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1. Hospital admissions from the emergency department of adult patients affected by myopathies

Author

Monforte, Mauro, Torchia, Eleonora, Bortolani, Sara, Ravera, Beatrice, Ricci, Enzo, Silvestri, Gabriella, Servidei, Serenella, Primiano, Guido Alessandro, Mirabella, Massimiliano, Sabatelli, Mario, Mercuri, Eugenio Maria, Franceschi, Francesco, Calabresi, Paolo, Covino, Marcello, Tasca, Giorgio, Ricci, Enzo (ORCID:0000-0003-3092-3597), Silvestri, Gabriella (ORCID:0000-0002-1950-1468), Servidei, Serenella (ORCID:0000-0001-8478-2799), Primiano, Guido, Mirabella, Massimiliano (ORCID:0000-0002-7783-114X), Sabatelli, Mario (ORCID:0000-0001-6635-4985), Mercuri, Eugenio (ORCID:0000-0002-9851-5365), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Calabresi, Paolo (ORCID:0000-0003-0326-5509), Covino, Marcello (ORCID:0000-0002-6709-2531), Monforte, Mauro, Torchia, Eleonora, Bortolani, Sara, Ravera, Beatrice, Ricci, Enzo, Silvestri, Gabriella, Servidei, Serenella, Primiano, Guido Alessandro, Mirabella, Massimiliano, Sabatelli, Mario, Mercuri, Eugenio Maria, Franceschi, Francesco, Calabresi, Paolo, Covino, Marcello, Tasca, Giorgio, Ricci, Enzo (ORCID:0000-0003-3092-3597), Silvestri, Gabriella (ORCID:0000-0002-1950-1468), Servidei, Serenella (ORCID:0000-0001-8478-2799), Primiano, Guido, Mirabella, Massimiliano (ORCID:0000-0002-7783-114X), Sabatelli, Mario (ORCID:0000-0001-6635-4985), Mercuri, Eugenio (ORCID:0000-0002-9851-5365), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Calabresi, Paolo (ORCID:0000-0003-0326-5509), and Covino, Marcello (ORCID:0000-0002-6709-2531)

Abstract

Background and purposeMyopathies are associated with classic signs and symptoms, but also with possible life-threatening complications that may require assistance in an emergency setting. This phenomenon is understudied in the literature. We aimed to assess the presentation, management, and outcomes of clinical manifestations potentially related to a muscle disorder requiring referral to the adult emergency department (ED) and hospitalization.MethodsAnonymized patient data retrieved using the International Classification of Diseases, Ninth Revision codes related to muscle disorders over 4 years were retrospectively analyzed. Medical reports were evaluated to extract demographic and clinical variables, along with outcomes. Two groups were defined based on the presence (known diagnosis [KD] group) or absence (unknown diagnosis [UD] group) of a diagnosed muscle disorder at arrival.ResultsA total of 244 patients were included, 51% of whom were affected by a known myopathy, predominantly limb-girdle muscular dystrophies and myotonic dystrophies. The main reasons for ED visits in the KD group were respiratory issues, worsening of muscle weakness, and gastrointestinal problems. Heart complications were less prevalent. In the UD group, 27 patients received a new diagnosis of a specific primary muscle disorder after the ED access, mostly an inflammatory myopathy. Death during hospitalization was recorded in 26 patients, with a higher rate in the KD group and in patients affected by mitochondrial and inflammatory myopathies. Sepsis and dyspnea were associated with increased death risk.ConclusionsRespiratory complications are the most common reason for myopathic patients accessing the ED, followed by gastrointestinal issues. Infections are severe threats and, once hospitalized, these patients have relatively high mortality.

Published
2024

2. A novel risk score predicting 30-day hospital re-admission of patients with acute stroke by machine learning model

Author

Mercurio, Giovanna, Gottardelli, Benedetta, Lenkowicz, Jacopo, Patarnello, Stefano, Bellavia, Simone, Scala, Irene, Rizzo, Pierandrea, de Belvis, Antonio Giulio, Del Signore, Anna Benedetta, Maviglia, Riccardo, Bocci, Maria Grazia, Olivi, Alessandro, Franceschi, Francesco, Urbani, Andrea, Calabresi, Paolo, Valentini, Vincenzo, Antonelli, Massimo, Frisullo, Giovanni, Olivi, Alessandro (ORCID:0000-0002-4489-7564), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Urbani, Andrea (ORCID:0000-0001-9168-3174), Calabresi, Paolo (ORCID:0000-0003-0326-5509), Valentini, Vincenzo (ORCID:0000-0003-4637-6487), Antonelli, Massimo (ORCID:0000-0003-3007-1670), Mercurio, Giovanna, Gottardelli, Benedetta, Lenkowicz, Jacopo, Patarnello, Stefano, Bellavia, Simone, Scala, Irene, Rizzo, Pierandrea, de Belvis, Antonio Giulio, Del Signore, Anna Benedetta, Maviglia, Riccardo, Bocci, Maria Grazia, Olivi, Alessandro, Franceschi, Francesco, Urbani, Andrea, Calabresi, Paolo, Valentini, Vincenzo, Antonelli, Massimo, Frisullo, Giovanni, Olivi, Alessandro (ORCID:0000-0002-4489-7564), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Urbani, Andrea (ORCID:0000-0001-9168-3174), Calabresi, Paolo (ORCID:0000-0003-0326-5509), Valentini, Vincenzo (ORCID:0000-0003-4637-6487), and Antonelli, Massimo (ORCID:0000-0003-3007-1670)

Abstract

Background: The 30-day hospital re-admission rate is a quality measure of hospital care to monitor the efficiency of the healthcare system. The hospital re-admission of acute stroke (AS) patients is often associated with higher mortality rates, greater levels of disability and increased healthcare costs. The aim of our study was to identify predictors of unplanned 30-day hospital re-admissions after discharge of AS patients and define an early re-admission risk score (RRS).Methods: This observational, retrospective study was performed on AS patients who were discharged between 2014 and 2019. Early re-admission predictors were identified by machine learning models. The performances of these models were assessed by receiver operating characteristic curve analysis.Results: Of 7599 patients with AS, 3699 patients met the inclusion criteria, and 304 patients (8.22%) were re-admitted within 30 days from discharge. After identifying the predictors of early re-admission by logistic regression analysis, RRS was obtained and consisted of seven variables: hemoglobin level, atrial fibrillation, brain hemorrhage, discharge home, chronic obstructive pulmonary disease, one and more than one hospitalization in the previous year. The cohort of patients was then stratified into three risk categories: low (RRS = 0-1), medium (RRS = 2-3) and high (RRS >3) with re-admission rates of 5%, 8% and 14%, respectively.Conclusions: The identification of risk factors for early re-admission after AS and the elaboration of a score to stratify at discharge time the risk of re-admission can provide a tool for clinicians to plan a personalized follow-up and contain healthcare costs.

Published
2024

3. Ursodeoxycholic acid does not affect the clinical outcome of SARS-CoV-2 infection: A retrospective study of propensity score-matched cohorts

Author

Marrone, Giuseppe, Covino, Marcello, Merra, Giuseppe, Piccioni, Andrea, Amodeo, Annamaria, Novelli, Angela, Murri, Rita, Pompili, Maurizio, Gasbarrini, Antonio, Franceschi, Francesco, Covino, Marcello (ORCID:0000-0002-6709-2531), Murri, Rita (ORCID:0000-0003-4263-7854), Pompili, Maurizio (ORCID:0000-0001-6699-7980), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Marrone, Giuseppe, Covino, Marcello, Merra, Giuseppe, Piccioni, Andrea, Amodeo, Annamaria, Novelli, Angela, Murri, Rita, Pompili, Maurizio, Gasbarrini, Antonio, Franceschi, Francesco, Covino, Marcello (ORCID:0000-0002-6709-2531), Murri, Rita (ORCID:0000-0003-4263-7854), Pompili, Maurizio (ORCID:0000-0001-6699-7980), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

Abstract

Background: Ursodeoxycholic acid (UDCA) has been recently proposed as a modulator of angiotensin-converting enzyme 2 (ACE2) receptor expression, with potential effects on COVID-19.Aim and Study Design: We retrospectively evaluated the clinical course and outcome of subjects taking UDCA admitted to the hospital for COVID-19 compared with matched infected subjects. Differences regarding the severity and outcome of the disease between treated and non-treated subjects were assessed. The Kaplan-Meier survival analysis and log-rank test were used to evaluate the effect of UDCA on all-cause intra-hospital mortality.Results: Among 6444 subjects with confirmed COVID-19 admitted to the emergency department (ED) from 1 March 2020 to 31 December 2022, 109 subjects were taking UDCA. After matching 629 subjects were included in the study: 521 in the no UDCA group and 108 in the UDCA group. In our matched cohort, 144 subjects (22.9%) died, 118 (22.6%) in the no-UDCA group and 26 (24.1%) in the UDCA group. The Kaplan-Meier analysis showed no significant difference in survival between groups. In univariate regression analysis, the presence of pneumonia, National Early Warning Score (NEWS) score, and Charlson Comorbidity Index (CCI) were significant independent predictors of death. At multivariate Cox regression analysis, age, NEWS, pneumonia and CCI index were confirmed significant independent predictors of death. UDCA treatment was not a predictor of survival both in univariate and multivariate regressions.Conclusions: UDCA treatment does not appear to have significant effects on the outcome of COVID-19. Specially designed prospective studies are needed to evaluate efficacy in preventing infection and severe disease.

Published
2024

4. The role of procalcitonin as a risk stratification tool of severity, prognosis, and need for surgery in patients with acute left-sided colonic diverticulitis

Author

Schena, Carlo Alberto, Covino, Marcello, Laterza, Vito, Quero, Giuseppe, La Greca, Antonio, Cina, Caterina, De'Angelis, Nicola, Marchegiani, Francesco, Sganga, Gabriele, Gasbarrini, Antonio, Franceschi, Francesco, Longo, Fabio, Alfieri, Sergio, Rosa, Fausto, Covino, Marcello (ORCID:0000-0002-6709-2531), Quero, Giuseppe (ORCID:0000-0002-0001-9479), La Greca, Antonio (ORCID:0000-0002-7587-7427), Sganga, Gabriele (ORCID:0000-0001-5079-0395), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Alfieri, Sergio (ORCID:0000-0002-0404-724X), Rosa, Fausto (ORCID:0000-0002-7280-8354), Schena, Carlo Alberto, Covino, Marcello, Laterza, Vito, Quero, Giuseppe, La Greca, Antonio, Cina, Caterina, De'Angelis, Nicola, Marchegiani, Francesco, Sganga, Gabriele, Gasbarrini, Antonio, Franceschi, Francesco, Longo, Fabio, Alfieri, Sergio, Rosa, Fausto, Covino, Marcello (ORCID:0000-0002-6709-2531), Quero, Giuseppe (ORCID:0000-0002-0001-9479), La Greca, Antonio (ORCID:0000-0002-7587-7427), Sganga, Gabriele (ORCID:0000-0001-5079-0395), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Alfieri, Sergio (ORCID:0000-0002-0404-724X), and Rosa, Fausto (ORCID:0000-0002-7280-8354)

Abstract

Background: Imaging-based classifications do not always reflect the clinical severity and prognosis of acute left-sided colonic diverticulitis. This study aims to investigate the role of an early procalcitonin assessment in the emergency department as a risk stratification tool for severity, prognosis, and need for surgery in patients with acute left-sided colonic diverticulitis. Methods: In this retrospective cohort study, all adult patients consecutively admitted from January 2015 to September 2020 for acute left-sided colonic diverticulitis and having a procalcitonin determination at admission were enrolled. The following data were collected: age, sex, comorbidities, laboratory parameters, level of urgency, clinical presentation, type of treatment, complications, and post-management outcomes. The association between the procalcitonin value at admission and the following endpoints was analyzed: type of treatment, classification of acute left-sided colonic diverticulitis, mortality, and type of surgery. Results: A total of 503 consecutive patients were enrolled. Procalcitonin >0.5 ng/mL emerged as an independent risk factor for complicated acute left-sided colonic diverticulitis (P = .007). Procalcitonin >0.5 ng/mL (P = .033), together with a history of complicated acute left-sided colonic diverticulitis (P < .001), abdominal pain (P = .04), bowel perforation (P < .001), and peritonitis (P < .001), was a significant risk factor for surgery. Procalcitonin >0.5 ng/mL (P = .007) and peritonitis (P = .03) emerged as independent risk factors for sigmoidectomy without colorectal anastomosis. Procalcitonin >0.5 ng/mL (P = .004), a higher level of urgency at admission (P = .005), Hartmann's procedure (P = .002), and the necessity of mechanical ventilation (P = .004) emerged as independent risk factors for mortality. Conclusion: Procalcitonin >0.05 ng/mL at emergency department admission is a useful risk s

Published
2024

5. Head CT Scans in the Emergency Department during the COVID-19 Pandemic: Use or Overuse?

Author

Covino, Marcello, Piccioni, Andrea, Merra, Giuseppe, Giordano, Carolina, Russo, Rosellina, Infante, Amato, Ausili Cefaro, Luca, Natale, Luigi, Franceschi, Francesco, Gaudino, Simona, Covino, Marcello (ORCID:0000-0002-6709-2531), Natale, Luigi (ORCID:0000-0002-7949-5119), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Gaudino, Simona (ORCID:0000-0003-1681-4343), Covino, Marcello, Piccioni, Andrea, Merra, Giuseppe, Giordano, Carolina, Russo, Rosellina, Infante, Amato, Ausili Cefaro, Luca, Natale, Luigi, Franceschi, Francesco, Gaudino, Simona, Covino, Marcello (ORCID:0000-0002-6709-2531), Natale, Luigi (ORCID:0000-0002-7949-5119), Franceschi, Francesco (ORCID:0000-0001-6266-445X), and Gaudino, Simona (ORCID:0000-0003-1681-4343)

Abstract

Background: The COVID-19 pandemic seemed to mainly involve the respiratory system, but it was realized that it could affect any organ, including the CNS. The pandemic has followed a wave-like trend, with its peaks being due to the COVID-19 different variants and the introduction of the vaccine, which led to an apparent reduction in hospitalizations but also brought about perplexities related to its adverse effects. The aim of this study was to analyze the changes in the use of head CT/contrast CT and their impacts on the onset of cerebrovascular disease in our emergency department during the COVID-19 period and the vaccine rollout. Methods: Patients >= 18 years old admitted to our emergency department from January 2018 to September 2021 were enrolled. The patients were divided into three groups. The COVID-19 period included patients who visited our emergency department from 1 March 2020 to 31 January 2021; the vaccine period was considered to range from 1 February 2021 to 30 September 2021. The patients who visited the emergency department from 1 January 2018 to 31 January 2020 were considered the controls. Results: We found an increase in head CT/contrast CT requests during the COVID-19 period and increase in head contrast CT during the vaccine period, without an increase in the incidence of cerebrovascular disease. Conclusions: The uncertainty regarding the possible thrombotic events associated with COVID-19 and its vaccine increased the relative use of head CT/contrast CT by about 20% compared to the control period

Published
2024

6. Is BMI Associated with COVID-19 Severity? A Retrospective Observational Study

Author

Candelli, Marcello, Pignataro, Giulia, Saviano, Angela, Ojetti, Veronica, Gabrielli, Maurizio, Piccioni, Andrea, Gullì, Antonio, Antonelli, Massimo, Gasbarrini, Antonio, Franceschi, Francesco, Candelli, Marcello (ORCID:0000-0001-8443-7880), Ojetti, Veronica (ORCID:0000-0002-8953-0707), Antonelli, Massimo (ORCID:0000-0003-3007-1670), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Candelli, Marcello, Pignataro, Giulia, Saviano, Angela, Ojetti, Veronica, Gabrielli, Maurizio, Piccioni, Andrea, Gullì, Antonio, Antonelli, Massimo, Gasbarrini, Antonio, Franceschi, Francesco, Candelli, Marcello (ORCID:0000-0001-8443-7880), Ojetti, Veronica (ORCID:0000-0002-8953-0707), Antonelli, Massimo (ORCID:0000-0003-3007-1670), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

Abstract

Background: Coronavirus-19 disease (COVID-19) is an infection with high morbidity and mortality. Obesity and low body mass index (BMI) have both been linked to severe COVID-19, but recent studies have failed to confirm these associations. Objectives: The aim of this study was to examine the relationship between BMI and disease progression in hospitalised patients with COVID-19. Methods: We performed a monocentric, retrospective observational study at the Fondazione Policlinico Gemelli in Rome. We enrolled 1544 (977 men) patients who presented to the emergency department with a positive COVID-19 test between January and December 2021. We divided patients into five classes based on BMI. Demographic, clinical, laboratory, and radiological data were collected for all patients. Results: Of the 1544 patients, 1297 recovered after hospitalization, whereas 247 (16%) died. Of those who died, 16/247 (6.5%) had a BMI below18.5 kg/m2, 72/247 (29%) had a BMI between 18.5 and 24.99 kg/m2, 103/247 (42%) had a BMI between 25 and 29.99 kg/m2, 36/247 (15%) had a BMI between 30 and 35 kg/m2, and 20/247 (8%) had a BMI above 35 kg/m2. After adjusting the results for age, sex, and concomitant diseases using multivariate logistic regression, we found a significantly increased risk of intensive care unit (ICU) admission in severely obese patients (BMI > 35) compared to normal weight patients (BMI: 18.5-24.99) (p > 0.001). Mortality was not associated with BMI. Conclusion: We confirm that severe obesity is a risk factor for ICU admission in patients with COVID-19. No association was found between BMI and mortality.

Published
2023

7. Effectiveness of first and second-line empirical treatment in Italy: Results of the European registry on Helicobacter pylori management

Author

Gatta, Gian Luigi, Nyssen, Olga P, Fiorini, Giulia, Saracino, Ilaria Maria, Pavoni, Matteo, Romano, Marco, Gravina, Antonietta Gerarda, Granata, Lucia, Pellicano, Rinaldo, Gasbarrini, Antonio, Di Leo, Alfredo, Losurdo, Giuseppe, Franceschi, Francesco, Nardone, Gerardo, Rocco, Alba, Dore, Maria Pina, Farinati, Fabio, Ghisa, Matteo, Bellini, Massimo, Holton, John, Puig, Ignasi, Vaira, Dino, Borghi, Claudio, Mégraud, Franci, O'Morain, Colm, Gisbert, Javier P, Gatta, Luigi, Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Gatta, Gian Luigi, Nyssen, Olga P, Fiorini, Giulia, Saracino, Ilaria Maria, Pavoni, Matteo, Romano, Marco, Gravina, Antonietta Gerarda, Granata, Lucia, Pellicano, Rinaldo, Gasbarrini, Antonio, Di Leo, Alfredo, Losurdo, Giuseppe, Franceschi, Francesco, Nardone, Gerardo, Rocco, Alba, Dore, Maria Pina, Farinati, Fabio, Ghisa, Matteo, Bellini, Massimo, Holton, John, Puig, Ignasi, Vaira, Dino, Borghi, Claudio, Mégraud, Franci, O'Morain, Colm, Gisbert, Javier P, Gatta, Luigi, Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

Abstract

Background and AimsThe optimal management of naive and not naive Helicobacter pylori patients remains unclear. Therefore, it is essential to evaluate whether the actual clinical practice mirrors the indications suggested by the guidelines. This study aimed to assess the effectiveness and the safety of the empirical first- and second-line treatments prescribed to patients enroled at Italian centres participating in the European Registry on H. pylori Management (Hp-EuReg). MethodsThe Hp-EuReg is an international multicentre prospective non-interventional registry starting in 2013 aiming to evaluate the management of H. pylori infection by European gastroenterologists. Patients were registered in an e-CRF by AEG-REDCap. Variables assessed included demographics, previous eradication attempts, treatment regimen, effectiveness, and tolerance. ResultsOverall, 3723 patients from 2013 to February 2021 were included: 2996 and 727 received an empirical first- and second-line treatment, respectively. According to the modified ITT analysis, among the first-line regimens, only the bismuth quadruple therapy with three-in-one-single capsule (BQT-TSC), the concomitant, and the sequential treatment - all lasting 10 days - achieved an eradication rate >90%. Among the second-line regimens, only the 10-day BQT-TSC reported an effectiveness >90%. High-dose PPI twice daily also significantly increased the effectiveness of some therapies. The BQT-TSC was the regimen with the highest incidence of adverse events. ConclusionsOnly quadruple therapies lasting at least 10 days achieved over 90% eradication rates among the empirical first- and second-line regimens. It remains unclear whether high-dose PPI twice daily can improve the efficacy of quadruple treatment.

Published
2023

8. A New Clinical Prediction Rule for Infective Endocarditis in Emergency Department Patients With Fever: Definition and First Validation of the CREED Score

Author

Covino, Marcello, De Vita, Antonio, D'Aiello, Alessia, Ravenna, Salvatore Emanuele, Ruggio, Aureliano, Genuardi, Lorenzo, Simeoni, Benedetta, Piccioni, Andrea, De Matteis, Giuseppe, Murri, Rita, Leone, Antonio Maria, Flex, Andrea, Gasbarrini, Antonio, Liuzzo, Giovanna, Massetti, Massimo, Franceschi, Francesco, Covino, Marcello (ORCID:0000-0002-6709-2531), d'Aiello, Alessia, Murri, Rita (ORCID:0000-0003-4263-7854), Leone, Antonio Maria (ORCID:0000-0002-1276-9883), Flex, Andrea (ORCID:0000-0003-2664-4165), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Liuzzo, Giovanna (ORCID:0000-0002-5714-0907), Massetti, Massimo (ORCID:0000-0002-7100-8478), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Covino, Marcello, De Vita, Antonio, D'Aiello, Alessia, Ravenna, Salvatore Emanuele, Ruggio, Aureliano, Genuardi, Lorenzo, Simeoni, Benedetta, Piccioni, Andrea, De Matteis, Giuseppe, Murri, Rita, Leone, Antonio Maria, Flex, Andrea, Gasbarrini, Antonio, Liuzzo, Giovanna, Massetti, Massimo, Franceschi, Francesco, Covino, Marcello (ORCID:0000-0002-6709-2531), d'Aiello, Alessia, Murri, Rita (ORCID:0000-0003-4263-7854), Leone, Antonio Maria (ORCID:0000-0002-1276-9883), Flex, Andrea (ORCID:0000-0003-2664-4165), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Liuzzo, Giovanna (ORCID:0000-0002-5714-0907), Massetti, Massimo (ORCID:0000-0002-7100-8478), and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

Abstract

Background Infective endocarditis (IE) could be suspected in any febrile patients admitted to the emergency department (ED). This study was aimed at assessing clinical criteria predictive of IE and identifying and prospectively validating a sensible and easy-to-use clinical prediction score for the diagnosis of IE in the ED. Methods and Results We conducted a retrospective observational study, enrolling consecutive patients with fever admitted to the ED between January 2015 and December 2019 and subsequently hospitalized. Several clinical and anamnestic standardized variables were collected and evaluated for the association with IE diagnosis. We derived a multivariate prediction model by logistic regression analysis. The identified predictors were assigned a score point value to obtain the Clinical Rule for Infective Endocarditis in the Emergency Department (CREED) score. To validate the CREED score we conducted a prospective observational study between January 2020 and December 2021, enrolling consecutive febrile patients hospitalized after the ED visit, and evaluating the association between the CREED score values and the IE diagnosis. A total of 15 689 patients (median age, 71 [56-81] years; 54.1% men) were enrolled in the retrospective cohort, and IE was diagnosed in 267 (1.7%). The CREED score included 12 variables: male sex, anemia, dialysis, pacemaker, recent hospitalization, recent stroke, chest pain, specific infective diagnosis, valvular heart disease, valvular prosthesis, previous endocarditis, and clinical signs of suspect endocarditis. The CREED score identified 4 risk groups for IE diagnosis, with an area under the receiver operating characteristic curve of 0.874 (0.849-0.899). The prospective cohort included 13 163 patients, with 130 (1.0%) IE diagnoses. The CREED score had an area under the receiver operating characteristic curve of 0.881 (0.848-0.913) in the validation cohort, not significantly different from the one calculated in the retrospectiv

Published
2023

9. The Impact of Smoking on Microbiota: A Narrative Review

Author

Cicchinelli, Sara, Rosa, Federico, Manca, Federica, Zanza, Christian, Ojetti, Veronica, Covino, Marcello, Candelli, Marcello, Gasbarrini, Antonio, Franceschi, Francesco, Piccioni, Andrea, Ojetti, Veronica (ORCID:0000-0002-8953-0707), Covino, Marcello (ORCID:0000-0002-6709-2531), Candelli, Marcello (ORCID:0000-0001-8443-7880), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Cicchinelli, Sara, Rosa, Federico, Manca, Federica, Zanza, Christian, Ojetti, Veronica, Covino, Marcello, Candelli, Marcello, Gasbarrini, Antonio, Franceschi, Francesco, Piccioni, Andrea, Ojetti, Veronica (ORCID:0000-0002-8953-0707), Covino, Marcello (ORCID:0000-0002-6709-2531), Candelli, Marcello (ORCID:0000-0001-8443-7880), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

Abstract

Cigarette smoke is a classic risk factor for many diseases. The microbiota has been recently indicated as a new, major player in human health. Its deregulation-dysbiosis-is considered a new risk factor for several illnesses. Some studies highlight a cross-interaction between these two risk factors-smoke and dysbiosis-that may explain the pathogenesis of some diseases. We searched the keywords '' smoking OR smoke AND microbiota '' in the title of articles on PubMed((R)), UptoDate((R)), and Cochrane((R)). We included articles published in English over the last 25 years. We collected approximately 70 articles, grouped into four topics: oral cavity, airways, gut, and other organs. Smoke may impair microbiota homeostasis through the same harmful mechanisms exerted on the host cells. Surprisingly, dysbiosis and its consequences affect not only those organs that are in direct contact with the smoke, such as the oral cavity or the airways, but also involve distant organs, such as the gut, heart, vessels, and genitourinary tract. These observations yield a deeper insight into the mechanisms implicated in the pathogenesis of smoke-related diseases, suggesting a role of dysbiosis. We speculate that modulation of the microbiota may help prevent and treat some of these illnesses.

Published
2023

10. Effect of COVID-19 Vaccination on the In-Hospital Prognosis of Patients Admitted during Delta and Omicron Waves in Italy

Author

Cianci, Rossella, Franza, Laura, Pignataro, Giulia, Massaro, Maria Grazia, Rio, Pierluigi, Tota, Antonio, Ocarino, Francesca, Sacco Fernandez, Marta, Franceschi, Francesco, Gasbarrini, Antonio, Gambassi, Giovanni, Candelli, Marcello, Cianci, Rossella (ORCID:0000-0001-5378-8442), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Gambassi, Giovanni (ORCID:0000-0002-7030-9359), Candelli, Marcello (ORCID:0000-0001-8443-7880), Cianci, Rossella, Franza, Laura, Pignataro, Giulia, Massaro, Maria Grazia, Rio, Pierluigi, Tota, Antonio, Ocarino, Francesca, Sacco Fernandez, Marta, Franceschi, Francesco, Gasbarrini, Antonio, Gambassi, Giovanni, Candelli, Marcello, Cianci, Rossella (ORCID:0000-0001-5378-8442), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Gambassi, Giovanni (ORCID:0000-0002-7030-9359), and Candelli, Marcello (ORCID:0000-0001-8443-7880)

Abstract

All-cause mortality related to the SARS-CoV-2 infection has declined from the first wave to subsequent waves, probably through vaccination programs and the availability of effective antiviral therapies. Our study aimed to evaluate the impact of the SARS-CoV-2 vaccination on the prognosis of infected patients. Overall, we enrolled 545 subjects during the Delta variant wave and 276 ones during the Omicron variant wave. Data were collected concerning vaccination status, clinical parameters, comorbidities, lung involvement, laboratory parameters, and pharmacological treatment. Outcomes were admission to the intensive care unit (ICU) and 30-day all-cause mortality. Overall, the final sample included 821 patients with a mean age of 62 +/- 18 years [range 18-100], and 59% were men. Vaccinated patients during the Delta wave were 37% (over 3/4 with two doses), while during the Omicron wave they were 57%. Vaccinated patients were older (68 vs. 57 years), and 62% had at least one comorbidity Admission to the ICU was 20%, and the mortality rate at 30 days was 14%. ICU admissions were significantly higher during the Delta wave than during Omicron (OR 1.9, 95% CI 1.2-3.1), while all-cause mortality did not differ. Unvaccinated patients had a higher risk of ICU admission (OR 2.0, 95% CI 1.3-3.1) and 30-day all-cause mortality (OR 1.7, 95% CI 1.3-2.7). Results were consistent for both Delta and Omicron variants. Overall, vaccination with at least two doses was associated with a reduced need for ICU admission. Even one shot of the vaccine was associated with a significantly reduced 30-day mortality.

Published
2023

11. Familial Hypercholesterolemia and Acute Coronary Syndromes: The Microbiota-Immunity Axis in the New Diagnostic and Prognostic Frontiers

Author

Piccioni, Andrea, Niccolai, Elena, Rozzi, Gloria, Spaziani, Giacomo, Zanza, Christian, Candelli, Marcello, Covino, Marcello, Gasbarrini, Antonio, Franceschi, Francesco, Amedei, Amedeo, Candelli, Marcello (ORCID:0000-0001-8443-7880), Covino, Marcello (ORCID:0000-0002-6709-2531), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Piccioni, Andrea, Niccolai, Elena, Rozzi, Gloria, Spaziani, Giacomo, Zanza, Christian, Candelli, Marcello, Covino, Marcello, Gasbarrini, Antonio, Franceschi, Francesco, Amedei, Amedeo, Candelli, Marcello (ORCID:0000-0001-8443-7880), Covino, Marcello (ORCID:0000-0002-6709-2531), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

Abstract

Familial hypercholesterolemia is a common genetic disorder with a propensity towards early onset of atherosclerotic cardiovascular disease (CVD). The main goal of therapy is to reduce the LDL cholesterol and the current treatment generally consists of statin, ezetimibe and PCSK9 inhibitors. Unfortunately, lowering LDL cholesterol may be difficult for many reasons such as the variation of response to statin therapy among the population or the high cost of some therapies (i.e., PCSK9 inhibitors). In addition to conventional therapy, additional strategies may be used. The gut microbiota has been recently considered to play a part in chronic systemic inflammation and hence in CVD. Several studies, though they are still preliminary, consider dysbiosis a risk factor for various CVDs through several mechanisms. In this review, we provide an update of the current literature about the intricate relation between the gut microbiota and the familial hypercholesterolemia.

Published
2023

12. Predicting in-hospital mortality in pulmonary embolism patients: development and external validation of the PATHOS score

Author

Spampinato, Michele Domenico, Covino, Marcello, Passaro, Angelina, Benedetto, Marcello, D'Angelo, Luca, Galizia, Giorgio, Fabbri, Irma Sofia, Pagano, Teresa, Portoraro, Andrea, Guarino, Matteo, Previati, Rita, Tullo, Gianluca, Gasbarrini, Antonio, Giorgio, Roberto De, Franceschi, Francesco, Covino, Marcello (ORCID:0000-0002-6709-2531), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Spampinato, Michele Domenico, Covino, Marcello, Passaro, Angelina, Benedetto, Marcello, D'Angelo, Luca, Galizia, Giorgio, Fabbri, Irma Sofia, Pagano, Teresa, Portoraro, Andrea, Guarino, Matteo, Previati, Rita, Tullo, Gianluca, Gasbarrini, Antonio, Giorgio, Roberto De, Franceschi, Francesco, Covino, Marcello (ORCID:0000-0002-6709-2531), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

Abstract

Objective According to the 2019 European Society of Cardiology (ESC) guidelines on pulmonary embolism (PE), prognosis is calculated using the Pulmonary Embolism Severity Index (PESI), a complex score with debated validity, or simplified PESI (sPESI). We have developed and validated a new risk score for in-hospital mortality (IHM) of patients with PE in the emergency depart-ment.Methods This retrospective, dual-center cohort study was conducted in the emergency depart-ments of two third-level university hospitals. Patients aged > 18 years with a contrast-enhanced computed tomography-confirmed PE were included. Clinical variables and laboratory tests were evaluated blindly to IHM. Multivariable logistic regression was performed to identify the new score's predictors, and the new score was compared with the PESI, sPESI, and shock index.Results A total of 1,358 patients were included in this study: 586 in the derivation cohort and 772 in the validation cohort, with a global 10.6% of IHM. The PATHOS scores were developed using independent variables to predict mortality: platelet count, age, troponin, heart rate, oxy-genation, and systolic blood pressure. The PATHOS score showed good calibration and high dis-crimination, with an area under the receiver operating characteristics curve of 0.83 (95% confi-dence interval [CI], 0.77-0.89) in the derivation population and 0.74 (95% CI, 0.68-0.80) in the validation cohort, which is significantly higher than the PESI, sPESI, and shock index in both co-horts (P< 0.01 for all comparisons).Conclusion PATHOS is a simple and effective prognostic score for predicting IHM in patients with PE in an emergency setting.

Published
2023

13. Pancreatic Cancer Resistance to Treatment: The Role of Microbiota

Author

Nista, Enrico Celestino, Del Gaudio, Angelo, Del Vecchio, Livio Enrico, Mezza, Teresa, Pignataro, Giulia, Piccioni, Andrea, Gasbarrini, Antonio, Franceschi, Francesco, Candelli, Marcello, Mezza, Teresa (ORCID:0000-0001-5407-9576), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Candelli, Marcello (ORCID:0000-0001-8443-7880), Nista, Enrico Celestino, Del Gaudio, Angelo, Del Vecchio, Livio Enrico, Mezza, Teresa, Pignataro, Giulia, Piccioni, Andrea, Gasbarrini, Antonio, Franceschi, Francesco, Candelli, Marcello, Mezza, Teresa (ORCID:0000-0001-5407-9576), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), and Candelli, Marcello (ORCID:0000-0001-8443-7880)

Abstract

Pancreatic cancer (PC) is an aggressive malignancy and the fourth leading cause of cancer death in the United States and Europe. It is estimated that PC will be the second leading cause of cancer death by 2030. In addition to late diagnosis, treatment resistance is a major cause of shortened survival in pancreatic cancer. In this context, there is growing evidence that microbes play a regulatory role, particularly in therapy resistance and in creating a microenvironment in the tumor, that favors cancer progression. The presence of certain bacteria belonging to the gamma-proteobacteria or mycoplasmas appears to be associated with both pharmacokinetic and pharmacodynamic changes. Recent evidence suggests that the microbiota may also play a role in resistance mechanisms to immunotherapy and radiotherapy. However, the interactions between microbiota and therapy are bilateral and modulate therapy tolerance. Future perspectives are increasingly focused on elucidating the role of the microbiota in tumorigenesis and processes of therapy resistance, and a better understanding of these mechanisms may provide important opportunities to improve survival in these patients.

Published
2023

14. Is BMI Associated with Covid-19 Severity? A Retrospective Observational Study

Author

Candelli, Marcello, Pignataro, Giulia, Saviano, Angela, Ojetti, Veronica, Gabrielli, Maurizio, Piccioni, Andrea, Gullì, Antonio, Antonelli, Massimo, Gasbarrini, Antonio, Franceschi, Francesco, Candelli, Marcello (ORCID:0000-0001-8443-7880), Saviano, Angela (ORCID:0000-0002-2820-7180), Ojetti, Veronica (ORCID:0000-0002-8953-0707), Antonelli, Massimo (ORCID:0000-0003-3007-1670), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Candelli, Marcello, Pignataro, Giulia, Saviano, Angela, Ojetti, Veronica, Gabrielli, Maurizio, Piccioni, Andrea, Gullì, Antonio, Antonelli, Massimo, Gasbarrini, Antonio, Franceschi, Francesco, Candelli, Marcello (ORCID:0000-0001-8443-7880), Saviano, Angela (ORCID:0000-0002-2820-7180), Ojetti, Veronica (ORCID:0000-0002-8953-0707), Antonelli, Massimo (ORCID:0000-0003-3007-1670), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

Abstract

Background: Coronavirus-19 disease (Covid-19) is an infection with high morbidity and mortality. Obesity and low body mass index (BMI) have both been linked to severe Covid-19, but recent studies have failed to confirm these associations. Objectives: The aim of this study was to examine the relationship between BMI and disease progression in hospitalised patients with Covid-19. Methods: We performed a monocentric, retrospective observational study at the Fondazione Policlinico Gemelli in Rome. We enrolled 1544 (977 men) patients who presented to the emergency department with a positive Covid-19 test between January and December 2021. We divided patients into five classes based on BMI. Demographic, clinical, laboratory, and radiological data were collected for all patients. Results: Of the 1544 patients, 1297 recovered after hospitalization, whereas 247 (16%) died. Of those who died, 16/247 (6.5%) had a BMI below18.5 kg/m2, 72/247 (29%) had a BMI between 18.5 and 24.99 kg/m2, 103/247 (42%) had a BMI between 25 and 29.99 kg/m2, 36/247 (15%) had a BMI between 30 and 35 kg/m2, and 20/247 (8%) had a BMI above 35 kg/m2. After adjusting the results for age, sex, and concomitant diseases using multivariate logistic regression, we found a significantly increased risk of intensive care unit (ICU) admission in severely obese patients (BMI > 35) compared to normal weight patients (BMI: 18.5-24.99) (p > 0.001). Mortality was not associated with BMI. Conclusion: We confirm that severe obesity is a risk factor for ICU admission in patients with Covid-19. No association was found between BMI and mortality.

Published
2023

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

Author

Covino, Marcello, Sandroni, Claudio, Della Polla, Davide, De Matteis, Giuseppe, Piccioni, Andrea, De Vita, Antonio, Russo, Andrea, Salini, Sara, Carbone, Luigi, Petrucci, Martina, Pennisi, Mariano Alberto, Gasbarrini, Antonio, Franceschi, Francesco, Covino, Marcello (ORCID:0000-0002-6709-2531), Sandroni, Claudio (ORCID:0000-0002-8878-2611), Pennisi, Mariano (ORCID:0000-0001-8761-5144), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Covino, Marcello, Sandroni, Claudio, Della Polla, Davide, De Matteis, Giuseppe, Piccioni, Andrea, De Vita, Antonio, Russo, Andrea, Salini, Sara, Carbone, Luigi, Petrucci, Martina, Pennisi, Mariano Alberto, Gasbarrini, Antonio, Franceschi, Francesco, Covino, Marcello (ORCID:0000-0002-6709-2531), Sandroni, Claudio (ORCID:0000-0002-8878-2611), Pennisi, Mariano (ORCID:0000-0001-8761-5144), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

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 24h 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.

Published
2023

16. Successful Nonoperative Management (NOM) in Elderly Patients with Adhesive Small Bowel Obstruction (ASBO): a Cross-Sectional Analysis.

Author

Rosa, Fausto, Covino, Marcello, Schena, Carlo Alberto, Quero, Giuseppe, Franceschi, Francesco, Sganga, Gabriele, Alfieri, Sergio, Rosa, Fausto (ORCID:0000-0002-7280-8354), Covino, Marcello (ORCID:0000-0002-6709-2531), Quero, Giuseppe (ORCID:0000-0002-0001-9479), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Sganga, Gabriele (ORCID:0000-0001-5079-0395), Alfieri, Sergio (ORCID:0000-0002-0404-724X), Rosa, Fausto, Covino, Marcello, Schena, Carlo Alberto, Quero, Giuseppe, Franceschi, Francesco, Sganga, Gabriele, Alfieri, Sergio, Rosa, Fausto (ORCID:0000-0002-7280-8354), Covino, Marcello (ORCID:0000-0002-6709-2531), Quero, Giuseppe (ORCID:0000-0002-0001-9479), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Sganga, Gabriele (ORCID:0000-0001-5079-0395), and Alfieri, Sergio (ORCID:0000-0002-0404-724X)

Abstract

The best treatment strategy for adhesive small bowel obstruction (ASBO) in elderly patients is still a matter of debate.[1] If success with a nonoperative management (NOM) allows the patient avoid the negative effects of perioperative complications, NOM failure could lead to a significant delay in surgical treatment, potentially causing a further depletion of physiological reserves.[2,3] Therefore, a comprehensive geriatric assessment is always recommended to optimize the diagnostic and clinical strategies in cases of ASBO.[1] The present study was conducted to define predictive factors for successful NOM in elderly patients (≥ 65 years) presenting with ASBO at a tertiary emergency department (ED).

Published
2023

17. The Impact of Smoking on Microbiota: A Narrative Review

Author

Cicchinelli, Sara, Rosa, Federico, Manca, Federica, Zanza, Christian, Ojetti, Veronica, Covino, Marcello, Candelli, Marcello, Gasbarrini, Antonio, Franceschi, Francesco, Piccioni, Andrea, Ojetti, Veronica (ORCID:0000-0002-8953-0707), Covino, Marcello (ORCID:0000-0002-6709-2531), Candelli, Marcello (ORCID:0000-0001-8443-7880), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Cicchinelli, Sara, Rosa, Federico, Manca, Federica, Zanza, Christian, Ojetti, Veronica, Covino, Marcello, Candelli, Marcello, Gasbarrini, Antonio, Franceschi, Francesco, Piccioni, Andrea, Ojetti, Veronica (ORCID:0000-0002-8953-0707), Covino, Marcello (ORCID:0000-0002-6709-2531), Candelli, Marcello (ORCID:0000-0001-8443-7880), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

Abstract

Cigarette smoke is a classic risk factor for many diseases. The microbiota has been recently indicated as a new, major player in human health. Its deregulation-dysbiosis-is considered a new risk factor for several illnesses. Some studies highlight a cross-interaction between these two risk factors-smoke and dysbiosis-that may explain the pathogenesis of some diseases. We searched the keywords '' smoking OR smoke AND microbiota '' in the title of articles on PubMed((R)), UptoDate((R)), and Cochrane((R)). We included articles published in English over the last 25 years. We collected approximately 70 articles, grouped into four topics: oral cavity, airways, gut, and other organs. Smoke may impair microbiota homeostasis through the same harmful mechanisms exerted on the host cells. Surprisingly, dysbiosis and its consequences affect not only those organs that are in direct contact with the smoke, such as the oral cavity or the airways, but also involve distant organs, such as the gut, heart, vessels, and genitourinary tract. These observations yield a deeper insight into the mechanisms implicated in the pathogenesis of smoke-related diseases, suggesting a role of dysbiosis. We speculate that modulation of the microbiota may help prevent and treat some of these illnesses.

Published
2023

18. Nutrition in Acute Pancreatitis: From the Old Paradigm to the New Evidence

Author

De Lucia, Sara Sofia, Candelli, Marcello, Polito, Giorgia, Maresca, Rossella, Mezza, Teresa, Schepis, Tommaso, Pellegrino, Antonio Agostino, Zileri Dal Verme, Lorenzo, Nicoletti, Alberto, Franceschi, Francesco, Gasbarrini, Antonio, Nista, Enrico Celestino, Candelli, Marcello (ORCID:0000-0001-8443-7880), Mezza, Teresa (ORCID:0000-0001-5407-9576), Pellegrino, Antonio, Franceschi, Francesco (ORCID:0000-0001-6266-445X), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), De Lucia, Sara Sofia, Candelli, Marcello, Polito, Giorgia, Maresca, Rossella, Mezza, Teresa, Schepis, Tommaso, Pellegrino, Antonio Agostino, Zileri Dal Verme, Lorenzo, Nicoletti, Alberto, Franceschi, Francesco, Gasbarrini, Antonio, Nista, Enrico Celestino, Candelli, Marcello (ORCID:0000-0001-8443-7880), Mezza, Teresa (ORCID:0000-0001-5407-9576), Pellegrino, Antonio, Franceschi, Francesco (ORCID:0000-0001-6266-445X), and Gasbarrini, Antonio (ORCID:0000-0002-7278-4823)

Abstract

The nutritional management of acute pancreatitis (AP) patients has widely changed over time. The "pancreatic rest" was the cornerstone of the old paradigm, and nutritional support was not even included in AP management. Traditional management of AP was based on intestinal rest, with or without complete parenteral feeding. Recently, evidence-based data underlined the superiority of early oral or enteral feeding with significantly decreased multiple-organ failure, systemic infections, surgery need, and mortality rate. Despite the current recommendations, experts still debate the best route for enteral nutritional support and the best enteral formula. The aim of this work is to collect and analyze evidence over the nutritional aspects of AP management to investigate its impact. Moreover, the role of immunonutrition and probiotics in modulating inflammatory response and gut dysbiosis during AP was extensively studied. However, we have no significant data for their use in clinical practice. This is the first work to move beyond the mere opposition between the old and the new paradigm, including an analysis of several topics still under debate in order to provide a comprehensive overview of nutritional management of AP.

Published
2023

19. Gut Microbiota, LADA, and Type 1 Diabetes Mellitus: An Evolving Relationship

Author

Piccioni, Andrea, Rosa, Federico, Mannucci, Sergio, Manca, Federica, Merra, Giuseppe, Chiloiro, Sabrina, Candelli, Marcello, Covino, Marcello, Gasbarrini, Antonio, Franceschi, Francesco, Chiloiro, Sabrina (ORCID:0000-0001-9241-2392), Candelli, Marcello (ORCID:0000-0001-8443-7880), Covino, Marcello (ORCID:0000-0002-6709-2531), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Piccioni, Andrea, Rosa, Federico, Mannucci, Sergio, Manca, Federica, Merra, Giuseppe, Chiloiro, Sabrina, Candelli, Marcello, Covino, Marcello, Gasbarrini, Antonio, Franceschi, Francesco, Chiloiro, Sabrina (ORCID:0000-0001-9241-2392), Candelli, Marcello (ORCID:0000-0001-8443-7880), Covino, Marcello (ORCID:0000-0002-6709-2531), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

Abstract

There is much evidence confirming the crucial role played by the gut microbiota in modulating the immune system in the onset of autoimmune diseases. In this article, we focus on the relationship between alterations in the microbiome and the onset of diabetes mellitus type 1 and LADA, in light of the latest evidence. We will then look at both how the role of the gut microbiota appears to be increasingly crucial in the pathogenesis of these disorders and how this aspect may be instrumental in the development of new potential therapeutic strategies that modulate the gut microbiota, such as probiotics, prebiotics, and fecal microbiota transplantation.

Published
2023

20. Emergencies cards for neuromuscular disorders 1st Consensus Meeting from UILDM - Italian Muscular Dystrophy Association Workshop report

Author

Racca, Fabrizio, Sansone, Valeria A, Ricci, Federica, Filosto, Massimiliano, Pedroni, Stefania, Mazzone, Elena Stacy, Longhitano, Yaroslava, Zanza, Christian, Ardissone, Anna, Adorisio, Rachele, Berardinelli, Angela, Bondone, Claudia, Briani, Chiara, Cairello, Francesca, Carraro, Elena, Comi, Giacomo P, Crescimanno, Grazia, D'Amico, Adele, Deiaco, Fabio, Fabiano, Alessia, Franceschi, Francesco, Mancuso, Michelangelo, Massè, Alessandro, Messina, Sonia, Mongini, Tiziana, Moroni, Isabella, Moscatelli, Andrea, Musumeci, Olimpia, Navalesi, Paolo, Nigro, Gerardo, Origo, Carlo, Panicucci, Chiara, Pane, Marika, Pavone, Martino, Pedemonte, Marina, Pegoraro, Elena, Piastra, Marco, Pini, Antonella, Politano, Luisa, Previtali, Stefano, Rao, Fabrizio, Ricci, Giulia, Toscano, Antonio, Wolfler, Andrea, Zoccola, Khristian, Sancricca, Cristina, Nigro, Vincenzo, Trabacca, Antonio, Vianello, Andrea, Bruno, Claudio, Mazzone, Elena, Franceschi, Francesco (ORCID:0000-0001-6266-445X), Pane, Marika (ORCID:0000-0002-4851-6124), Racca, Fabrizio, Sansone, Valeria A, Ricci, Federica, Filosto, Massimiliano, Pedroni, Stefania, Mazzone, Elena Stacy, Longhitano, Yaroslava, Zanza, Christian, Ardissone, Anna, Adorisio, Rachele, Berardinelli, Angela, Bondone, Claudia, Briani, Chiara, Cairello, Francesca, Carraro, Elena, Comi, Giacomo P, Crescimanno, Grazia, D'Amico, Adele, Deiaco, Fabio, Fabiano, Alessia, Franceschi, Francesco, Mancuso, Michelangelo, Massè, Alessandro, Messina, Sonia, Mongini, Tiziana, Moroni, Isabella, Moscatelli, Andrea, Musumeci, Olimpia, Navalesi, Paolo, Nigro, Gerardo, Origo, Carlo, Panicucci, Chiara, Pane, Marika, Pavone, Martino, Pedemonte, Marina, Pegoraro, Elena, Piastra, Marco, Pini, Antonella, Politano, Luisa, Previtali, Stefano, Rao, Fabrizio, Ricci, Giulia, Toscano, Antonio, Wolfler, Andrea, Zoccola, Khristian, Sancricca, Cristina, Nigro, Vincenzo, Trabacca, Antonio, Vianello, Andrea, Bruno, Claudio, Mazzone, Elena, Franceschi, Francesco (ORCID:0000-0001-6266-445X), and Pane, Marika (ORCID:0000-0002-4851-6124)

Abstract

Acute hospitalisation may be required to support patients with Neuromuscular disorders (NMDs) mainly experiencing respiratory complications, swallowing difficulties, heart failure, urgent surgical procedures. As NMDs may need specific treatments, they should be ideally managed in specialized hospitals. Nevertheless, if urgent treatment is required, patients with NMD should be managed at the closest hospital site, which may not be a specialized centre where local emergency physicians have the adequate experience to manage these patients. Although NMDs are a group of conditions that can differ in terms of disease onset, progression, severity and involvement of other systems, many recommendations are transversal and apply to the most frequent NMDs. Emergency Cards (EC), which report the most common recommendations on respiratory and cardiac issues and provide indications for drugs/treatments to be used with caution, are actively used in some countries by patients with NMDs. In Italy, there is no consensus on the use of any EC, and a minority of patients adopt it regularly in case of emergency. In April 2022, 50 participants from different centres in Italy met in Milan, Italy, to agree on a minimum set of recommendations for urgent care management which can be extended to the vast majority of NMDs. The aim of the workshop was to agree on the most relevant information and recommendations regarding the main topics related to emergency care of patients with NMD in order to produce specific ECs for the 13 most frequent NMDs.

Published
2022

21. Reply to 'In-Hospital Mortality Risk of Older Patients With COVID-19 Infection'

Author

Covino, Marcello, Russo, Andrea, Salini, Sara, De Matteis, Giuseppe, Simeoni, Benedetta, Della Polla, Davide, Sandroni, Claudio, Landi, Francesco, Gasbarrini, Antonio, Franceschi, Francesco, Covino, Marcello (ORCID:0000-0002-6709-2531), Sandroni, Claudio (ORCID:0000-0002-8878-2611), Landi, Francesco (ORCID:0000-0002-3472-1389), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Covino, Marcello, Russo, Andrea, Salini, Sara, De Matteis, Giuseppe, Simeoni, Benedetta, Della Polla, Davide, Sandroni, Claudio, Landi, Francesco, Gasbarrini, Antonio, Franceschi, Francesco, Covino, Marcello (ORCID:0000-0002-6709-2531), Sandroni, Claudio (ORCID:0000-0002-8878-2611), Landi, Francesco (ORCID:0000-0002-3472-1389), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

Abstract

N/A

Published
2022

22. Outcomes and Predictors of In-Hospital Mortality among Older Patients with Dementia

Author

De Matteis, Giuseppe, Burzo, Maria Livia, Della Polla, Davide Antonio, Serra, Amato, Russo, Andrea, Landi, Francesco, Gasbarrini, Antonio, Gambassi, Giovanni, Franceschi, Francesco, Covino, Marcello, Landi, Francesco (ORCID:0000-0002-3472-1389), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Gambassi, Giovanni (ORCID:0000-0002-7030-9359), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Covino, Marcello (ORCID:0000-0002-6709-2531), De Matteis, Giuseppe, Burzo, Maria Livia, Della Polla, Davide Antonio, Serra, Amato, Russo, Andrea, Landi, Francesco, Gasbarrini, Antonio, Gambassi, Giovanni, Franceschi, Francesco, Covino, Marcello, Landi, Francesco (ORCID:0000-0002-3472-1389), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Gambassi, Giovanni (ORCID:0000-0002-7030-9359), Franceschi, Francesco (ORCID:0000-0001-6266-445X), and Covino, Marcello (ORCID:0000-0002-6709-2531)

Abstract

Dementia is associated with high rates of admission to hospital, due to acute illness, and in-hospital mortality. The study aimed to investigate the impact of dementia on in-hospital mortality and identify the predictors of in-hospital mortality in these patients. This was a retrospective study evaluating all the patients >= 65 years consecutively admitted to our Emergency Department (ED). We compared the clinical outcomes of the patients with dementia at ED admission with those who did not have dementia, using a propensity score-matched (PSM) paired cohort of controls. The patients were matched for age, sex, Charlson Comorbidity Index value, and clinical severity at presentation (based on NEWS >= 5). The primary study endpoint was all-cause in-hospital death. After the PSM, a total of 7118 patients, 3559 with dementia and 3559 in the control group, were included in the study cohort. The mean age was 84 years, and 59.8% were females. The overall mortality rate was higher for the demented patients compared with the controls (18.7% vs. 16.0%, p = 0.002). The multivariate-adjusted hazard ratio (HR) showed that dementia was an independent risk factor for death (HR 1.13 [1.01-1.27]; p = 0.033). In the patients with dementia, respiratory failure (HR 3.08 [2.6-3.65]), acute renal failure (HR 1.64 [1.33-2.02]; p < 0.001), hemorrhagic stroke (HR 1.84 [1.38-2.44]; p < 0.001), and bloodstream infection (HR 1.41 [1.17-1.71]; p = 0.001) were significant predictors of worse outcomes. Finally, the comorbidities and severity of illness at ED admission negatively influenced survival among the patients with dementia (CCI HR 1.05 [1.01-1.1] p = 0.005; NEWS >= 5 HR 2.45 [1.88-3.2] p < 0.001). In conclusion, among the hospitalized older patients, dementia was associated with a higher risk of mortality. Furthermore, among the older patients with dementia, respiratory failure and bloodstream infections were independently associated with an increased risk of in-hospital m

Published
2022

23. Liver Injury in Patients Hospitalized for COVID-19: Possible Role of Therapy

Author

Gabrielli, Maurizio, Franza, Laura, Esperide, Alessandra, Gasparrini, Irene, Gasbarrini, Antonio, Franceschi, Francesco, On Behalf Of Gemelli Against Covid, Null, Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Gabrielli, Maurizio, Franza, Laura, Esperide, Alessandra, Gasparrini, Irene, Gasbarrini, Antonio, Franceschi, Francesco, On Behalf Of Gemelli Against Covid, Null, Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

Abstract

Patients with COVID-19 show a high prevalence of liver injury. The pattern of this liver damage is still not fully understood. Different etiopathogenetic factors may concur; from a direct cytopathic effect, once the virus binds to the ACE-2 receptors, to the immune-mediated collateral damage, due to cytokine storm. The presence of pre-existing chronic liver disease is a contributing factor for acute organ damage during SARS-CoV2 infection. Last but not least, treatments probably play a role, also, in determining hepatotoxicity: many of the drugs we have used or are still using to treat COVID-19, combined with non-invasive ventilation, are known to sometimes determine acute liver injury. Although liver damage associated with COVID-19 is often transient and can resolve without any special treatment, it is important to understand the underlying mechanisms, particularly to better treat its more severe forms.

Published
2022

24. Early Prognostic Stratification of Clostridioides difficile Infection in the Emergency Department: The Role of Age and Comorbidities

Author

Covino, Marcello, Gallo, Antonella, Pero, Erika, Simeoni, Benedetta, Macerola, Noemi, Murace, Celeste Ambra, Ibba, Francesca, Landi, Francesco, Franceschi, Francesco, Montalto, Massimo, Covino, Marcello (ORCID:0000-0002-6709-2531), Landi, Francesco (ORCID:0000-0002-3472-1389), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Montalto, Massimo (ORCID:0000-0001-8819-3684), Covino, Marcello, Gallo, Antonella, Pero, Erika, Simeoni, Benedetta, Macerola, Noemi, Murace, Celeste Ambra, Ibba, Francesca, Landi, Francesco, Franceschi, Francesco, Montalto, Massimo, Covino, Marcello (ORCID:0000-0002-6709-2531), Landi, Francesco (ORCID:0000-0002-3472-1389), Franceschi, Francesco (ORCID:0000-0001-6266-445X), and Montalto, Massimo (ORCID:0000-0001-8819-3684)

Abstract

Clostridioides difficile infection (CDI) represents a significant cause of morbidity and mortality, mainly in older and frail subjects. Early identification of outcome predictors, starting from emergency department (ED) admission, could help to improve their management. In a retrospective single-center study on patients accessing the ED for diarrhea and hospitalized with a diagnosis of CDI infection, the patients' clinical history, presenting symptoms, vital signs, and laboratory exams at ED admission were recorded. Quick sequential organ failure assessments (qSOFA) were conducted and Charlson's comorbidity indices (CCI) were calculated. The primary outcomes were represented by all-cause in-hospital death and the occurrence of major cumulative complications. Univariate and multivariate Cox regression analyses were performed to establish predictive risk factors for poor outcomes. Out of 450 patients, aged > 81 years, dyspnea at ED admission, creatinine > 2.5 mg/dL, white blood cell count > 13.31 x 10(9)/L, and albumin < 30 mu mol/L were independently associated with in-hospital death and major complications (except for low albumin). Both in-hospital death and major complications were not associated with multimorbidity. In patients with CDI, the risk of in-hospital death and major complications could be effectively predicted upon ED admission. Patients in their 8th decade have an increased risk independent of comorbidities.

Published
2022

25. Gut Microbiota and Autoimmune Diseases: A Charming Real World Together with Probiotics

Author

Piccioni, Andrea, Cicchinelli, Sara, Valletta, Federico, De Luca, Giulio, Longhitano, Yaroslava, Candelli, Marcello, Ojetti, Veronica, Sardeo, Francesco, Navarra, Simone, Covino, Marcello, Franceschi, Francesco, Candelli, Marcello (ORCID:0000-0001-8443-7880), Ojetti, Veronica (ORCID:0000-0002-8953-0707), Covino, Marcello (ORCID:0000-0002-6709-2531), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Piccioni, Andrea, Cicchinelli, Sara, Valletta, Federico, De Luca, Giulio, Longhitano, Yaroslava, Candelli, Marcello, Ojetti, Veronica, Sardeo, Francesco, Navarra, Simone, Covino, Marcello, Franceschi, Francesco, Candelli, Marcello (ORCID:0000-0001-8443-7880), Ojetti, Veronica (ORCID:0000-0002-8953-0707), Covino, Marcello (ORCID:0000-0002-6709-2531), and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

Abstract

Background: The role of gut microbiota in human disease is fascinating for hundreds of researchers worldwide. Many works have highlighted that gut microbiota modulates the immune system and that its disruption can trigger autoimmune and inflammatory immune-mediated diseases. Probiotics are able to positively modify microbiota composition. Objective: The aim of this review is to report the most important findings regarding the effects of probiotics administration in the most common autoimmune disease and inflammatory immune-mediated diseases. Methods: Literature research was performed in PubMed, Google Scholar, and Medline, as well as in specific journal websites using the keywords: "autoimmunity", "microbiota", and "probiotics". The article selection has been made independently by three authors, and controversies have been solved by a fourth researcher. Only English-language articles were included and preference was given to clinical trials, meta-analysis, and case series. After the review process, 68 articles have been considered. Results: Relying on this evidence, many studies have investigated the potential of probiotics in restoring gut eubiosis, thus affecting pathogenesis, clinical manifestations, and course of these pathologies. Even in the light of few and sometimes contradictory studies, physicians should start to consider these preliminary findings when approaching patients suffering from autoimmune disease. After an accurate case-by-case evaluation of potential candidates, probiotics might be introduced besides the standard therapeutic plan as supportive measures.

Published
2022

26. Procalcitonin for the early discrimination of fever etiology in patients with systemic autoimmune diseases attending the emergency department

Author

Covino, Marcello, Gallo, Antonella, Simeoni, Benedetta, Murace, Celeste Ambra, Ibba, Francesca, Pero, Erika, Franceschi, Francesco, Landi, Francesco, Montalto, Massimo, Covino, Marcello (ORCID:0000-0002-6709-2531), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Landi, Francesco (ORCID:0000-0002-3472-1389), Montalto, Massimo (ORCID:0000-0001-8819-3684), Covino, Marcello, Gallo, Antonella, Simeoni, Benedetta, Murace, Celeste Ambra, Ibba, Francesca, Pero, Erika, Franceschi, Francesco, Landi, Francesco, Montalto, Massimo, Covino, Marcello (ORCID:0000-0002-6709-2531), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Landi, Francesco (ORCID:0000-0002-3472-1389), and Montalto, Massimo (ORCID:0000-0001-8819-3684)

Abstract

In febrile patients with known systemic autoimmune disease, early discrimination between infection and disease flare often represents a clinical challenge. This study aimed at evaluating the efficacy of procalcitonin (PCT) and other common inflammatory biomarkers in discriminating disease flare from bacterial infections in the Emergency Department (ED). In a cross-sectional observational retrospective study, we identified consecutive febrile patients with a known diagnosis of systemic autoimmune disease, admitted to the ED, and subsequently hospitalized. Flare vs infective disease was defined on clinical records at hospital discharge. Dosage of common inflammatory markers was performed at ED admission. Out of 177 patients, those with infection were most commonly elderly, frail, and with reduced peripheral oxygen saturation at admission. When compared to C-reactive protein (CRP) and white blood count (WBC), PCT showed the best performance in discriminating infections vs flare. However, only at a very high threshold value of 2 ng/ml, the PCT had a satisfactory negative predictive value of 88.9%, although with a very low specificity of 13.6% and a positive predictive value of 35.8%. Our data suggest that in the ED setting, the early PCT determination has low accuracy in the differentiation of disease flare from infection in patients with known rheumatologic disease. However, the PCT could be useful in elderly and comorbid subjects, in supporting clinical assessment and in recognizing those febrile patients needing prompt antibiotic treatment.

Published
2022

27. Clinical Implications of Helicobacter pylori Antibiotic Resistance in Italy: A Review of the Literature

Author

Nista, Enrico Celestino, Pellegrino, Antonio Agostino, Giuli, Lucia, Candelli, Marcello, Schepis, Tommaso, De Lucia, Sara Sofia, Ojetti, Veronica, Franceschi, Francesco, Gasbarrini, Antonio, Pellegrino, Antonio, Candelli, Marcello (ORCID:0000-0001-8443-7880), Ojetti, Veronica (ORCID:0000-0002-8953-0707), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Nista, Enrico Celestino, Pellegrino, Antonio Agostino, Giuli, Lucia, Candelli, Marcello, Schepis, Tommaso, De Lucia, Sara Sofia, Ojetti, Veronica, Franceschi, Francesco, Gasbarrini, Antonio, Pellegrino, Antonio, Candelli, Marcello (ORCID:0000-0001-8443-7880), Ojetti, Veronica (ORCID:0000-0002-8953-0707), Franceschi, Francesco (ORCID:0000-0001-6266-445X), and Gasbarrini, Antonio (ORCID:0000-0002-7278-4823)

Abstract

Helicobacter pylori (H. pylori) resistance to antibiotics has increased worldwide in recent decades, especially to clarithromycin. As a result, the World Health Organization (WHO) identified clarithromycin-resistant H. pylori as a "high priority" pathogen in 2017. As international guidelines recommend empirical therapy as first-line treatment, it is crucial to know local resistance rates and history of antibiotic use to determine the most appropriate first-line antibiotic treatment. Italy is one of the European countries with the highest prevalence of H. pylori infection and the highest percentage of antibiotic-resistant H. pylori. The aim of this review is to summarize all data on H. pylori antibiotic resistance in Italy in order to quantify the current rate and determine the most effective therapeutic approach. The study confirms an elevated level of resistance to clarithromycin, metronidazole, and levofloxacin in Italy. In addition, our results show a satisfactory eradication rate for a bismuth-based regimen when used as first- or second-line treatment. Naive patients are also successfully treated with clarithromycin-based quadruple therapies. Considering the good results of bismuth-based therapy as recovery therapy, this argues for the potential use of clarithromycin quadruple therapy as a first-line treatment.

Published
2022

28. ABCD2, ABCD2-I, and OTTAWA scores for stroke risk assessment: a direct retrospective comparison

Author

Spampinato, Michele Domenico, Covino, Marcello, Passaro, Angelina, Guarino, Matteo, Marziani, Beatrice, Ghirardi, Caterina, Ricciardelli, Adelina, Fabbri, Irma Sofia, Strada, Andrea, Gasbarrini, Antonio, Franceschi, Francesco, De Giorgio, Roberto, Covino, Marcello (ORCID:0000-0002-6709-2531), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Spampinato, Michele Domenico, Covino, Marcello, Passaro, Angelina, Guarino, Matteo, Marziani, Beatrice, Ghirardi, Caterina, Ricciardelli, Adelina, Fabbri, Irma Sofia, Strada, Andrea, Gasbarrini, Antonio, Franceschi, Francesco, De Giorgio, Roberto, Covino, Marcello (ORCID:0000-0002-6709-2531), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

Abstract

Transient ischemic attack (TIA) is a neurologic emergency characterized by cerebral ischemia eliciting a temporary focal neurological deficit. Many clinical prediction scores have been proposed to assess the risk of stroke after TIA; however, studies on their clinical validity and comparisons among them are scarce. The objective is to compare the accuracy of ABCD2, ABCD2-I, and OTTAWA scores in the prediction of a stroke at 7, 90 days, and 1 year in patients presenting with TIA. Single-centre, retrospective study including patients with TIA admitted to the Emergency Department of our third-level, University Hospital, between 2018 and 2019. Five hundred three patients were included. Thirty-nine (7.7%) had a stroke within 1 year from the TIA: 9 (1.7%) and 24 (4.7%) within 7 and 90 days, respectively. ABCD2, ABCD2-I, and OTTAWA scores were significantly higher in patients who developed a stroke. AUROCs ranged from 0.66 to 0.75, without statistically significant differences at each time-point. Considering the best cut-off of each score, only ABCD2 > 3 showed a sensitivity of 100% only in the prediction of stroke within 7 days. Among clinical items of each score, duration of symptoms, previous TIA, hemiparesis, speech disturbance, gait disturbance, previous cerebral ischemic lesions, and known carotid artery disease were independent predictors of stroke. Clinical scores have moderate prognostic accuracy for stroke after TIA. Considering the independent predictors for stroke, our study indicates the need to continue research and prompts the development of new tools on predictive scores for TIA.

Published
2022

29. Long-Term Effects of Hospitalization for COVID-19 on Frailty and Quality of Life in Older Adults ≥80 Years

Author

Covino, Marcello, Russo, Andrea, Salini, Sara, De Matteis, Giuseppe, Simeoni, Benedetta, Pirone, Flavia, Massaro, Claudia, Recupero, Carla, Landi, Francesco, Gasbarrini, Antonio, Franceschi, Francesco, Covino, Marcello (ORCID:0000-0002-6709-2531), Landi, Francesco (ORCID:0000-0002-3472-1389), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Covino, Marcello, Russo, Andrea, Salini, Sara, De Matteis, Giuseppe, Simeoni, Benedetta, Pirone, Flavia, Massaro, Claudia, Recupero, Carla, Landi, Francesco, Gasbarrini, Antonio, Franceschi, Francesco, Covino, Marcello (ORCID:0000-0002-6709-2531), Landi, Francesco (ORCID:0000-0002-3472-1389), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

Abstract

Objectives: This study aimed to assess the effects of frailty and the perceived quality of life (QOL) on the long-term survival (at least 1 year) of patients >= 80 years hospitalized for COVID-19 and the predictors of frailty and QOL deterioration in survivors. Design: This is a single-center, prospective observational cohort study. Setting and Participants: The study was conducted in a teaching hospital and enrolled all COVID-19 patients >= 80 years old consecutively hospitalized between April 2020 and March 2021. Methods: Clinical variables assessed in the Emergency Department (ED), and during hospitalization, were evaluated for association with all-cause death at a follow-up. Frailty was assessed by the clinical frailty scale (CFS), and the QOL was assessed by the five-level EuroQol EQ-5d tool. Multivariate Cox regression analyses and logistic regression analyses were used to identify independent factors for poor outcomes. Results: A total of 368 patients aged >= 80 years survived the index hospitalization (age 85 years [interquartile range 82-89]; males 163 (44.3%)). Compared to non-frail patients (CFS 1-3), patients with CFS 4-6 and patients with CFS 7-9 had an increased risk of death (hazard ratio 6.75 [1.51, 30.2] and HR 3.55 [2.20, 5.78], respectively). In patients alive at the 1-year follow-up, the baseline QOL was an independent predictor of an increase in frailty (OR 1.12 [1.01, 1.24]). Male sex was associated with lower odds of QOL worsening (OR 0.61 [0.35, 1.07]). Conclusions and Implications: In older adults >= 80 years hospitalized for COVID-19, the frailty assessment by the CFS could effectively stratify the risk of long-term death after discharge. In survivors, the hospitalization could produce a long-term worsening in frailty, particularly in patients with a pre-existing reduced baseline QOL. A long-term reduction in the perceived QOL is frequent in >= 80 survivors, and the effect appears more pronounced in female patients.

Published
2022

30. Autoimmune Pancreatitis: From Pathogenesis to Treatment

Author

Nista, Enrico Celestino, De Lucia, Sara Sofia, Manilla, Vittoria, Schepis, Tommaso, Pellegrino, Antonio Agostino, Ojetti, Veronica, Pignataro, Giulia, Zileri Dal Verme, Lorenzo, Franceschi, Francesco, Gasbarrini, Antonio, Candelli, Marcello, Pellegrino, Antonio, Ojetti, Veronica (ORCID:0000-0002-8953-0707), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Candelli, Marcello (ORCID:0000-0001-8443-7880), Nista, Enrico Celestino, De Lucia, Sara Sofia, Manilla, Vittoria, Schepis, Tommaso, Pellegrino, Antonio Agostino, Ojetti, Veronica, Pignataro, Giulia, Zileri Dal Verme, Lorenzo, Franceschi, Francesco, Gasbarrini, Antonio, Candelli, Marcello, Pellegrino, Antonio, Ojetti, Veronica (ORCID:0000-0002-8953-0707), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), and Candelli, Marcello (ORCID:0000-0001-8443-7880)

Abstract

Autoimmune pancreatitis (AIP) is a rare disease. The diagnosis of AIP is difficult and should be made by a comprehensive evaluation of clinical, radiological, serological, and pathological findings. Two different types of AIP have been identified: autoimmune pancreatitis type 1 (AIP-1), which is considered a pancreatic manifestation of multiorgan disease related to IgG4, and autoimmune pancreatitis type 2 (AIP-2), which is considered a pancreas-specific disease not related to IgG4. Although the pathophysiological conditions seem to differ between type 1 and type 2 pancreatitis, both respond well to steroid medications. In this review, we focused on the pathogenesis of the disease to develop a tool that could facilitate diagnosis and lead to the discovery of new therapeutic strategies to combat autoimmune pancreatitis and its relapses. The standard therapy for AIP is oral administration of corticosteroids. Rituximab (RTX) has also been proposed for induction of remission and maintenance therapy in relapsing AIP-1. In selected patients, immunomodulators such as azathioprine are used to maintain remission. The strength of this review, compared with previous studies, is that it focuses on the clear difference between the two types of autoimmune pancreatitis with a clearly delineated and separate pathogenesis. In addition, the review also considers various therapeutic options, including biologic drugs, such as anti-tumor necrosis factor (TNF) therapy, a well-tolerated and effective second-line therapy for AIP type 2 relapses or steroid dependence. Other biologic therapies are also being explored that could provide a useful therapeutic alternative to corticosteroids and immunosuppressants, which are poorly tolerated due to significant side effects.

Published
2022

31. Gut Microbiota and Clostridium difficile: What We Know and the New Frontiers

Author

Piccioni, Andrea, Rosa, Federico, Manca, Federica, Pignataro, Giulia, Zanza, Christian, Savioli, Gabriele, Covino, Marcello, Ojetti, Veronica, Gasbarrini, Antonio, Franceschi, Francesco, Candelli, Marcello, Covino, Marcello (ORCID:0000-0002-6709-2531), Ojetti, Veronica (ORCID:0000-0002-8953-0707), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Candelli, Marcello (ORCID:0000-0001-8443-7880), Piccioni, Andrea, Rosa, Federico, Manca, Federica, Pignataro, Giulia, Zanza, Christian, Savioli, Gabriele, Covino, Marcello, Ojetti, Veronica, Gasbarrini, Antonio, Franceschi, Francesco, Candelli, Marcello, Covino, Marcello (ORCID:0000-0002-6709-2531), Ojetti, Veronica (ORCID:0000-0002-8953-0707), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), and Candelli, Marcello (ORCID:0000-0001-8443-7880)

Abstract

Our digestive system, particularly our intestines, harbors a vast amount of microorganisms, whose genetic makeup is referred to as the microbiome. Clostridium difficile is a spore-forming Gram-positive bacterium, which can cause an infection whose symptoms range from asymptomatic colonization to fearsome complications such as the onset of toxic megacolon. The relationship between gut microbiota and Clostridium difficile infection has been studied from different perspectives. One of the proposed strategies is to be able to specifically identify which types of microbiota alterations are most at risk for the onset of CDI. In this article, we understood once again how crucial the role of the human microbiota is in health and especially how crucial it becomes, in the case of its alteration, for the individual's disease. Clostridium difficile infection is an emblematic example of how a normal and physiological composition of the human microbiome can play a very important role in immune defense against such a fearsome disease.

Published
2022

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

Author

Rosa, Fausto, Covino, Marcello, Russo, Andrea, Salini, Sara, Forino, Raffaele, Della Polla, Davide, Fransvea, Pietro, Quero, Giuseppe, Fiorillo, Claudio, La Greca, Antonio, Sganga, Gabriele, Gasbarrini, Antonio, Franceschi, Francesco, Alfieri, Sergio, Rosa, Fausto (ORCID:0000-0002-7280-8354), Covino, Marcello (ORCID:0000-0002-6709-2531), Fransvea, Pietro (ORCID:0000-0003-4969-3373), Quero, Giuseppe (ORCID:0000-0002-0001-9479), Fiorillo, Claudio (ORCID:0000-0001-7681-3567), La Greca, Antonio (ORCID:0000-0002-7587-7427), Sganga, Gabriele (ORCID:0000-0001-5079-0395), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Alfieri, Sergio (ORCID:0000-0002-0404-724X), Rosa, Fausto, Covino, Marcello, Russo, Andrea, Salini, Sara, Forino, Raffaele, Della Polla, Davide, Fransvea, Pietro, Quero, Giuseppe, Fiorillo, Claudio, La Greca, Antonio, Sganga, Gabriele, Gasbarrini, Antonio, Franceschi, Francesco, Alfieri, Sergio, Rosa, Fausto (ORCID:0000-0002-7280-8354), Covino, Marcello (ORCID:0000-0002-6709-2531), Fransvea, Pietro (ORCID:0000-0003-4969-3373), Quero, Giuseppe (ORCID:0000-0002-0001-9479), Fiorillo, Claudio (ORCID:0000-0001-7681-3567), La Greca, Antonio (ORCID:0000-0002-7587-7427), Sganga, Gabriele (ORCID:0000-0001-5079-0395), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), and Alfieri, Sergio (ORCID:0000-0002-0404-724X)

Abstract

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.

Published
2022

33. Effect of Lockdowns on Hospital Staff in a COVID Center: A Retrospective Observational Study

Author

Vetrugno, Giuseppe, Sanguinetti, Maurizio, Murri, Rita, Sali, Michela, Marchetti, Simona, Santangelo, Rosaria, Fantoni, Massimo, Cingolani, Antonella, Scoppettuolo, Giancarlo, Di Donato, Michele, Grassi, Vincenzo M, Foti, Federica, Marchese, Luca, De Giorgio, Fabio, Oliva, Antonio, Staiti, Domenico, De Simone, Francesco Maria, Pascucci, Domenico, Cascini, Fidelia, Pastorino, Roberta, Pires Marafon, Denise, Cambieri, Andrea, Laurenti, Patrizia, Boccia, Stefania, Ricciardi, Walter, Franceschi, Francesco, On Behalf Of Gemelli-Against-Covid, Null, Vetrugno, Giuseppe (ORCID:0000-0003-0181-2855), Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059), Murri, Rita (ORCID:0000-0003-4263-7854), Sali, Michela (ORCID:0000-0003-3609-2990), Santangelo, Rosaria (ORCID:0000-0002-8056-218X), Fantoni, Massimo (ORCID:0000-0001-6913-8460), Cingolani, Antonella (ORCID:0000-0002-3793-2755), De-Giorgio, Fabio (ORCID:0000-0002-9447-9707), Oliva, Antonio (ORCID:0000-0001-7120-616X), Staiti, Domenico (ORCID:0000-0001-5179-9690), Pascucci, Domenico (ORCID:0000-0002-5804-2284), Cascini, Fidelia (ORCID:0000-0001-6499-0734), Pastorino, Roberta (ORCID:0000-0001-5013-0733), Pires-Marafon, Denise, Laurenti, Patrizia (ORCID:0000-0002-8532-0593), Boccia, Stefania (ORCID:0000-0002-1864-749X), Ricciardi, Walter (ORCID:0000-0002-5655-688X), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Vetrugno, Giuseppe, Sanguinetti, Maurizio, Murri, Rita, Sali, Michela, Marchetti, Simona, Santangelo, Rosaria, Fantoni, Massimo, Cingolani, Antonella, Scoppettuolo, Giancarlo, Di Donato, Michele, Grassi, Vincenzo M, Foti, Federica, Marchese, Luca, De Giorgio, Fabio, Oliva, Antonio, Staiti, Domenico, De Simone, Francesco Maria, Pascucci, Domenico, Cascini, Fidelia, Pastorino, Roberta, Pires Marafon, Denise, Cambieri, Andrea, Laurenti, Patrizia, Boccia, Stefania, Ricciardi, Walter, Franceschi, Francesco, On Behalf Of Gemelli-Against-Covid, Null, Vetrugno, Giuseppe (ORCID:0000-0003-0181-2855), Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059), Murri, Rita (ORCID:0000-0003-4263-7854), Sali, Michela (ORCID:0000-0003-3609-2990), Santangelo, Rosaria (ORCID:0000-0002-8056-218X), Fantoni, Massimo (ORCID:0000-0001-6913-8460), Cingolani, Antonella (ORCID:0000-0002-3793-2755), De-Giorgio, Fabio (ORCID:0000-0002-9447-9707), Oliva, Antonio (ORCID:0000-0001-7120-616X), Staiti, Domenico (ORCID:0000-0001-5179-9690), Pascucci, Domenico (ORCID:0000-0002-5804-2284), Cascini, Fidelia (ORCID:0000-0001-6499-0734), Pastorino, Roberta (ORCID:0000-0001-5013-0733), Pires-Marafon, Denise, Laurenti, Patrizia (ORCID:0000-0002-8532-0593), Boccia, Stefania (ORCID:0000-0002-1864-749X), Ricciardi, Walter (ORCID:0000-0002-5655-688X), and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

Abstract

At the onset of the SARS-CoV-2 pandemic, individual and social measures were strengthened through restrictive non-pharmaceutical interventions, labelled with the term "lockdown". In Italy, there were two lockdowns (9 March 2020-3 May 2020 and 3 November 2020-27 March 2021). As part of preventive measures, healthcare workers and the administrative staff population of Policlinico A. Gemelli underwent nasopharyngeal swab tests from 1 March 2020 to 9 February 2022, a long time interval that includes the two aforementioned lockdowns. The population included 8958 people from 1 March 2020 to 31 December 2020; 8981 people from 1 January 2021 to 31 December 2021; and 8981 people from 1 January 2022 to 9 February 2022. We then analysed pseudo-anonymized data, using a retrospective observational approach to evaluate the impact of the lockdown on the incidence of SARS-CoV-2 infections within the population. Given the 14 day contagious period, the swab positivity rate (SPR) among the staff decreased significantly at the end of the first lockdown, every day prior to 18 May 2020, by 0.093 (p < 0.0001, CI = (-0.138--0.047)). After the fourteenth day post the end of the first lockdown (18 May 2020), the SPR increased daily at a rate of 0.024 (p < 0.0001, 95% CI = (0.013-0.034)). In addition, the SPR appeared to increase significantly every day prior to 17 November 2020 by 0.024 (p < 0.0001, CI = (0.013-0.034)). After the fourteenth day post the start of the second lockdown (17 November 2020), the SPR decreased daily at a rate of 0.039 (p < 0.0001, 95% CI = (-0.050--0.027)). These data demonstrate that, in our Institution, the lockdowns helped to both protect healthcare workers and maintain adequate standards of care for COVID and non-COVID patients for the duration of the state of emergency in Italy.

Published
2022

34. Effect of Lockdowns on Hospital Staff in a COVID Center: A Retrospective Observational Study

Author

Vetrugno, Giuseppe, Sanguinetti, Maurizio, Murri, Rita, Sali, Michela, Marchetti, Simona, Santangelo, Rosaria, Fantoni, Massimo, Cingolani, Antonella, Scoppettuolo, Giancarlo, Di Donato, Michele, Grassi, Vincenzo M, Foti, Federica, Marchese, Luca, De Giorgio, Fabio, Oliva, Antonio, Staiti, Domenico, De Simone, Francesco Maria, Pascucci, Domenico, Cascini, Fidelia, Pastorino, Roberta, Pires-Marafon, Denise, Cambieri, Andrea, Laurenti, Patrizia, Boccia, Stefania, Ricciardi, Walter, Franceschi, Francesco, On Behalf Of Gemelli-Against-Covid, Null, Vetrugno, Giuseppe (ORCID:0000-0003-0181-2855), Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059), Murri, Rita (ORCID:0000-0003-4263-7854), Sali, Michela (ORCID:0000-0003-3609-2990), Santangelo, Rosaria (ORCID:0000-0002-8056-218X), Fantoni, Massimo (ORCID:0000-0001-6913-8460), Cingolani, Antonella (ORCID:0000-0002-3793-2755), De-Giorgio, Fabio (ORCID:0000-0002-9447-9707), Oliva, Antonio (ORCID:0000-0001-7120-616X), Staiti, Domenico (ORCID:0000-0001-5179-9690), Pascucci, Domenico (ORCID:0000-0002-5804-2284), Cascini, Fidelia (ORCID:0000-0001-6499-0734), Pastorino, Roberta (ORCID:0000-0001-5013-0733), Laurenti, Patrizia (ORCID:0000-0002-8532-0593), Boccia, Stefania (ORCID:0000-0002-1864-749X), Ricciardi, Walter (ORCID:0000-0002-5655-688X), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Vetrugno, Giuseppe, Sanguinetti, Maurizio, Murri, Rita, Sali, Michela, Marchetti, Simona, Santangelo, Rosaria, Fantoni, Massimo, Cingolani, Antonella, Scoppettuolo, Giancarlo, Di Donato, Michele, Grassi, Vincenzo M, Foti, Federica, Marchese, Luca, De Giorgio, Fabio, Oliva, Antonio, Staiti, Domenico, De Simone, Francesco Maria, Pascucci, Domenico, Cascini, Fidelia, Pastorino, Roberta, Pires-Marafon, Denise, Cambieri, Andrea, Laurenti, Patrizia, Boccia, Stefania, Ricciardi, Walter, Franceschi, Francesco, On Behalf Of Gemelli-Against-Covid, Null, Vetrugno, Giuseppe (ORCID:0000-0003-0181-2855), Sanguinetti, Maurizio (ORCID:0000-0002-9780-7059), Murri, Rita (ORCID:0000-0003-4263-7854), Sali, Michela (ORCID:0000-0003-3609-2990), Santangelo, Rosaria (ORCID:0000-0002-8056-218X), Fantoni, Massimo (ORCID:0000-0001-6913-8460), Cingolani, Antonella (ORCID:0000-0002-3793-2755), De-Giorgio, Fabio (ORCID:0000-0002-9447-9707), Oliva, Antonio (ORCID:0000-0001-7120-616X), Staiti, Domenico (ORCID:0000-0001-5179-9690), Pascucci, Domenico (ORCID:0000-0002-5804-2284), Cascini, Fidelia (ORCID:0000-0001-6499-0734), Pastorino, Roberta (ORCID:0000-0001-5013-0733), Laurenti, Patrizia (ORCID:0000-0002-8532-0593), Boccia, Stefania (ORCID:0000-0002-1864-749X), Ricciardi, Walter (ORCID:0000-0002-5655-688X), and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

Abstract

At the onset of the SARS-CoV-2 pandemic, individual and social measures were strengthened through restrictive non-pharmaceutical interventions, labelled with the term "lockdown". In Italy, there were two lockdowns (9 March 2020-3 May 2020 and 3 November 2020-27 March 2021). As part of preventive measures, healthcare workers and the administrative staff population of Policlinico A. Gemelli underwent nasopharyngeal swab tests from 1 March 2020 to 9 February 2022, a long time interval that includes the two aforementioned lockdowns. The population included 8958 people from 1 March 2020 to 31 December 2020; 8981 people from 1 January 2021 to 31 December 2021; and 8981 people from 1 January 2022 to 9 February 2022. We then analysed pseudo-anonymized data, using a retrospective observational approach to evaluate the impact of the lockdown on the incidence of SARS-CoV-2 infections within the population. Given the 14 day contagious period, the swab positivity rate (SPR) among the staff decreased significantly at the end of the first lockdown, every day prior to 18 May 2020, by 0.093 (p < 0.0001, CI = (-0.138--0.047)). After the fourteenth day post the end of the first lockdown (18 May 2020), the SPR increased daily at a rate of 0.024 (p < 0.0001, 95% CI = (0.013-0.034)). In addition, the SPR appeared to increase significantly every day prior to 17 November 2020 by 0.024 (p < 0.0001, CI = (0.013-0.034)). After the fourteenth day post the start of the second lockdown (17 November 2020), the SPR decreased daily at a rate of 0.039 (p < 0.0001, 95% CI = (-0.050--0.027)). These data demonstrate that, in our Institution, the lockdowns helped to both protect healthcare workers and maintain adequate standards of care for COVID and non-COVID patients for the duration of the state of emergency in Italy.

Published
2022

35. The Gut Microbiota-Brain Axis in Acute Neurological Disease: Focus on Stroke

Author

Saviano, Angela, Gayani, Gunawardena, Migneco, Alessio, Candelli, Marcello, Franceschi, Francesco, Ojetti, Veronica, Zanza, Christian, Longhitano, Yaroslava, Saviano, Angela (ORCID:0000-0002-2820-7180), Candelli, Marcello (ORCID:0000-0001-8443-7880), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Ojetti, Veronica (ORCID:0000-0002-8953-0707), Saviano, Angela, Gayani, Gunawardena, Migneco, Alessio, Candelli, Marcello, Franceschi, Francesco, Ojetti, Veronica, Zanza, Christian, Longhitano, Yaroslava, Saviano, Angela (ORCID:0000-0002-2820-7180), Candelli, Marcello (ORCID:0000-0001-8443-7880), Franceschi, Francesco (ORCID:0000-0001-6266-445X), and Ojetti, Veronica (ORCID:0000-0002-8953-0707)

Abstract

The gut microbiota is one of the great innovations of modern medicine. In the modern microbiota revolution era, more comprehensive and in-depth studies have been performed regarding the microbial gut communities and their impact on acute and chronic diseases, including those of the nervous system as acute neurological diseases. The microbiota has changed our knowledge of medical conditions; in particular, considering stroke (both ischemic and hemorrhagic), literature studies, experimental and clinical researches indicate that the individual's risk and outcomes are substantially impacted by the gut microbiota. The aim of our review article is to investigate and discuss the recent insights into the emerging role of this complex "gut microbiota-brain axis" in affecting some acute neurological diseases, such as stroke, responsible for a significant number of deaths worldwide. We performed electronic research on PubMed (R) and collected articles published in the last ten years, finding that changes in the gut microbiota composition could affect various aspects of stroke pathophysiology and individual predisposition, risk, and outcomes. Our review article suggests that there is a strong connection between the gut microbiota and the brain, both in health and in acute neurological diseases such as stroke. Investigating and exploring this relationship can be a challenge useful to learn more about this disabling/deadly condition, and it can be a useful tool to identify novel potential therapeutic approaches, improving an individual's outcomes and life.

Published
2022

36. COVID-19 Pneumonia and Gut Inflammation: The Role of a Mix of Three Probiotic Strains in Reducing Inflammatory Markers and Need for Oxygen Support

Author

Saviano, Angela, Potenza, Annalisa, Siciliano, Valentina, Petruzziello, Carmine, Tarli, Claudia, Migneco, Alessio, Nasella, Flavia, Franceschi, Francesco, Ojetti, Veronica, Saviano, Angela (ORCID:0000-0002-2820-7180), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Ojetti, Veronica (ORCID:0000-0002-8953-0707), Saviano, Angela, Potenza, Annalisa, Siciliano, Valentina, Petruzziello, Carmine, Tarli, Claudia, Migneco, Alessio, Nasella, Flavia, Franceschi, Francesco, Ojetti, Veronica, Saviano, Angela (ORCID:0000-0002-2820-7180), Franceschi, Francesco (ORCID:0000-0001-6266-445X), and Ojetti, Veronica (ORCID:0000-0002-8953-0707)

Abstract

Background: COVID-19 disease, which typically presents with respiratory symptoms, can trigger intestinal inflammation through SARS-CoV-2 replication in the gastrointestinal tract. Supplementation with probiotics may have beneficial effects on gut inflammation due to their analgesic and anti-inflammatory properties. The primary objective of our study was to evaluate the efficacy of a mix of three probiotic strains (Bifidobacterium lactis LA 304, Lactobacillus salivarius LA 302, and Lactobacillus acidophilus LA 201; Lactibiane Iki (R)) in the reduction in fecal calprotectin in patients with COVID-19 pneumonia, compared to a control group. The secondary aim was to evaluate the reduction in oxygen support and length of hospital stay in patients taking the probiotic mix. Patients and Methods: We conducted a prospective randomized controlled trial at Fondazione Policlinico Gemelli, Rome. We enrolled patients with COVID-19 interstitial pneumonia. One group received the probiotic mix twice a day for 10 days in addition to the standard COVID-19 therapy, and a second group received standard COVID-19 therapy without probiotics. We administered oxygen support (through Ventimask or Optiflow (R)) on days (D) 1, 3, 5, 7 and 10, and the level of fecal calprotectin between D3-D5 and D7-D10. Results: A total of 80 patients (44 M/36 F; mean age: 59.8 +/- 17.3) were enrolled with a mean value of calprotectin at enrollment of 140 mg/dL. At D7-10, the probiotic group showed a 35% decrease in fecal calprotectin compared to 16% in the control group, a decrease in C-reactive protein (CRP) of 72.7% compared to 62%, and a slight but not significant decrease in oxygen support compared to the control group. Conclusion: Supplementation with a mix of probiotics for 10 days in patients with COVID-19 interstitial pneumonia significantly reduces inflammatory markers.

Published
2022

37. Adhesive small bowel obstruction in elderly patients: a single-center analysis of treatment strategies and clinical outcomes

Author

Quero, Giuseppe, Covino, Marcello, Laterza, Vito, Fiorillo, Claudio, Rosa, Fausto, Menghi, Roberta, Fransvea, Pietro, Cozza, Valerio, Sganga, Gabriele, Franceschi, Francesco, Alfieri, Sergio, Quero, Giuseppe (ORCID:0000-0002-0001-9479), Covino, Marcello (ORCID:0000-0002-6709-2531), Fiorillo, Claudio (ORCID:0000-0001-7681-3567), Rosa, Fausto (ORCID:0000-0002-7280-8354), Fransvea, Pietro (ORCID:0000-0003-4969-3373), Sganga, Gabriele (ORCID:0000-0001-5079-0395), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Alfieri, Sergio (ORCID:0000-0002-0404-724X), Quero, Giuseppe, Covino, Marcello, Laterza, Vito, Fiorillo, Claudio, Rosa, Fausto, Menghi, Roberta, Fransvea, Pietro, Cozza, Valerio, Sganga, Gabriele, Franceschi, Francesco, Alfieri, Sergio, Quero, Giuseppe (ORCID:0000-0002-0001-9479), Covino, Marcello (ORCID:0000-0002-6709-2531), Fiorillo, Claudio (ORCID:0000-0001-7681-3567), Rosa, Fausto (ORCID:0000-0002-7280-8354), Fransvea, Pietro (ORCID:0000-0003-4969-3373), Sganga, Gabriele (ORCID:0000-0001-5079-0395), Franceschi, Francesco (ORCID:0000-0001-6266-445X), and Alfieri, Sergio (ORCID:0000-0002-0404-724X)

Abstract

Introduction The incidence of adhesive bowel obstruction (ASBO) progressively increases with age. Strong evidences on the influencing role of age on ASBO clinical course and management are still lacking. Aim of this study is to retrospectively analyze the clinical outcomes of patients older than 65 years of age admitted to a tertiary referral Emergency Department with a diagnosis of ASBO. Materials and methods We reviewed the clinical records of patients admitted for ASBO in the period 2014-2019. Patients were divided in elderly (>= 65 years) and non-elderly (<65 years). Primary endpoint was to compare the all-cause in-hospital mortality and the occurrence of major complications in the two groups. Secondary endpoint was a comparison of clinical presentation, clinical course and management. Results We enrolled 285 elderly and 492 non-elderly patients. Vomit was more frequent in the elderly (51.9% vs 34.6%; p < .001), while no difference was evidenced for the remaining symptoms of ASBO presentation. A higher rate of non-operative management (NOM) (26.3% vs 16.5%; p = .010), ICU admission (16% vs 0.6%; p < .001), mortality (2.1% vs 0.2%; p = .007) and cumulative major complications (8.8% vs 3.3%; p = .001), as well as a prolonged hospitalization (8.2 vs 5.4 days; p < .001) was evidenced in the >= 65 years group. Multivariate analysis identified increasing age (OR:2.8; 95%CI:1.09-7.2; p = .040) and Charlson comorbidity index >= 2 (OR:2.5; 95% CI:1.2-6.4; p = .050) as the only independent predictors of cumulative major complications. Conclusions Despite the similarity in terms of clinical presentation, elderly patient present higher mortality rate and occurrence of major complications. A comprehensive geriatric assessment is recommended to optimize the diagnostic and clinical strategies in case of ASBO.

Published
2021

38. Asthma in patients admitted to emergency department for COVID-19: prevalence and risk of hospitalization

Author

Gabrielli, Maurizio, Pignataro, Giulia, Candelli, Marcello, Sacco Fernandez, Marta, Bizzarri, Martina, Esperide, Alessandra, Franceschi, Francesco, Abbate, Valeria, Nicola, Acampora, Addolorato, Giovanni, Agostini, Fabiana, Ainora, Maria Elena, Akacha, Karim, Amato, Elena, Andreani, Francesca, Andriollo, Gloria, Annetta, Maria Giuseppina, Annicchiarico, Brigida Eleonora, Mariangela, Antonelli, Antonucci, Gabriele, Marco, Anzellotti Gian, Armuzzi, Alessandro, Baldi, Fabiana, Barattucci, Ilaria, Barillaro, Christian, Fabiana, Barone, Bellantone, Rocco Domenico Alfonso, Andrea, Bellieni, Bello, Giuseppe, Benicchi, Andrea, Benvenuto, Francesca, Berardini, Ludovica, Berloco, Filippo, Bernabei, Roberto, Bianchi, Antonio, Biasucci, Daniele Guerino, Biasucci, Luigi Marzio, Stefano, Bibbò, Bini, Alessandra, Alessandra, Bisanti, Biscetti, Federico, Bocci, Maria Grazia, Nicola, Bonadia, Bongiovanni, Filippo, Borghetti, Alberto, Bosco, Giulia, Bosello, Silvia Laura, Bove, Vincenzo, Bramato, Giulia, Brandi, Vincenzo, Teresa, Bruni, Bruno, Carmine, Bruno, Dario, Bungaro, Maria Chiara, Buonomo, Alessandro, Livia, Burzo, Angelo, Calabrese, Rosaria, Calvello Maria, Andrea, Cambieri, Cambise, Chiara, Camma, Giulia, Gennaro, Canistro, Antonello, Cantanale, Capalbo, Gennaro, Capaldi, Lorenzo, Capone, Emanuele, Capristo, Esmeralda, Carbone, Luigi, Silvia, Cardone, Carelli, Simone, Carfi', Angelo, Annamaria, Carnicelli, Caruso, Cristiano, Antonio, Casciaro Francesco, Catalano, Lucio, Cauda, Roberto, Cecchini, Andrea Leonardo, Cerrito, Lucia, Melania, Cesarano, Chiarito, Annalisa, Cianci, Rossella, Cicetti, Marta, Cicchinelli, Sara, Arturo, Ciccullo, Ciciarello, Francesca, Cingolani, Antonella, Cipriani, Maria Camilla, Consalvo, Ludovica Maria, Coppola, Gaetano, Corbo, Giuseppe Maria, Corsello, Andrea, Costante, Federico, Matteo, Costanzi, Covino, Marcello, Davide, Crupi, Lucio, Cutuli Salvatore, D'Addio, Stefano, D'Alessandro, Alessia, D'Alfonso, Maria Elena, D'Angelo, Emanuela, Francesca, D’Aversa, Damiano, Fernando, De Maria, Berardinis Gian, De Cunzo, Tommaso, De Gaetano Donati, Katleen, De Luca, Giulio, De Matteis, Giuseppe, De Pascale, Gennaro, De Paolo, Santi, De Martina, Siena, De Francesco, Vito, Del Valeria, Gatto, Del Paola, Giacomo, Del Fabio, Zompo, Maria, Dell’Anna Antonio, Della Davide, Polla, Di Luca, Gialleonardo, Di Simona, Giambenedetto, Di Roberta, Luca, Di Luca, Maurizio, Di Mariangela, Muro, Alex, Dusina, Davide, Eleuteri, Alessandra, Esperide, Daniele, Facheci, Domenico, Faliero, Cinzia, Falsiroli, Massimo, Fantoni, Annalaura, Fedele, Daniela, Feliciani, Cristina, Ferrante, Giuliano, Ferrone, Rossano, Festa, Chiara, Fiore Maria, Andrea, Flex, Evelina, Forte, Francesco, Franceschi, Alessandra, Francesconi, Laura, Franza, Barbara, Funaro, Mariella, Fuorlo, Domenico, Fusco, Maurizio, Gabrielli, Eleonora, Gaetani, Claudia, Galletta, Antonella, Gallo, Giovanni, Gambassi, Matteo, Garcovich, Antonio, Gasbarrini, Irene, Gasparrini, Silvia, Gelli, Antonella, Giampietro, Laura, Gigante, Gabriele, Giuliano, Giorgia, Giuliano, Bianca, Giupponi, Elisa, Gremese, Grieco, Domenico Luca, Manuel, Guerrera, Valeria, Guglielmi, Caterina, Guidone, Antonio, Gullì, Amerigo, Iaconelli, Aurora, Iafrati, Ianiro, Gianluca, Angela, Iaquinta, Michele, Impagnatiello, Riccardo, Inchingolo, Enrica, Intini, Raffaele, Iorio, Maria, Izzi Immacolata, Tamara, Jovanovic, Cristina, Kadhim, Rosa, La Macchia, Ignazio, La Milia Daniele, Francesco, Landi, Giovanni, Landi, Rosario, Landi, Raffaele, Landolfi, Massimo, Leo, Maria, Leone Paolo, Laura, Levantesi, Antonio, Liguori, Rosa, Liperoti, Maria, Lizzio Marco, Rita, Lo Monaco Maria, Pietro, Locantore, Francesco, Lombardi, Gianmarco, Lombardi, Loris, Lopetuso, Valentina, Loria, Raffaella, Losito Angela, Patricia, Lucia Mothanje Barbara, Francesco, Macagno, Noemi, Macerola, Giampaolo, Maggi, Giuseppe, Maiuro, Francesco, Mancarella, Francesca, Mangiola, Alberto, Manno, Debora, Marchesini, Marco, Maresca Gian, Giuseppe, Marrone, Ilaria, Marti, Maria, Martone Anna, Marzetti, Emanuele, Chiara, Mattana, Valeria, Matteo Maria, Riccardo, Maviglia, Ada, Mazzarella, Carmen, Memoli, Miele, Luca, Alessio, Migneco, Irene, Mignini, Alessandro, Milani, Domenico, Milardi, Massimo, Montalto, Giuliano, Montemurro, Flavia, Monti, Montini, Luca, Christian, Morena Tony, Vincenzina, Morra, Davide, Moschese, Ambra, Murace Celeste, Martina, Murdolo, Rita, Murri, Marco, Napoli, Elisabetta, Nardella, Gerlando, Natalello, Daniele, Natalini, Maria, Navarra Simone, Antonio, Nesci, Alberto, Nicoletti, Rocco, Nicoletti, Filippo, Nicoletti Tommaso, Rebecca, Nicolò, Nicola, Nicolotti, Celestino, Nista Enrico, Eugenia, Nuzzo, Marco, Oggiano, Veronica, Ojetti, Cosimo, Pagano Francesco, Gianfranco, Paiano, Cristina, Pai, Federico, Paolillo, Federico, Pallavicini, Andrea, Palombo, Alfredo, Papa, Domenico, Papanice, Giovanni, Papparella Luigi, Mattia, Paratore, Giuseppe, Parrinello, Giuliana, Pasciuto, Pierpaolo, Pasculli, Giovanni, Pecorini, Simone, Perniola, Erika, Pero, Luca, Petricca, Martina, Petrucci, Chiara, Picarelli, Andrea, Piccioni, Annalisa, Piccolo, Edoardo, Piervincenzi, Giulia, Pignataro, Raffaele, Pignataro, Gabriele, Pintaudi, Luca, Pisapia, Marco, Pizzoferrato, Fabrizio, Pizzolante, Roberto, Pola, Caterina, Policola, Maurizio, Pompili, Flavia, Pontecorvi, Valerio, Pontecorvi, Francesca, Ponziani, Valentina, Popolla, Enrica, Porceddu, Angelo, Porfidia, Maria, Porro Lucia, Annalisa, Potenza, Francesca, Pozzana, Giuseppe, Privitera, Daniela, Pugliese, Gabriele, Pulcini, Simona, Racco, Francesca, Raffaelli, Vittoria, Ramunno, Ludovico, Rapaccini Gian, Richeldi, Luca, Rinninella, Emanuele, Sara, Rocchi, Bruno, Romanò, Stefano, Romano, Federico, Rosa, Laura, Rossi, Raimondo, Rossi, Enrica, Rossini, Elisabetta, Rota, Fabiana, Rovedi, Carlotta, Rubino, Gabriele, Rumi, Andrea, Russo, Luca, Sabia, Andrea, Salerno, Sara, Salini, Lucia, Salvatore, Dehara, Samori, Sandroni, Claudio, Maurizio, Sanguinetti, Luca, Santarelli, Paolo, Santini, Danilo, Santolamazza, Angelo, Santoliquido, Francesco, Santopaolo, Cosimo, Santoro Michele, Francesco, Sardeo, Caterina, Sarnari, Angela, Saviano, Luisa, Saviano, Scaldaferri, Franco, Roberta, Scarascia, Tommaso, Schepi, Francesca, Schiavello, Giancarlo, Scoppettuolo, Davide, Sedda, Flaminio, Sessa, Luisa, Sestito, Carlo, Settanni, Matteo, Siciliano, Valentina, Siciliano, Rossella, Sicuranza, Benedetta, Simeoni, Jacopo, Simonetti, Andrea, Smargiassi, Maurizio, Soave Paolo, Chiara, Sonnino, Domenico, Staiti, Claudia, Stella, Leonardo, Stella, Eleonora, Stival, Eleonora, Taddei, Rossella, Talerico, Elio, Tamburello, Enrica, Tamburrini, Sofia, Tanzarella Eloisa, Elena, Tarascio, Claudia, Tarli, Alessandra, Tersali, Pietro, Tilli, Jacopo, Timpano, Enrico, Torelli, Flavia, Torrini, Matteo, Tosato, Alberto, Tosoni, Luca, Tricoli, Marcello, Tritto, Mario, Tumbarello, Maria, Tummolo Anita, Sole, Vallecoccia Maria, Federico, Valletta, Francesco, Varone, Francesco, Vassalli, Giulio, Ventura, Lucrezia, Verardi, Lorenzo, Vetrone, Giuseppe, Vetrugno, Elena, Visconti, Felicia, Visconti, Andrea, Viviani, Raffaella, Zaccaria, Carmelina, Zaccone, Lorenzo, Zelano, Lorenzo, Zileri Dal Verme, Giuseppe, Zuccalà, Candelli, Marcello (ORCID:0000-0001-8443-7880), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Valeria, Abbate, Giovanni, Addolorato (ORCID:0000-0002-1522-9946), Fabiana, Agostini, Elena, Ainora Maria, Karim, Akacha, Elena, Amato, Francesca, Andreani, Gloria, Andriollo, Giuseppina, Annetta Maria (ORCID:0000-0001-7574-1311), Eleonora, Annicchiarico Brigida, Gabriele, Antonucci, Alessandro, Armuzzi (ORCID:0000-0003-1572-0118), Fabiana, Baldi, Ilaria, Barattucci, Christian, Barillaro, Alfonso, Bellantone Rocco Domenico (ORCID:0000-0002-0844-3469), Giuseppe, Bello (ORCID:0000-0003-2648-7235), Andrea, Benicchi, Francesca, Benvenuto, Ludovica, Berardini, Filippo, Berloco, Roberto, Bernabei (ORCID:0000-0002-9197-004X), Antonio, Bianchi, Guerino, Biasucci Daniele, Marzio, Biasucci Luigi (ORCID:0000-0002-6921-6497), Alessandra, Bini, Federico, Biscetti (ORCID:0000-0001-7449-657X), Grazia, Bocci Maria, Filippo, Bongiovanni, Alberto, Borghetti, Giulia, Bosco, Silvia, Bosello (ORCID:0000-0002-4837-447X), Vincenzo, Bove, Giulia, Bramato, Vincenzo, Brandi, Carmine, Bruno, Dario, Bruno, Chiara, Bungaro Maria, Alessandro, Buonomo, Chiara, Cambise, Giulia, Cammà, Marcello, Candelli (ORCID:0000-0001-8443-7880), Gennaro, Capalbo, Lorenzo, Capaldi, Emanuele, Capone, Esmeralda, Capristo (ORCID:0000-0002-5753-3495), Luigi, Carbone, Simone, Carelli, Angelo, Carfì, Cristiano, Caruso, Lucio, Catalano, Roberto, Cauda (ORCID:0000-0002-1498-4229), Leonardo, Cecchini Andrea, Lucia, Cerrito, Annalisa, Chiarito, Rossella, Cianci (ORCID:0000-0001-5378-8442), Marta, Cicetti, Sara, Cicchinelli, Francesca, Ciciarello, Antonella, Cingolani (ORCID:0000-0002-3793-2755), Camilla, Cipriani Maria, Ludovica, Consalvo Maria, Gaetano, Coppola, Maria, Corbo Giuseppe (ORCID:0000-0002-8104-4659), Andrea, Corsello, Federico, Costante, Marcello, Covino (ORCID:0000-0002-6709-2531), Stefano, D’Addio, Alessia, D’Alessandro, Elena, D’alfonso Maria, Emanuela, D’Angelo, Fernando, Damiano (ORCID:0000-0003-0960-0232), De Tommaso, Cunzo, de Katleen, Gaetano Donati, De Giulio, Luca, De Giuseppe, Matteis, De Gennaro, Pascale (ORCID:0000-0002-8255-0676), Luca, Grieco Domenico (ORCID:0000-0002-4557-6308), Gianluca, Ianiro (ORCID:0000-0002-8318-0515), Emanuele, Marzetti (ORCID:0000-0001-9567-6983), Luca, Miele (ORCID:0000-0003-3464-0068), Luca, Montini (ORCID:0000-0003-4602-5134), Luca, Richeldi (ORCID:0000-0001-8594-1448), Emanuele, Rinninella (ORCID:0000-0002-9165-2367), Claudio, Sandroni (ORCID:0000-0002-8878-2611), Franco, Scaldaferri (ORCID:0000-0001-8334-7541), Gabrielli, Maurizio, Pignataro, Giulia, Candelli, Marcello, Sacco Fernandez, Marta, Bizzarri, Martina, Esperide, Alessandra, Franceschi, Francesco, Abbate, Valeria, Nicola, Acampora, Addolorato, Giovanni, Agostini, Fabiana, Ainora, Maria Elena, Akacha, Karim, Amato, Elena, Andreani, Francesca, Andriollo, Gloria, Annetta, Maria Giuseppina, Annicchiarico, Brigida Eleonora, Mariangela, Antonelli, Antonucci, Gabriele, Marco, Anzellotti Gian, Armuzzi, Alessandro, Baldi, Fabiana, Barattucci, Ilaria, Barillaro, Christian, Fabiana, Barone, Bellantone, Rocco Domenico Alfonso, Andrea, Bellieni, Bello, Giuseppe, Benicchi, Andrea, Benvenuto, Francesca, Berardini, Ludovica, Berloco, Filippo, Bernabei, Roberto, Bianchi, Antonio, Biasucci, Daniele Guerino, Biasucci, Luigi Marzio, Stefano, Bibbò, Bini, Alessandra, Alessandra, Bisanti, Biscetti, Federico, Bocci, Maria Grazia, Nicola, Bonadia, Bongiovanni, Filippo, Borghetti, Alberto, Bosco, Giulia, Bosello, Silvia Laura, Bove, Vincenzo, Bramato, Giulia, Brandi, Vincenzo, Teresa, Bruni, Bruno, Carmine, Bruno, Dario, Bungaro, Maria Chiara, Buonomo, Alessandro, Livia, Burzo, Angelo, Calabrese, Rosaria, Calvello Maria, Andrea, Cambieri, Cambise, Chiara, Camma, Giulia, Gennaro, Canistro, Antonello, Cantanale, Capalbo, Gennaro, Capaldi, Lorenzo, Capone, Emanuele, Capristo, Esmeralda, Carbone, Luigi, Silvia, Cardone, Carelli, Simone, Carfi', Angelo, Annamaria, Carnicelli, Caruso, Cristiano, Antonio, Casciaro Francesco, Catalano, Lucio, Cauda, Roberto, Cecchini, Andrea Leonardo, Cerrito, Lucia, Melania, Cesarano, Chiarito, Annalisa, Cianci, Rossella, Cicetti, Marta, Cicchinelli, Sara, Arturo, Ciccullo, Ciciarello, Francesca, Cingolani, Antonella, Cipriani, Maria Camilla, Consalvo, Ludovica Maria, Coppola, Gaetano, Corbo, Giuseppe Maria, Corsello, Andrea, Costante, Federico, Matteo, Costanzi, Covino, Marcello, Davide, Crupi, Lucio, Cutuli Salvatore, D'Addio, Stefano, D'Alessandro, Alessia, D'Alfonso, Maria Elena, D'Angelo, Emanuela, Francesca, D’Aversa, Damiano, Fernando, De Maria, Berardinis Gian, De Cunzo, Tommaso, De Gaetano Donati, Katleen, De Luca, Giulio, De Matteis, Giuseppe, De Pascale, Gennaro, De Paolo, Santi, De Martina, Siena, De Francesco, Vito, Del Valeria, Gatto, Del Paola, Giacomo, Del Fabio, Zompo, Maria, Dell’Anna Antonio, Della Davide, Polla, Di Luca, Gialleonardo, Di Simona, Giambenedetto, Di Roberta, Luca, Di Luca, Maurizio, Di Mariangela, Muro, Alex, Dusina, Davide, Eleuteri, Alessandra, Esperide, Daniele, Facheci, Domenico, Faliero, Cinzia, Falsiroli, Massimo, Fantoni, Annalaura, Fedele, Daniela, Feliciani, Cristina, Ferrante, Giuliano, Ferrone, Rossano, Festa, Chiara, Fiore Maria, Andrea, Flex, Evelina, Forte, Francesco, Franceschi, Alessandra, Francesconi, Laura, Franza, Barbara, Funaro, Mariella, Fuorlo, Domenico, Fusco, Maurizio, Gabrielli, Eleonora, Gaetani, Claudia, Galletta, Antonella, Gallo, Giovanni, Gambassi, Matteo, Garcovich, Antonio, Gasbarrini, Irene, Gasparrini, Silvia, Gelli, Antonella, Giampietro, Laura, Gigante, Gabriele, Giuliano, Giorgia, Giuliano, Bianca, Giupponi, Elisa, Gremese, Grieco, Domenico Luca, Manuel, Guerrera, Valeria, Guglielmi, Caterina, Guidone, Antonio, Gullì, Amerigo, Iaconelli, Aurora, Iafrati, Ianiro, Gianluca, Angela, Iaquinta, Michele, Impagnatiello, Riccardo, Inchingolo, Enrica, Intini, Raffaele, Iorio, Maria, Izzi Immacolata, Tamara, Jovanovic, Cristina, Kadhim, Rosa, La Macchia, Ignazio, La Milia Daniele, Francesco, Landi, Giovanni, Landi, Rosario, Landi, Raffaele, Landolfi, Massimo, Leo, Maria, Leone Paolo, Laura, Levantesi, Antonio, Liguori, Rosa, Liperoti, Maria, Lizzio Marco, Rita, Lo Monaco Maria, Pietro, Locantore, Francesco, Lombardi, Gianmarco, Lombardi, Loris, Lopetuso, Valentina, Loria, Raffaella, Losito Angela, Patricia, Lucia Mothanje Barbara, Francesco, Macagno, Noemi, Macerola, Giampaolo, Maggi, Giuseppe, Maiuro, Francesco, Mancarella, Francesca, Mangiola, Alberto, Manno, Debora, Marchesini, Marco, Maresca Gian, Giuseppe, Marrone, Ilaria, Marti, Maria, Martone Anna, Marzetti, Emanuele, Chiara, Mattana, Valeria, Matteo Maria, Riccardo, Maviglia, Ada, Mazzarella, Carmen, Memoli, Miele, Luca, Alessio, Migneco, Irene, Mignini, Alessandro, Milani, Domenico, Milardi, Massimo, Montalto, Giuliano, Montemurro, Flavia, Monti, Montini, Luca, Christian, Morena Tony, Vincenzina, Morra, Davide, Moschese, Ambra, Murace Celeste, Martina, Murdolo, Rita, Murri, Marco, Napoli, Elisabetta, Nardella, Gerlando, Natalello, Daniele, Natalini, Maria, Navarra Simone, Antonio, Nesci, Alberto, Nicoletti, Rocco, Nicoletti, Filippo, Nicoletti Tommaso, Rebecca, Nicolò, Nicola, Nicolotti, Celestino, Nista Enrico, Eugenia, Nuzzo, Marco, Oggiano, Veronica, Ojetti, Cosimo, Pagano Francesco, Gianfranco, Paiano, Cristina, Pai, Federico, Paolillo, Federico, Pallavicini, Andrea, Palombo, Alfredo, Papa, Domenico, Papanice, Giovanni, Papparella Luigi, Mattia, Paratore, Giuseppe, Parrinello, Giuliana, Pasciuto, Pierpaolo, Pasculli, Giovanni, Pecorini, Simone, Perniola, Erika, Pero, Luca, Petricca, Martina, Petrucci, Chiara, Picarelli, Andrea, Piccioni, Annalisa, Piccolo, Edoardo, Piervincenzi, Giulia, Pignataro, Raffaele, Pignataro, Gabriele, Pintaudi, Luca, Pisapia, Marco, Pizzoferrato, Fabrizio, Pizzolante, Roberto, Pola, Caterina, Policola, Maurizio, Pompili, Flavia, Pontecorvi, Valerio, Pontecorvi, Francesca, Ponziani, Valentina, Popolla, Enrica, Porceddu, Angelo, Porfidia, Maria, Porro Lucia, Annalisa, Potenza, Francesca, Pozzana, Giuseppe, Privitera, Daniela, Pugliese, Gabriele, Pulcini, Simona, Racco, Francesca, Raffaelli, Vittoria, Ramunno, Ludovico, Rapaccini Gian, Richeldi, Luca, Rinninella, Emanuele, Sara, Rocchi, Bruno, Romanò, Stefano, Romano, Federico, Rosa, Laura, Rossi, Raimondo, Rossi, Enrica, Rossini, Elisabetta, Rota, Fabiana, Rovedi, Carlotta, Rubino, Gabriele, Rumi, Andrea, Russo, Luca, Sabia, Andrea, Salerno, Sara, Salini, Lucia, Salvatore, Dehara, Samori, Sandroni, Claudio, Maurizio, Sanguinetti, Luca, Santarelli, Paolo, Santini, Danilo, Santolamazza, Angelo, Santoliquido, Francesco, Santopaolo, Cosimo, Santoro Michele, Francesco, Sardeo, Caterina, Sarnari, Angela, Saviano, Luisa, Saviano, Scaldaferri, Franco, Roberta, Scarascia, Tommaso, Schepi, Francesca, Schiavello, Giancarlo, Scoppettuolo, Davide, Sedda, Flaminio, Sessa, Luisa, Sestito, Carlo, Settanni, Matteo, Siciliano, Valentina, Siciliano, Rossella, Sicuranza, Benedetta, Simeoni, Jacopo, Simonetti, Andrea, Smargiassi, Maurizio, Soave Paolo, Chiara, Sonnino, Domenico, Staiti, Claudia, Stella, Leonardo, Stella, Eleonora, Stival, Eleonora, Taddei, Rossella, Talerico, Elio, Tamburello, Enrica, Tamburrini, Sofia, Tanzarella Eloisa, Elena, Tarascio, Claudia, Tarli, Alessandra, Tersali, Pietro, Tilli, Jacopo, Timpano, Enrico, Torelli, Flavia, Torrini, Matteo, Tosato, Alberto, Tosoni, Luca, Tricoli, Marcello, Tritto, Mario, Tumbarello, Maria, Tummolo Anita, Sole, Vallecoccia Maria, Federico, Valletta, Francesco, Varone, Francesco, Vassalli, Giulio, Ventura, Lucrezia, Verardi, Lorenzo, Vetrone, Giuseppe, Vetrugno, Elena, Visconti, Felicia, Visconti, Andrea, Viviani, Raffaella, Zaccaria, Carmelina, Zaccone, Lorenzo, Zelano, Lorenzo, Zileri Dal Verme, Giuseppe, Zuccalà, Candelli, Marcello (ORCID:0000-0001-8443-7880), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Valeria, Abbate, Giovanni, Addolorato (ORCID:0000-0002-1522-9946), Fabiana, Agostini, Elena, Ainora Maria, Karim, Akacha, Elena, Amato, Francesca, Andreani, Gloria, Andriollo, Giuseppina, Annetta Maria (ORCID:0000-0001-7574-1311), Eleonora, Annicchiarico Brigida, Gabriele, Antonucci, Alessandro, Armuzzi (ORCID:0000-0003-1572-0118), Fabiana, Baldi, Ilaria, Barattucci, Christian, Barillaro, Alfonso, Bellantone Rocco Domenico (ORCID:0000-0002-0844-3469), Giuseppe, Bello (ORCID:0000-0003-2648-7235), Andrea, Benicchi, Francesca, Benvenuto, Ludovica, Berardini, Filippo, Berloco, Roberto, Bernabei (ORCID:0000-0002-9197-004X), Antonio, Bianchi, Guerino, Biasucci Daniele, Marzio, Biasucci Luigi (ORCID:0000-0002-6921-6497), Alessandra, Bini, Federico, Biscetti (ORCID:0000-0001-7449-657X), Grazia, Bocci Maria, Filippo, Bongiovanni, Alberto, Borghetti, Giulia, Bosco, Silvia, Bosello (ORCID:0000-0002-4837-447X), Vincenzo, Bove, Giulia, Bramato, Vincenzo, Brandi, Carmine, Bruno, Dario, Bruno, Chiara, Bungaro Maria, Alessandro, Buonomo, Chiara, Cambise, Giulia, Cammà, Marcello, Candelli (ORCID:0000-0001-8443-7880), Gennaro, Capalbo, Lorenzo, Capaldi, Emanuele, Capone, Esmeralda, Capristo (ORCID:0000-0002-5753-3495), Luigi, Carbone, Simone, Carelli, Angelo, Carfì, Cristiano, Caruso, Lucio, Catalano, Roberto, Cauda (ORCID:0000-0002-1498-4229), Leonardo, Cecchini Andrea, Lucia, Cerrito, Annalisa, Chiarito, Rossella, Cianci (ORCID:0000-0001-5378-8442), Marta, Cicetti, Sara, Cicchinelli, Francesca, Ciciarello, Antonella, Cingolani (ORCID:0000-0002-3793-2755), Camilla, Cipriani Maria, Ludovica, Consalvo Maria, Gaetano, Coppola, Maria, Corbo Giuseppe (ORCID:0000-0002-8104-4659), Andrea, Corsello, Federico, Costante, Marcello, Covino (ORCID:0000-0002-6709-2531), Stefano, D’Addio, Alessia, D’Alessandro, Elena, D’alfonso Maria, Emanuela, D’Angelo, Fernando, Damiano (ORCID:0000-0003-0960-0232), De Tommaso, Cunzo, de Katleen, Gaetano Donati, De Giulio, Luca, De Giuseppe, Matteis, De Gennaro, Pascale (ORCID:0000-0002-8255-0676), Luca, Grieco Domenico (ORCID:0000-0002-4557-6308), Gianluca, Ianiro (ORCID:0000-0002-8318-0515), Emanuele, Marzetti (ORCID:0000-0001-9567-6983), Luca, Miele (ORCID:0000-0003-3464-0068), Luca, Montini (ORCID:0000-0003-4602-5134), Luca, Richeldi (ORCID:0000-0001-8594-1448), Emanuele, Rinninella (ORCID:0000-0002-9165-2367), Claudio, Sandroni (ORCID:0000-0002-8878-2611), and Franco, Scaldaferri (ORCID:0000-0001-8334-7541)

Published
2021

39. Early Procalcitonin Assessment in the Emergency Department in Patients with Intra-Abdominal Infection: An Excess or a Need?

Author

Covino, Marcello, Fransvea, Pietro, Rosa, Fausto, Cozza, Valerio, Quero, Giuseppe, Simeoni, Benedetta, Gasbarrini, Antonio, Alfieri, Sergio, Franceschi, Francesco, Sganga, Gabriele, Covino, Marcello (ORCID:0000-0002-6709-2531), Fransvea, Pietro (ORCID:0000-0003-4969-3373), Rosa, Fausto (ORCID:0000-0002-7280-8354), Quero, Giuseppe (ORCID:0000-0002-0001-9479), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Alfieri, Sergio (ORCID:0000-0002-0404-724X), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Sganga, Gabriele (ORCID:0000-0001-5079-0395), Covino, Marcello, Fransvea, Pietro, Rosa, Fausto, Cozza, Valerio, Quero, Giuseppe, Simeoni, Benedetta, Gasbarrini, Antonio, Alfieri, Sergio, Franceschi, Francesco, Sganga, Gabriele, Covino, Marcello (ORCID:0000-0002-6709-2531), Fransvea, Pietro (ORCID:0000-0003-4969-3373), Rosa, Fausto (ORCID:0000-0002-7280-8354), Quero, Giuseppe (ORCID:0000-0002-0001-9479), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Alfieri, Sergio (ORCID:0000-0002-0404-724X), Franceschi, Francesco (ORCID:0000-0001-6266-445X), and Sganga, Gabriele (ORCID:0000-0001-5079-0395)

Abstract

Background: Intra-abdominal infection (IAI) is a wide range of intra-abdominal disease. Management involves empirical therapy and source control. Procalcitonin (PCT) has been suggested to assist in defining individual infection status and delivering individualized therapy. The aim of this study was to investigate the effects on patient outcomes of an early procalcitonin (PCT) assessment (in the emergency department [ED]) in patients with IAI.Methods: This was a retrospective, mono-centric study evaluating consecutive patients admitted to the ED from 2015 to 2019 with diagnosis of IAI. According to whether there had been PCT determination in the ED, patients were divided into no ePCT determination (no-ePCT) and early PCT determination in the ED (ePCT). The primary endpoint was the intra-hospital mortality rate. Secondary endpoints were occurrence of major complications and length of hospital stay (LOS). The propensity score match (PSM) was generated using a logistic regression model on the baseline covariates considered to be potentially influencing the decision to determine PCT in the ED and confounding factors identified as significant at a preliminary statistical analysis with respect to in-hospital death.Results: A series of 3,429 patients were included. The ePCT group consisted to 768 (22.4%), whereas the no-ePCT group contained 2,661 patients (77.6%). When the PSM was matched to the two groups, no significant difference was observed. Considering patients with uncomplicated infections, the PCT determination was associated with a higher mortality rate. We found no significant differences regarding outcomes with the exception of LOS, which was slightly longer in the ePCT group. However, we observed a tendency toward a minor difference in the number of complications in the ePCT group, in particular a reduced rate of progression to sepsis.Conclusion: Early PCT determination could be irrelevant in IAIs. The PCT value may be cost-effective and possibly improve the pro

Published
2021

40. Management of acute cholecystitis in elderly patients: A propensity score-matched analysis of surgical vs. medical treatment

Author

Rosa, Fausto, Covino, Marcello, Cozza, Valerio, Fransvea, Pietro, Quero, Giuseppe, Fiorillo, Claudio, Simeoni, Benedetta, Sganga, Gabriele, Gasbarrini, Antonio, Franceschi, Francesco, Alfieri, Sergio, Rosa, Fausto (ORCID:0000-0002-7280-8354), Covino, Marcello (ORCID:0000-0002-6709-2531), Fransvea, Pietro (ORCID:0000-0003-4969-3373), Quero, Giuseppe (ORCID:0000-0002-0001-9479), Fiorillo, Claudio (ORCID:0000-0001-7681-3567), Sganga, Gabriele (ORCID:0000-0001-5079-0395), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Alfieri, Sergio (ORCID:0000-0002-0404-724X), Rosa, Fausto, Covino, Marcello, Cozza, Valerio, Fransvea, Pietro, Quero, Giuseppe, Fiorillo, Claudio, Simeoni, Benedetta, Sganga, Gabriele, Gasbarrini, Antonio, Franceschi, Francesco, Alfieri, Sergio, Rosa, Fausto (ORCID:0000-0002-7280-8354), Covino, Marcello (ORCID:0000-0002-6709-2531), Fransvea, Pietro (ORCID:0000-0003-4969-3373), Quero, Giuseppe (ORCID:0000-0002-0001-9479), Fiorillo, Claudio (ORCID:0000-0001-7681-3567), Sganga, Gabriele (ORCID:0000-0001-5079-0395), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), and Alfieri, Sergio (ORCID:0000-0002-0404-724X)

Abstract

Background: Acute cholecystitis (AC) is a life-threatening emergency in elderly patients. Aims: To compare the commonly used management strategies for elderly patients with AC as well as resulting morbidity, mortality and length of hospital stay (LOS). Methods: All patients ≥ 65 years admitted to our emergency department for AC between January 1st, 2014 and December 31st, 2018 were included in the study. We compared patients that received medical treatment to patients who received operative procedures. In order to correct for baseline covariates and factors associated to clinical management, we used a 1:1 propensity score matching (PSM) analysis. The primary outcome was the overall in-hospital mortality. Secondary outcomes included occurrence of major complications and LOS. Results: A total of 1075 patients were enrolled: 483 patients received a medical treatment and 592 patients underwent interventional procedures. After PSM, 770 patients (385 for each treatment group) were included in the analysis. The analysis revealed that both mortality and cumulative major complications were similar in medical and interventional group. We found that among comorbidities, Charlson comorbidity index and congestive heart failure were significantly higher in the medical treatment group (5 [4-6] vs. 4 [3-6] and 11.7% vs. 4.7%, respectively; p<0.001). LOS was slightly lower in the medical treatment group (7.0 days [4.9-11.1] vs. 7.9 [4.9-13.5]; p = 0.046). Conclusion: Medical management outcomes for AC in elderly patients were similar to operative treatments in terms of mortality and cumulative major complications. A conservative approach should always be considered.

Published
2021

41. Lactobacillus Reuteri DSM 17938 (Limosilactobacillus reuteri) in Diarrhea and Constipation: Two Sides of the Same Coin?

Author

Saviano, Angela, Brigida, Mattia, Migneco, Alessio, Gunawardena, Gayani, Zanza, Christian, Candelli, Marcello, Franceschi, Francesco, Ojetti, Veronica, Saviano, Angela (ORCID:0000-0002-2820-7180), Candelli, Marcello (ORCID:0000-0001-8443-7880), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Ojetti, Veronica (ORCID:0000-0002-8953-0707), Saviano, Angela, Brigida, Mattia, Migneco, Alessio, Gunawardena, Gayani, Zanza, Christian, Candelli, Marcello, Franceschi, Francesco, Ojetti, Veronica, Saviano, Angela (ORCID:0000-0002-2820-7180), Candelli, Marcello (ORCID:0000-0001-8443-7880), Franceschi, Francesco (ORCID:0000-0001-6266-445X), and Ojetti, Veronica (ORCID:0000-0002-8953-0707)

Abstract

Background and Objectives: Lactobacillus reuteri DSM 17938 (L. reuteri) is a probiotic that can colonize different human body sites, including primarily the gastrointestinal tract, but also the urinary tract, the skin, and breast milk. Literature data showed that the administration of L. reuteri can be beneficial to human health. The aim of this review was to summarize current knowledge on the role of L. reuteri in the management of gastrointestinal symptoms, abdominal pain, diarrhea and constipation, both in adults and children, which are frequent reasons for admission to the emergency department (ED), in order to promote the best selection of probiotic type in the treatment of these uncomfortable and common symptoms. Materials and Methods: We searched articles on PubMed(R) from January 2011 to January 2021. Results: Numerous clinical studies suggested that L. reuteri may be helpful in modulating gut microbiota, eliminating infections, and attenuating the gastrointestinal symptoms of enteric colitis, antibiotic-associated diarrhea (also related to the treatment of Helicobacter pylori (HP) infection), irritable bowel syndrome, inflammatory bowel disease, and chronic constipation. In both children and in adults, L. reuteri shortens the duration of acute infectious diarrhea and improves abdominal pain in patients with colitis or inflammatory bowel disease. It can ameliorate dyspepsia and symptoms of gastritis in patients with HP infection. Moreover, it improves gut motility and chronic constipation. Conclusion: Currently, probiotics are widely used to prevent and treat numerous gastrointestinal disorders. In our opinion, L. reuteri meets all the requirements to be considered a safe, well-tolerated, and efficacious probiotic that is able to contribute to the beneficial effects on gut-human health, preventing and treating many gastrointestinal symptoms, and speeding up the recovery and discharge of patients accessing the emergency department.

Published
2021

42. Letter: prevalence and patterns of gastrointestinal symptoms in a large Western cohort of patients with COVID-19

Author

Ianiro, Gianluca, Porcari, Serena, Settanni, Carlo Romano, Bibbo', Stefano, Ponziani, Francesca Romana, Zileri Dal Verme, Lorenzo, Franceschi, Francesco, Cammarota, Giovanni, Gasbarrini, Antonio, Miele, Luca, Bosello, Silvia Laura, Gemelli against COVID-19 Working, Group, Ianiro, Gianluca (ORCID:0000-0002-8318-0515), Ponziani, Francesca Romana (ORCID:0000-0002-5924-6238), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Cammarota, Giovanni (ORCID:0000-0002-3626-6148), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Miele, Luca (ORCID:0000-0003-3464-0068), Bosello, Silvia (ORCID:0000-0002-4837-447X), Ianiro, Gianluca, Porcari, Serena, Settanni, Carlo Romano, Bibbo', Stefano, Ponziani, Francesca Romana, Zileri Dal Verme, Lorenzo, Franceschi, Francesco, Cammarota, Giovanni, Gasbarrini, Antonio, Miele, Luca, Bosello, Silvia Laura, Gemelli against COVID-19 Working, Group, Ianiro, Gianluca (ORCID:0000-0002-8318-0515), Ponziani, Francesca Romana (ORCID:0000-0002-5924-6238), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Cammarota, Giovanni (ORCID:0000-0002-3626-6148), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Miele, Luca (ORCID:0000-0003-3464-0068), and Bosello, Silvia (ORCID:0000-0002-4837-447X)

Abstract

LINKED CONTENT This article is linked to Tian et al and Tian and Rong papers. To view these articles, visit https://doi.org/10.1111/apt.15731 and https://doi.org/10.1111/apt.15986

Published
2020

43. Novel biomarkers to assess the risk for acute coronary syndrome: beyond troponins

Author

Piccioni, Andrea, Valletta, Federico, Zanza, Christian, Esperide, Alessandra, Franceschi, Francesco, Franceschi, Francesco (ORCID:0000-0001-6266-445X), Piccioni, Andrea, Valletta, Federico, Zanza, Christian, Esperide, Alessandra, Franceschi, Francesco, and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

Abstract

Current diagnostic biomarkers for ACS are mainly represented by troponin I and troponin T. Dosing of these two molecules often leads to false positive results, since their plasma levels can increase in several different systemic settings. Therefore, identification of new markers able to detect patients with acute coronary syndromes is an emerging priority. On this view, many studies have been performed on different microRNAs, mitochondrial peptides, inflammatory cytokines and adhesion molecules with very promising results. Besides their introduction in screening programs, further studies are now needed in the acute setting, beyond or in association with troponin levels. This will help to better discriminate the real occurrence of an ACS in many patients accessing the emergency department for chest pain.

Published
2020

44. COVID-19 and intestinal inflammation: Role of fecal calprotectin

Author

Ojetti, Veronica, Saviano, Angela, Covino, Marcello, Acampora, Nicola, Troiani, Eliana, Franceschi, Francesco, Bosello, Silvia Laura, GEMELLI AGAINST COVID‐19, Group, Ojetti, Veronica (ORCID:0000-0002-8953-0707), Saviano, Angela (ORCID:0000-0002-2820-7180), Covino, Marcello (ORCID:0000-0002-6709-2531), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Bosello, Silvia (ORCID:0000-0002-4837-447X), Ojetti, Veronica, Saviano, Angela, Covino, Marcello, Acampora, Nicola, Troiani, Eliana, Franceschi, Francesco, Bosello, Silvia Laura, GEMELLI AGAINST COVID‐19, Group, Ojetti, Veronica (ORCID:0000-0002-8953-0707), Saviano, Angela (ORCID:0000-0002-2820-7180), Covino, Marcello (ORCID:0000-0002-6709-2531), Franceschi, Francesco (ORCID:0000-0001-6266-445X), and Bosello, Silvia (ORCID:0000-0002-4837-447X)

Abstract

N/a

Published
2020

45. Electrocardiographic Findings and Clinical Outcome in Patients with COVID-19 or Other Acute Infectious Respiratory Diseases

Author

De Vita, Antonio, Ravenna, Salvatore Emanuele, Covino, Marcello, Lanza, Oreste, Franceschi, Francesco, Crea, Filippo, Lanza, Gaetano Antonio, Covino, Marcello (ORCID:0000-0002-6709-2531), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Crea, Filippo (ORCID:0000-0001-9404-8846), Lanza, Gaetano Antonio (ORCID:0000-0003-2187-6653), De Vita, Antonio, Ravenna, Salvatore Emanuele, Covino, Marcello, Lanza, Oreste, Franceschi, Francesco, Crea, Filippo, Lanza, Gaetano Antonio, Covino, Marcello (ORCID:0000-0002-6709-2531), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Crea, Filippo (ORCID:0000-0001-9404-8846), and Lanza, Gaetano Antonio (ORCID:0000-0003-2187-6653)

Abstract

Background: Cardiac involvement in coronavirus SARS-CoV-2 infection (COVID-19) has been reported in a sizeable proportion of patients and associated with a negative outcome; furthermore, a pre-existing heart disease is associated with increased mortality in these patients. In this prospective single-center case-control study we investigated whether COVID-19 patients present different rates and clinical implications of an abnormal electrocardiogram (ECG) compared to patients with an acute infectious respiratory disease (AIRD) caused by other pathogens. Methods: We studied 556 consecutive patients admitted to the emergency department of our hospital with symptoms of AIRD; 324 were diagnosed to have COVID-19 and 232 other causes of AIRD (no-COVID-19 group). Standard 12-lead ECG performed on admission was assessed for various kinds of abnormalities, including ST segment/T wave changes, atrial fibrillation, ventricular arrhythmias, and intraventricular conduction disorders. Results: ECG abnormalities were found in 120 (37.0%) and 101 (43.5%) COVID-19 and no-COVID-19 groups, respectively (p = 0.13). No differences in ECG abnormalities were found between the 2 groups after adjustment for clinical and laboratory variables. During a follow-up of 45 ± 16 days, 51 deaths (15.7%) occurred in the COVID-19 and 30 (12.9%) in the no-COVID-19 groups (p = 0.39). ST segment depression ≥ 0.5 mm (p = 0.016), QRS duration (p = 0.016) and presence of any ECG abnormality (p = 0.027) were independently associated with mortality at multivariable Cox regression analysis. Conclusion: Among patients hospitalized because of AIRD, we found no significant differences in abnormal ECG findings between COVID-19 vs. no-COVID-19 patients. The ECG on admission was helpful to identify patients with increased risk of death in both groups of patients.

Published
2020

46. Acute Diverticulitis in Elderly Patients: Does Age Really Matter?

Author

Covino, Marcello, Rosa, Fausto, Ojetti, Veronica, Quero, Giuseppe, Fiorillo, Claudio, Sganga, Gabriele, Gasbarrini, Antonio, Franceschi, Francesco, Alfieri, Sergio, Covino, Marcello (ORCID:0000-0002-6709-2531), Rosa, Fausto (ORCID:0000-0002-7280-8354), Ojetti, Veronica (ORCID:0000-0002-8953-0707), Quero, Giuseppe (ORCID:0000-0002-0001-9479), Fiorillo, Claudio (ORCID:0000-0001-7681-3567), Sganga, Gabriele (ORCID:0000-0001-5079-0395), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Alfieri, Sergio (ORCID:0000-0002-0404-724X), Covino, Marcello, Rosa, Fausto, Ojetti, Veronica, Quero, Giuseppe, Fiorillo, Claudio, Sganga, Gabriele, Gasbarrini, Antonio, Franceschi, Francesco, Alfieri, Sergio, Covino, Marcello (ORCID:0000-0002-6709-2531), Rosa, Fausto (ORCID:0000-0002-7280-8354), Ojetti, Veronica (ORCID:0000-0002-8953-0707), Quero, Giuseppe (ORCID:0000-0002-0001-9479), Fiorillo, Claudio (ORCID:0000-0001-7681-3567), Sganga, Gabriele (ORCID:0000-0001-5079-0395), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Franceschi, Francesco (ORCID:0000-0001-6266-445X), and Alfieri, Sergio (ORCID:0000-0002-0404-724X)

Published
2020

47. Lung ultrasonography for early management of patients with respiratory symptoms during COVID-19 pandemic

Author

Smargiassi, Andrea, Soldati, Gino, Borghetti, Alberto, Scoppettuolo, Giancarlo, Tamburrini, Enrica, Testa, Antonia Carla, Moro, Francesca, Natale, Luigi, Larici, Anna Rita, Buonsenso, Danilo, Valentini, Piero, Draisci, Gaetano, Zanfini, Bruno Antonio, Pompili, Maurizio, Scambia, Giovanni, Lanzone, Antonio, Franceschi, Francesco, Rapaccini, Gian Ludovico, Gasbarrini, Antonio, Giorgini, Paolo, Richeldi, Luca, Demi, Libertario, Inchingolo, Riccardo, Tamburrini, Enrica (ORCID:0000-0003-4930-426X), Testa, Antonia Carla (ORCID:0000-0003-2217-8726), Natale, Luigi (ORCID:0000-0002-7949-5119), Larici, Anna Rita (ORCID:0000-0002-1882-6244), Valentini, Piero (ORCID:0000-0001-6095-9510), Draisci, Gaetano (ORCID:0000-0003-0148-5073), Pompili, Maurizio (ORCID:0000-0001-6699-7980), Scambia, Giovanni (ORCID:0000-0003-2758-1063), Lanzone, Antonio (ORCID:0000-0003-4119-414X), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Rapaccini, Gian Ludovico (ORCID:0000-0002-6467-857X), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), Richeldi, Luca (ORCID:0000-0001-8594-1448), Smargiassi, Andrea, Soldati, Gino, Borghetti, Alberto, Scoppettuolo, Giancarlo, Tamburrini, Enrica, Testa, Antonia Carla, Moro, Francesca, Natale, Luigi, Larici, Anna Rita, Buonsenso, Danilo, Valentini, Piero, Draisci, Gaetano, Zanfini, Bruno Antonio, Pompili, Maurizio, Scambia, Giovanni, Lanzone, Antonio, Franceschi, Francesco, Rapaccini, Gian Ludovico, Gasbarrini, Antonio, Giorgini, Paolo, Richeldi, Luca, Demi, Libertario, Inchingolo, Riccardo, Tamburrini, Enrica (ORCID:0000-0003-4930-426X), Testa, Antonia Carla (ORCID:0000-0003-2217-8726), Natale, Luigi (ORCID:0000-0002-7949-5119), Larici, Anna Rita (ORCID:0000-0002-1882-6244), Valentini, Piero (ORCID:0000-0001-6095-9510), Draisci, Gaetano (ORCID:0000-0003-0148-5073), Pompili, Maurizio (ORCID:0000-0001-6699-7980), Scambia, Giovanni (ORCID:0000-0003-2758-1063), Lanzone, Antonio (ORCID:0000-0003-4119-414X), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Rapaccini, Gian Ludovico (ORCID:0000-0002-6467-857X), Gasbarrini, Antonio (ORCID:0000-0002-7278-4823), and Richeldi, Luca (ORCID:0000-0001-8594-1448)

Abstract

COVID-19 pandemic is representing a serious challenge to worldwide public health. Lung Ultrasonography (LUS) has been signaled as a potential useful tool in this pandemic contest either to intercept viral pneumonia or to foster alternative paths. LUS could be useful in determining early lung involvement suggestive or not of COVID-19 pneumonia and potentially plays a role in managing decisions for hospitalization in isolation or admission in general ward. In order to face pandemic, in a period in which a large number of emergency room accesses with suspicious symptoms are expected, physicians need a standardized ultrasonographic approach, fast educational processes in order to be able to recognize both suggestive and not suggestive echographic signs and shared algorithms for LUS role in early management of patients.

Published
2020

48. A 12-year retrospective analysis of differences between elderly and oldest old patients referred to the emergency department of a large tertiary hospital

Author

Covino, Marcello, Petruzziello, Carmine, Onder, Graziano, Migneco, Alessio, Simeoni, Benedetta, Franceschi, Francesco, Ojetti, Veronica, Covino, Marcello (ORCID:0000-0002-6709-2531), Onder, Graziano (ORCID:0000-0003-3400-4491), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Ojetti, Veronica (ORCID:0000-0002-8953-0707), Covino, Marcello, Petruzziello, Carmine, Onder, Graziano, Migneco, Alessio, Simeoni, Benedetta, Franceschi, Francesco, Ojetti, Veronica, Covino, Marcello (ORCID:0000-0002-6709-2531), Onder, Graziano (ORCID:0000-0003-3400-4491), Franceschi, Francesco (ORCID:0000-0001-6266-445X), and Ojetti, Veronica (ORCID:0000-0002-8953-0707)

Abstract

Objectives: Globally, the average age of the population is increasing. Patients aged >65 years attending hospital emergency departments (EDs) differ from younger patients; in particular, they often present with multiple comorbidities. Our retrospective study evaluates the number of attendances at our ED by elderly patients in the 12 years from January 2005 to December 2017. Our first aim was to evaluate differences presented by elderly patients regarding symptoms, clinical features, color code (i.e. priority assigned to the case, where red is highest and yellow is medium), waiting time and outcome. Patients and methods: We analyzed data from 201,580 patients aged >65, divided into two groups: 65–84 years and >85 years. Clinical and demographic data were collected from the computerized clinical record (GIPSE®). Results: 201,580 patients fulfilled the inclusion criteria, of whom 93,262 (46.3%) were male. There were 162,373 patients aged 65–84, and 39,207 aged >85. Patients aged >85 presented more complex cases, and were admitted more frequently with a red color code and were more frequently hospitalized. Larger proportions of this group had dementia, and attended the ED for trauma or gastrointestinal bleeding. The group aged 65–84 were admitted more frequently with a yellow color code and then discharged. They typically attended the ED for chest and abdominal pain. Conclusion: There is an increase in the request for health care especially in an emergency setting. The hospitalization of elderly patients is associated with a deterioration in motor skills and quality of life. Being able to reduce hospitalization in the elderly means avoiding disruption to the home care of people with dementia, and reducing both the risk of falls and hospital infections. In Italy, a program (as already experimented with in the USA) dedicated to the elderly who attend hospital EDs is desirable.

Published
2019

49. Acute pancreatitis in elderly patients: a single-center retrospective evaluation of clinical outcomes

Author

Quero, Giuseppe, Covino, Marcello, Fiorillo, Claudio, Rosa, Fausto, Menghi, Roberta, Simeoni, Benedetta, Potenza, Annalisa, Ojetti, Veronica, Alfieri, Sergio, Franceschi, Francesco, Quero, Giuseppe (ORCID:0000-0002-0001-9479), Covino, Marcello (ORCID:0000-0002-6709-2531), Fiorillo, Claudio (ORCID:0000-0001-7681-3567), Rosa, Fausto (ORCID:0000-0002-7280-8354), Ojetti, Veronica (ORCID:0000-0002-8953-0707), Alfieri, Sergio (ORCID:0000-0002-0404-724X), Franceschi, Francesco (ORCID:0000-0001-6266-445X), Quero, Giuseppe, Covino, Marcello, Fiorillo, Claudio, Rosa, Fausto, Menghi, Roberta, Simeoni, Benedetta, Potenza, Annalisa, Ojetti, Veronica, Alfieri, Sergio, Franceschi, Francesco, Quero, Giuseppe (ORCID:0000-0002-0001-9479), Covino, Marcello (ORCID:0000-0002-6709-2531), Fiorillo, Claudio (ORCID:0000-0001-7681-3567), Rosa, Fausto (ORCID:0000-0002-7280-8354), Ojetti, Veronica (ORCID:0000-0002-8953-0707), Alfieri, Sergio (ORCID:0000-0002-0404-724X), and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

Abstract

INTRODUCTION: Acute pancreatitis (AP) incidence in the elderly population has increased in the last years. However, the role of age as influencing factor on the AP clinical course is still debated. METHODS: We reviewed clinical records of consecutive patients admitted with diagnosis of AP. Patients were divided in elderly (≥65 years) and non-elderly (<65 years). Primary endpoint was comparison of overall mortality. Secondary endpoint included ICU admission, in-hospital length of stay (LOS) and surgical procedures. RESULTS: We enrolled 352 elderly and 532 non-elderly patients. A higher mortality rate (7.4% vs 1.9%; p < .001), ICU admission rate (18.9% vs 6.3%; p < .001) and prolonged length of hospital stay (9 (6-14) vs 7 (5-11.7) days; p = .01) were registered in the ≥65 years group. Multivariate analysis identified age (OR: 3.5; 95% CI:1.645-7.555; p = .001), a higher Ranson score at admission (OR: 5.52; 95% CI:1.11-27.41; p<.001) and necrotic pancreatitis (OR: 8.6; 95% CI:2.46-30.27; p = .001) as independent predictors of mortality. Conversely age and necrotic pancreatitis were independent risk factors for higher LOS and ICU admission. CONCLUSIONS: Patients with AP and age ≥65 years have a higher mortality, ICU admission and prolonged LOS. Early recognition and prompt treatment are key elements to improve outcomes in this population.

Published
2019

50. Use of oral anticoagulant drugs in older patients with atrial fibrillation in internal medicine wards

Author

Proietti, Marco, Antoniazzi, Stefania, Monzani, Valter, Santalucia, Paola, Franchi, Carlotta, Fenoglio, Luigi M., Melchio, Remo, Fabris, Fabrizio, Sartori, Maria Teresa, Manfredini, Roberto, De Giorgi, Alfredo, Fabbian, Fabio, Biolo, Gianni, Zanetti, Michela, Altamura, Nicola, Sabbà, Carlo, Suppressa, Patrizia, Bandiera, Francesco, Usai, Carlo, Murialdo, Giovanni, Fezza, Francesca, Marra, Alessio, Castelli, Francesca, Cattaneo, Federico, Beccati, Valentina, di Minno, Giovanni, Tufano, Antonella, Contaldi, Paola, Lupattelli, Graziana, Bianconi, Vanessa, Cappellini, Domenica, Hu, Cinzia, Minonzio, Francesca, Fargion, Silvia, Burdick, Larry, Francione, Paolo, Peyvandi, Flora, Rossio, Raffaella, Colombo, Giulia, Ceriani, Giuliana, Lucchi, Tiziano, Brignolo, Barbara, Manfellotto, Dario, Caridi, Irene, Corazza, Gino Roberto, Miceli, Emanuela, Padula, Donatella, Fraternale, Giacomo, Guasti, Luigina, Squizzato, Alessandro, Maresca, Andrea, Liberato, Nicola Lucio, Tognin, Tiziana, Rozzini, Renzo, Bellucci, Francesco Baffa, Muscaritoli, Maurizio, Molfino, Alessio, Petrillo, Enrico, Dore, Maurizio, Mete, Francesca, Gino, Miriam, Franceschi, Francesco, Gabrielli, Maurizio, Perticone, Francesco, Perticone, Maria, Bertolotti, Marco, Mussi, Chiara, Borghi, Claudio, Strocchi, Enrico, Durazzo, Marilena, Fornengo, Paolo, Dallegri, Franco, Ottonello, Luciano Carlo, Salam, Kassem, Caserza, Lara, Barbagallo, Mario, Di Bella, Giovanna, Annoni, Giorgio, Bruni, Adriana Antonella, Odetti, Patrizio, Nencioni, Alessio, Monacelli, Fiammetta, Napolitano, Armando, Brucato, Antonio, Valenti, Anna, Castellino, Pietro, Zanoli, Luca, Mazzeo, Marco, Franceschi, Francesco (ORCID:0000-0001-6266-445X), Proietti, Marco, Antoniazzi, Stefania, Monzani, Valter, Santalucia, Paola, Franchi, Carlotta, Fenoglio, Luigi M., Melchio, Remo, Fabris, Fabrizio, Sartori, Maria Teresa, Manfredini, Roberto, De Giorgi, Alfredo, Fabbian, Fabio, Biolo, Gianni, Zanetti, Michela, Altamura, Nicola, Sabbà, Carlo, Suppressa, Patrizia, Bandiera, Francesco, Usai, Carlo, Murialdo, Giovanni, Fezza, Francesca, Marra, Alessio, Castelli, Francesca, Cattaneo, Federico, Beccati, Valentina, di Minno, Giovanni, Tufano, Antonella, Contaldi, Paola, Lupattelli, Graziana, Bianconi, Vanessa, Cappellini, Domenica, Hu, Cinzia, Minonzio, Francesca, Fargion, Silvia, Burdick, Larry, Francione, Paolo, Peyvandi, Flora, Rossio, Raffaella, Colombo, Giulia, Ceriani, Giuliana, Lucchi, Tiziano, Brignolo, Barbara, Manfellotto, Dario, Caridi, Irene, Corazza, Gino Roberto, Miceli, Emanuela, Padula, Donatella, Fraternale, Giacomo, Guasti, Luigina, Squizzato, Alessandro, Maresca, Andrea, Liberato, Nicola Lucio, Tognin, Tiziana, Rozzini, Renzo, Bellucci, Francesco Baffa, Muscaritoli, Maurizio, Molfino, Alessio, Petrillo, Enrico, Dore, Maurizio, Mete, Francesca, Gino, Miriam, Franceschi, Francesco, Gabrielli, Maurizio, Perticone, Francesco, Perticone, Maria, Bertolotti, Marco, Mussi, Chiara, Borghi, Claudio, Strocchi, Enrico, Durazzo, Marilena, Fornengo, Paolo, Dallegri, Franco, Ottonello, Luciano Carlo, Salam, Kassem, Caserza, Lara, Barbagallo, Mario, Di Bella, Giovanna, Annoni, Giorgio, Bruni, Adriana Antonella, Odetti, Patrizio, Nencioni, Alessio, Monacelli, Fiammetta, Napolitano, Armando, Brucato, Antonio, Valenti, Anna, Castellino, Pietro, Zanoli, Luca, Mazzeo, Marco, and Franceschi, Francesco (ORCID:0000-0001-6266-445X)

Abstract

Atrial fibrillation (AF) is independently associated with a higher risk of morbidity and mortality, in particular with an increased risk of thromboembolic events [1]. Use of oral anticoagulant (OAC) drugs reduces the risk of stroke and systemic embolism, as well as mortality among patients with AF [1]. In recent years, the non-vitamin K antagonist oral anticoagulants (NOACs) have been proved to be at least as effective and safer than warfarin, the most widely used VKA [2], such that NOACs are the recommended choice in many patients [1]. Notwithstanding, the number of untreated patients is still relevant [3]. In particular, in the clinical setting of internal medicine and geriatric wards, previous data showed that elderly hospitalized patients with AF were largely not prescribed with OAC [4] or treated in a non-guideline adherent manner [5]. After NOACs have been marketed, a significant increase in OAC uptake was recorded, but a substantial portion of patients still does not receive the appropriate treatment based on their cardioembolic risk [3,6]. In particular, scarce data are available about NOACs use in the non-cardiologic setting. Furthermore, elderly AF patients are less likely prescribed with OAC compared to the younger ones [5,7], even though the net clinical benefit of OAC treatment in these patients has been demonstrated [8]. With the aim to provide evidences about use of OAC and NOACs in older hospitalized patients, we here report data about the retrospective observational phase of the “Simulation-Based Technologies to Improve the Appropriate Use of Oral Anticoagulants in Hospitalized Elderly Patients with Atrial Fibrillation” (SIM-AF) Trial. The SIM-AF is a cluster randomized controlled trial aimed at increasing the rate of OAC prescription in elderly (≥65 years) AF patients admitted to 32 Italian Internal Medicine and Geriatric wards through a simulation-based e-learning educational intervention (ClinicalTrials.gov #NCT03188211). In this retrospective pr

Published
2018

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