L., Monti, M. G., Matarazzo, M., Stagnaro, F. M., Piccioli, L., Lombardi, A., Panicara, V., Flora, M., Golia, L., Faga, V., Ruocco, A., della Polla, D., Franco, R., Schiavo, A., Gigante, A., Spina, E., Sicuranza, M., Monaco, F., Apicella, M., Miele, C., Campanino, A. G., Mazza, L., Abete, R., Farro, A., Luciano, F., Polizzi, R., Ferrillo, G., de Luca, M., Crisci, G., Giardino, F., Barbato, M., Ranieri, B., Ferrara, F., Russo, V., Malinconico, M., Citro, R., Guastalamacchia, E., Leone, M., Giagulli, V. A., Amarelli, C., Mattucci, I., Calabro, P., Calabro, R., D'Andrea, A., Maddaloni, V., Pacileo, G., Scarafile, R., Belfiore, A., Casaretti, L., Favuzzi, A. M. R., Di Segni, C., Bruno, C., Vergani, E., Massaro, R., Grimaldi, F., Frigo, A., Campo, M. R., Sorrentino, M. R., Malandrino, D., Manfredini, R., Fabbian, F., Ragusa, L., Caliendo, L., Carbone, L., Frigiola, A., Generali, T., Giacomazzi, F., de Vincentiis, C., Garofalo, P., Malizia, G., Milano, S., Misiano, G., Israr, M. Z., Bernieh, D., Cassambai, S., Yazaki, Y., and Heaney, L. M.

Subjects
medicine.medical_specialty, Multiple hormonal and metabolic deficiency syndrome, Epidemiology, Prognosi, Anabolic deficiency, Socio-culturale, Heart failure, 030204 cardiovascular system & hematology, Ventricular Function, Left, 03 medical and health sciences, 0302 clinical medicine, Insulin resistance, Diabetes mellitus, Internal medicine, Multiple hormonal, medicine, Clinical endpoint, Humans, 030212 general & internal medicine, Prospective Studies, Registries, TOSCA, LS4_7, Ejection fraction, business.industry, Hazard ratio, Metabolic deficiency syndrome, Heart failure • Anabolic deficiency • Multiple hormonal and metabolic deficiency syndrome • Hormones • Prognosis • TOSCA, Stroke Volume, medicine.disease, Prognosis, Hormone, Confidence interval, Heart failure, Anabolic deficiency, Multiple hormonal and metabolic deficiency syndrome, Hormones, Prognosis, TOSCA, Hormones, Hospitalization, Observational study, Cardiology and Cardiovascular Medicine, business
Abstract

Aims Recent evidence supports the occurrence of multiple hormonal and metabolic deficiency syndrome (MHDS) in chronic heart failure (CHF). However, no large observational study has unequivocally demonstrated its impact on CHF progression and outcome. The T.O.S.CA. (Trattamento Ormonale nello Scompenso CArdiaco; Hormone Treatment in Heart Failure) Registry has been specifically designed to test the hypothesis that MHDS affects morbidity and mortality in CHF patients. Methods and Results The T.O.S.CA. Registry is a prospective, multicentre, observational study involving 19 Italian centres. Thyroid hormones, insulin-like growth factor-1, total testosterone, dehydropianoandrosterone sulfate, insulin resistance, and the presence of diabetes were evaluated. A MHDS was defined as the presence of ≥2 hormone deficiencies (HDs). Primary endpoint was a composite of all-cause mortality and cardiovascular hospitalizations. Four hundred and eighty heart failure patients with ejection fraction ≤45% were enrolled. MHDS or diabetes was diagnosed in 372 patients (77.5%). A total of 271 events (97 deaths and 174 cardiovascular hospitalizations) were recorded, 41% in NO-MHDS and 62% in MHDS (P Conclusion MHDS is common in CHF and independently associated with increased all-cause mortality and cardiovascular hospitalization, representing a promising therapeutic target. Trial registration ClinicalTrials.gov identifier: NCT023358017

Published
2021

6. Frailty Assessment in the Emergency Department for Risk Stratification of COVID-19 Patients Aged ≥80 Years

Author

Covino, Marcello, Russo, Andrea, Salini, S., De Matteis, Giuseppe, Simeoni, B., Della Polla, D., Sandroni, Claudio, Landi, Francesco, Gasbarrini, Antonio, Franceschi, Francesco, Covino M. (ORCID:0000-0002-6709-2531), Russo A., De Matteis G., Sandroni C. (ORCID:0000-0002-8878-2611), Landi F. (ORCID:0000-0002-3472-1389), Gasbarrini A. (ORCID:0000-0002-7278-4823), Franceschi F. (ORCID:0000-0001-6266-445X), Covino, Marcello, Russo, Andrea, Salini, S., De Matteis, Giuseppe, Simeoni, B., Della Polla, D., Sandroni, Claudio, Landi, Francesco, Gasbarrini, Antonio, Franceschi, Francesco, Covino M. (ORCID:0000-0002-6709-2531), Russo A., De Matteis G., Sandroni C. (ORCID:0000-0002-8878-2611), Landi F. (ORCID:0000-0002-3472-1389), Gasbarrini A. (ORCID:0000-0002-7278-4823), and Franceschi F. (ORCID:0000-0001-6266-445X)

Abstract

Objectives: To evaluate, in a cohort of adults aged ≥80 years, the overlapping effect of clinical severity, comorbidities, cognitive impairment, and frailty, for the in-hospital death risk stratification of COVID-19 older patients since emergency department (ED) admission. Design: Single-center prospective observational cohort study. Setting and Participants: The study was conducted in the ED of a teaching hospital that is a referral center for COVID-19 in central Italy. We enrolled all patients with aged ≥80 years old consecutively admitted to the ED between April 2020 and March 2021. Methods: Clinical variables assessed in the ED were evaluated for the association with all-cause in-hospital death. Evaluated parameters were severity of disease, frailty, comorbidities, cognitive impairment, delirium, and dependency in daily life activities. Cox regression analysis was used to identify independent risk factors for poor outcomes. Results: A total of 729 patients aged ≥80 years were enrolled [median age 85 years (interquartile range 82-89); 346 were males (47.3%)]. According to the Clinical Frailty Scale, 61 (8.4%) were classified as fit, 417 (57.2%) as vulnerable, and 251 (34.4%) as frail. Severe disease [hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.31-2.59], ≥3 comorbidities (HR 1.54, 95% CI 1.11-2.13), male sex (HR 1.46, 95% CI 1.14-1.87), and frailty (HR 6.93, 95% CI 1.69-28.27) for vulnerable and an overall HR of 12.55 (95% CI 2.96-53.21) for frail were independent risk factors for in-hospital death. Conclusions and Implications: The ED approach to older patients with COVID-19 should take into account the functional and clinical characteristics of patients being admitted. A sole evaluation based on the clinical severity and the presence of comorbidities does not reflect the complexity of this population. A comprehensive evaluation based on clinical severity, multimorbidity, and frailty could effectively predict the clinical risk of in-hospital death for

Published
2021

7. Does chronic oral anticoagulation reduce in-hospital mortality among COVID-19 older patients?

Author

Covino, M., De Matteis, G., Della Polla, D., Burzo, M. L., Pascale, M. M., Santoro, M., De Cristofaro, R., Gasbarrini, A., De Candia, E., Franceschi, F., Covino M. (ORCID:0000-0002-6709-2531), De Matteis G., Pascale M. M., Santoro M., De Cristofaro R. (ORCID:0000-0002-8066-8849), Gasbarrini A. (ORCID:0000-0002-7278-4823), De Candia E. (ORCID:0000-0003-0942-2819), Franceschi F. (ORCID:0000-0001-6266-445X), Covino, M., De Matteis, G., Della Polla, D., Burzo, M. L., Pascale, M. M., Santoro, M., De Cristofaro, R., Gasbarrini, A., De Candia, E., Franceschi, F., Covino M. (ORCID:0000-0002-6709-2531), De Matteis G., Pascale M. M., Santoro M., De Cristofaro R. (ORCID:0000-0002-8066-8849), Gasbarrini A. (ORCID:0000-0002-7278-4823), De Candia E. (ORCID:0000-0003-0942-2819), and Franceschi F. (ORCID:0000-0001-6266-445X)

Abstract

Background: Patients hospitalized with COVID-19 experienced an increased risk of venous thromboembolism. Aims: To evaluate the effect of chronic oral anticoagulation (OAC) therapy, both with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs), on prognosis of COVID-19 older patients. Methods: Single-center prospective study conducted in the Emergency Department (ED) of a teaching hospital, referral center for COVID-19 in central Italy. We evaluated all the patients ≥ 65 years, consecutively admitted to our ED for confirmed COVID-19. We compared the clinical outcome of those who were on chronic OAC at ED admission with those who did not, using a propensity score matched paired cohort of controls. The primary study endpoint was all-cause in-hospital death. Patients were matched for age, sex, clinical comorbidities, and clinical severity at presentation (based on NEWS ≥ 6). Study parameters were assessed for association to all-cause in-hospital death by a multivariate Cox regression analysis to identify independent risk factor for survival. Results: Although overall mortality was slightly higher for anticoagulated patients compared to controls (63.3% vs 43.5%, p = 0.012), the multivariate adjusted hazard ratio (HR) for death was not significant (HR = 1.56 [0.78–3.12]; p = 0.208). Both DOACs (HR 1.46 [0.73–2.92]; p = 0.283) and VKAs (HR 1.14 [0.48–2.73]; p = 0.761) alone did not affect overall survival in our cohort. Conclusions: Among older patients hospitalized for COVID-19, chronic OAC therapy was not associated with a reduced risk of in-hospital death. Moreover, our data suggest similar outcome both for patients on VKAs or in patients on DOACs.

Published
2021

9. The T.O.S.C.A. Project: Research, Education and Care

Author

Bossone, E, Limongelli, G, Malizia, G, Ferrara, F, Vriz, O, Citro, R, Marra, AM, Arcopinto, M, Bobbio, E, Sirico, D, Caliendo, L, Ballotta, A, D'Andrea, A, Frigiola, A, Isgaard, J, Saccà, L, Cittadini, A, De Paola, V, Di Benedetto, G, Gigantino, A, Silvestri, F, Cirrincione, V, De Vincentis, C, Generali, T, Giacomazzi, F, Bech Hanssen, O, Bollano, E, Karasori, K, Calabrò, P, Calabrò, R, Maddaloni, V, Pacileo, G, Scarafile, R, Polverino, M, Musella, V, Santoriello, C, Rega, S, D'Ambrosio, G, Monti, MG, Saldamarco, L, Salzano, A, Celentani, D, Luiso, D, Spina, E, Campanino, AG, Miele, C, Formicola, L, Santopaolo, ML, Della Polla, D, Graniero, F, Marcuzzi, G, Schiaulini, G., MILANO, Salvatore, MISIANO, Gabriella, Bossone, E, Limongelli, G, Malizia, G, Ferrara, F, Vriz, O, Citro, R, Marra, AM, Arcopinto, M, Bobbio, E, Sirico, D, Caliendo, L, Ballotta, A, D'Andrea, A, Frigiola, A, Isgaard, J, Saccà, L, Cittadini, A, De Paola, V, Di Benedetto, G, Gigantino, A, Silvestri, F, Cirrincione, V, De Vincentis, C, Generali, T, Giacomazzi, F, Bech Hanssen, O, Bollano, E, Karasori, K, Calabrò, P, Calabrò, R, Maddaloni, V, Pacileo, G, Scarafile, R, Milano, S, Misiano, G, Polverino, M, Musella, V, Santoriello, C, Rega, S, D'Ambrosio, G, Monti, MG, Saldamarco, L, Salzano, A, Celentani, D, Luiso, D, Spina, E, Campanino, AG, Miele, C, Formicola, L, Santopaolo, ML, Della Polla, D, Graniero, F, Marcuzzi, G, and Schiaulini, G

Subjects
heart failure, metabolic pathophysiological model, quality of care, TOSCA
Abstract

Despite recent and exponential improvements in diagnostic- therapeutic pathways, an existing “GAP” has been revealed between the “real world care” and the “optimal care” of patients with chronic heart failure (CHF). We present the T.O.S.CA. Project (Trattamento Ormonale dello Scompenso CArdiaco), an Italian multicenter initiative involving different health care professionals and services aiming to explore the CHF “metabolic pathophysiological model” and to improve the quality of care of HF patients through research and continuing medical education.

Published
2011

10. Predicting ICU admission and death in the Emergency Department: A comparison of six early warning scores.

Author

Covino M, Sandroni C, Della Polla D, De Matteis G, Piccioni A, De Vita A, Russo A, Salini S, Carbone L, Petrucci M, Pennisi M, Gasbarrini A, and Franceschi F

Subjects
Adult, Humans, Hospitalization, Emergency Service, Hospital, ROC Curve, Retrospective Studies, Hospital Mortality, Intensive Care Units, Early Warning Score
Abstract

Aim: To compare the ability of the most used Early Warning Scores (EWS) to identify adult patients at risk of poor outcomes in the emergency department (ED)., Methods: Single-center, retrospective observational study. We evaluated the digital records of consecutive ED admissions in patients ≥ 18 years from 2010 to 2019 and calculated NEWS, NEWS2, MEWS, RAPS, REMS, and SEWS based on parameters measured on ED arrival. We assessed the discrimination and calibration performance of each EWS in predicting death/ICU admission within 24 hours using ROC analysis and visual calibration. We also measured the relative weight of clinical and physiological derangements that identified patients missed by EWS risk stratification using neural network analysis., Results: Among 225,369 patients assessed in the ED during the study period, 1941 (0.9%) were admitted to ICU or died within 24 hours. NEWS was the most accurate predictor (area under the receiver operating characteristic [AUROC] curve 0.904 [95% CI 0.805-0.913]), followed by NEWS2 (AUROC 0.901). NEWS was also well calibrated. In patients judged at low risk (NEWS < 2), 359 events occurred (18.5% of the total). Neural network analysis revealed that age, systolic BP, and temperature had the highest relative weight for these NEWS-unpredicted events., Conclusions: NEWS is the most accurate EWS for predicting the risk of death/ICU admission within 24 h from ED arrival. The score also had a fair calibration with few events occurring in patients classified at low risk. Neural network analysis suggests the need for further improvements by focusing on the prompt diagnosis of sepsis and the development of practical tools for the measurement of the respiratory rate., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [Prof. Claudio Sandroni is a member of the journal’s Editorial Board.], (Copyright © 2023 Elsevier B.V. All rights reserved.)

Published
2023
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11. Frailty assessment as independent prognostic factor for patients ≥65 years undergoing urgent cholecystectomy for acute cholecystitis.

Author

Rosa F, Covino M, Russo A, Salini S, Forino R, Della Polla D, Fransvea P, Quero G, Fiorillo C, La Greca A, Sganga G, Gasbarrini A, Franceschi F, and Alfieri S

Subjects
Male, Adult, Humans, Aged, Prospective Studies, Prognosis, Hospital Mortality, Risk Factors, Cholecystectomy, Geriatric Assessment, Risk Assessment, Frailty complications, Frailty epidemiology, Cholecystitis, Acute surgery
Abstract

Background: To evaluate, in a prospective observational cohort study of adults ≥65 years old, the frailty status at the emergency department (ED) admission for the in-hospital death risk stratification of patients needing urgent cholecystectomy., Methods: Clinical variables and frailty status assessed in the ED were evaluated for the association with major complications and the need for open surgery. The parameters evaluated were frailty, comorbidities, physiological parameters, surgical approach, and laboratory values at admission. Logistic regression analysis was used to identify independent risk factors for poor outcomes., Results: The study enrolled 358 patients aged ≥65 years [median age 74 years]; 190 males (53.1%)]. Overall, 259 patients (72.4%) were classified as non-frail, and 99 (27.6%) as frail. The covariate-adjusted analysis revealed that frailty (P< 0.001), and open surgery (P = 0.015) were independent predictors of major complications. Frailty, peritonitis, constipation at ED admission, and Charlson Comorbidity Index ≥ 4 were associated with higher odds of open surgical approach (2.06 [1.23 - 3.45], 2.49 [1.13 - 5.48], 11.59 [2.26 - 59.55], 2.45 [1.49 - 4.02]; respectively)., Discussion: In patients aged ≥65 years undergoing urgent cholecystectomy, the evaluation of functional status in the ED could predict the risk of open surgical approach and major complications. Frail patients have an increased risk both for major complications and need for "open" surgical approach., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Published
2023
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13. Frailty in Elderly Patients with Covid-19: A Narrative Review.

Author

Salini S, Russo A, De Matteis G, Piccioni A, Della Polla D, Carbone L, Barillaro C, Landi F, Franceschi F, and Covino M

Abstract

Introduction: The SARS CoV-2 pandemic still generates a very high number of affected patients and a significant mortality rate. It is essential to establish objective criteria to stratify COVID-19 death risk. Frailty has been identified as a potential determinant of increased vulnerability in older adults affected by COVID-19, because it may suggest alterations of physical performance and functional autonomy., Methods: We have conducted a narrative review of the literature on the evidences regarding COVID-19 and the frailty condition. Thirteen observational studies were included., Conclusion: Data emerging from the studies indicate that older COVID-19 patients with a frailty condition have an increased risk of mortality compared with non-frail patients, and this association is independent of other clinical and demographic factors. A frailty evaluation is required to help clinicians to better stratify the overall risk of death for older patients with COVID-19., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Published
2022
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14. Frailty Assessment in the Emergency Department for Risk Stratification of COVID-19 Patients Aged ≥80 Years.

Author

Covino M, Russo A, Salini S, De Matteis G, Simeoni B, Della Polla D, Sandroni C, Landi F, Gasbarrini A, and Franceschi F

Subjects
Adult, Aged, Emergency Service, Hospital, Frail Elderly, Geriatric Assessment, Hospital Mortality, Humans, Infant, Newborn, Male, Prospective Studies, Risk Assessment, SARS-CoV-2, COVID-19, Frailty diagnosis, Frailty epidemiology
Abstract

Objectives: To evaluate, in a cohort of adults aged ≥80 years, the overlapping effect of clinical severity, comorbidities, cognitive impairment, and frailty, for the in-hospital death risk stratification of COVID-19 older patients since emergency department (ED) admission., Design: Single-center prospective observational cohort study., Setting and Participants: The study was conducted in the ED of a teaching hospital that is a referral center for COVID-19 in central Italy. We enrolled all patients with aged ≥80 years old consecutively admitted to the ED between April 2020 and March 2021., Methods: Clinical variables assessed in the ED were evaluated for the association with all-cause in-hospital death. Evaluated parameters were severity of disease, frailty, comorbidities, cognitive impairment, delirium, and dependency in daily life activities. Cox regression analysis was used to identify independent risk factors for poor outcomes., Results: A total of 729 patients aged ≥80 years were enrolled [median age 85 years (interquartile range 82-89); 346 were males (47.3%)]. According to the Clinical Frailty Scale, 61 (8.4%) were classified as fit, 417 (57.2%) as vulnerable, and 251 (34.4%) as frail. Severe disease [hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.31-2.59], ≥3 comorbidities (HR 1.54, 95% CI 1.11-2.13), male sex (HR 1.46, 95% CI 1.14-1.87), and frailty (HR 6.93, 95% CI 1.69-28.27) for vulnerable and an overall HR of 12.55 (95% CI 2.96-53.21) for frail were independent risk factors for in-hospital death., Conclusions and Implications: The ED approach to older patients with COVID-19 should take into account the functional and clinical characteristics of patients being admitted. A sole evaluation based on the clinical severity and the presence of comorbidities does not reflect the complexity of this population. A comprehensive evaluation based on clinical severity, multimorbidity, and frailty could effectively predict the clinical risk of in-hospital death for patients with COVID-19 aged ≥80 years at the time of ED presentation., (Copyright © 2021 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Published
2021
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15. Does chronic oral anticoagulation reduce in-hospital mortality among COVID-19 older patients?

Author

Covino M, De Matteis G, Della Polla D, Burzo ML, Pascale MM, Santoro M, De Cristofaro R, Gasbarrini A, De Candia E, and Franceschi F

Subjects
Administration, Oral, Anticoagulants adverse effects, Hospital Mortality, Humans, Italy epidemiology, Prospective Studies, Retrospective Studies, SARS-CoV-2, Vitamin K, COVID-19
Abstract

Background: Patients hospitalized with COVID-19 experienced an increased risk of venous thromboembolism., Aims: To evaluate the effect of chronic oral anticoagulation (OAC) therapy, both with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs), on prognosis of COVID-19 older patients., Methods: Single-center prospective study conducted in the Emergency Department (ED) of a teaching hospital, referral center for COVID-19 in central Italy. We evaluated all the patients ≥ 65 years, consecutively admitted to our ED for confirmed COVID-19. We compared the clinical outcome of those who were on chronic OAC at ED admission with those who did not, using a propensity score matched paired cohort of controls. The primary study endpoint was all-cause in-hospital death. Patients were matched for age, sex, clinical comorbidities, and clinical severity at presentation (based on NEWS ≥ 6). Study parameters were assessed for association to all-cause in-hospital death by a multivariate Cox regression analysis to identify independent risk factor for survival., Results: Although overall mortality was slightly higher for anticoagulated patients compared to controls (63.3% vs 43.5%, p = 0.012), the multivariate adjusted hazard ratio (HR) for death was not significant (HR = 1.56 [0.78-3.12]; p = 0.208). Both DOACs (HR 1.46 [0.73-2.92]; p = 0.283) and VKAs (HR 1.14 [0.48-2.73]; p = 0.761) alone did not affect overall survival in our cohort., Conclusions: Among older patients hospitalized for COVID-19, chronic OAC therapy was not associated with a reduced risk of in-hospital death. Moreover, our data suggest similar outcome both for patients on VKAs or in patients on DOACs., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Published
2021
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