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1. Clinical Course and Risk Factors for In-Hospital Mortality of 205 Patients with SARS-CoV-2 Pneumonia in Como, Lombardy Region, Italy

Author

Mauro Turrini, Angelo Gardellini, Livia Beretta, Lucia Buzzi, Stefano Ferrario, Sabrina Vasile, Raffaella Clerici, Andrea Colzani, Luigi Liparulo, Giovanni Scognamiglio, Gianni Imperiali, Giovanni Corrado, Antonello Strada, Marco Galletti, Nunzio Castiglione, and Claudio Zanon

Subjects
SARS-CoV 2, coronavirus disease 2019, pneumonia, therapy, treatment, mortality, Medicine
Abstract

The aim of this study is to explore risk factors for in-hospital mortality and describe the effectiveness of different treatment strategies of 205 laboratory-confirmed cases infected with SARS-CoV-2 during the Lombardy outbreak. All patients received the best supportive care and specific interventions that included the main drugs being tested for repurposing to treat COVID-19, such as hydroxychloroquine, anticoagulation and antiviral drugs, steroids, and interleukin-6 pathway inhibitors. Clinical, laboratory, and treatment characteristics were analyzed with univariate and multivariate logistic regression methods to explore their impact on in-hospital mortality. Univariate analyses showed prognostic significance for age greater than 70 years, the presence of two or more relevant comorbidities, a P/F ratio less than 200 at presentation, elevated LDH (lactate dehydrogenase) and CRP (C-reactive protein) values, intermediate- or therapeutic-dose anticoagulation, hydroxychloroquine, early antiviral therapy with lopinavir/ritonavir, short courses of steroids, and tocilizumab therapy. Multivariable regression confirmed increasing odds of in-hospital death associated with age older than 70 years (OR 3.26) and a reduction in mortality for patients treated with anticoagulant (−0.37), antiviral lopinavir/ritonavir (−1.22), or steroid (−0.59) therapy. In contrast, hydroxychloroquine and tocilizumab have not been confirmed to have a significant effect in the treatment of SARS-CoV-2 pneumonia. Results from this real-life single-center experience are in agreement and confirm actual literature data on SARS-CoV-2 pneumonia in terms of both clinical risk factors for in-hospital mortality and the effectiveness of the different therapies proposed for the management of COVID19 disease.

Published
2021
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2. Clinical Course and Risk Factors for In-Hospital Mortality of 205 Patients with SARS-CoV-2 Pneumonia in Como, Lombardy Region, Italy

Author

Nunzio Castiglione, Luigi Liparulo, Mauro Turrini, Sabrina Vasile, Gianni Imperiali, Claudio Zanon, Angelo Gardellini, Raffaella Clerici, Marco Galletti, Antonella Strada, Giovanni Corrado, Lucia Buzzi, Livia Beretta, Andrea Colzani, Giovanni Scognamiglio, and Stefano Ferrario

Subjects
medicine.medical_specialty, Immunology, Disease, 030204 cardiovascular system & hematology, Logistic regression, SARS-CoV 2, coronavirus disease 2019, pneumonia, therapy, treatment, mortality, risk factors, Article, law.invention, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Tocilizumab, Randomized controlled trial, law, Statistical significance, Internal medicine, Drug Discovery, medicine, Pharmacology (medical), 030212 general & internal medicine, Pharmacology, Univariate analysis, business.industry, Hydroxychloroquine, Lopinavir, Odds ratio, medicine.disease, Pneumonia, Infectious Diseases, chemistry, Cohort, Medicine, Ritonavir, business, medicine.drug
Abstract

ImportanceWith randomized clinical trials ongoing and vaccine still a long distance away, efforts to repurpose old medications used for other diseases provide hope for the treatment of COVID-19ObjectivesTo examine the risk factors for in-hospital mortality and describe the effectiveness of different treatment strategies in a real-life setting of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia.DesignReal-life single-center study during the Lombardy COVID-19 outbreak.SettingValduce Hospital in Como, Lombardy Region, Italy.Participants205 laboratory-confirmed patients presenting with SARS-Cov-2 pneumonia requiring hospitalization.InterventionsAll patients received best supportive care and, based on their clinical needs and comorbidities, specific interventions that included the main drugs being tested for repurposing to treat COVID-19, such as hydroxychloroquine, anticoagulation, antiviral drugs, steroids or interleukin-6 pathway inhibitors.Main outcomes and measuresClinical, laboratory and treatment characteristics were analyzed with univariate and multivariate logistic regression methods to explore their impact on in-hospital mortality and compared with current literature data.ResultsUnivariate analyses for clinical variables showed prognostic significance for age equal or greater than 70 years (estimated 28-days survival: 21.4 vs 67.4%; pConclusions and RelevanceResults from this real-life single-center experience are in agreement and confirm actual literature data on SARS-CoV-2 pneumonia, both in terms of clinical risk factors for in-hospital mortality and as regards the effectiveness of the different therapies proposed for the management of COVID-19 disease. Waiting the results from randomized clinical trials, these data could help clinicians to identify patients with poor prognosis at an early stage and guide the choice between the different treatments implied in COVID-19 disease.KEY POINTSQuestionAmong the main drugs that have been tested for repurposing to treat COVID-19, what are the most effective medical treatments for SARS-CoV-2 pneumonia?FindingsResults from these real-life cohort of 205 patients confirm at multivariate regression model an increasing odds of in-hospital death associated with age older than 70 years (OR 3.26) and a reduction in mortality for patients treated with anticoagulant (OR −0.37), antiviral lopinavir/ritonavir (OR −1.22), or steroids therapy (OR −0.59). In contrast, hydroxychloroquine and tocilizumab have not been confirmed to have a significant effect in the treatment of SARS-CoV-2 pneumonia, in accordance with the latest data from the international literature.MeaningWaiting the results from randomized clinical trials, these data could help clinicians to identify patients with poor prognosis at an early stage and guide the choice between the different treatments implied in COVID-19 disease.

Published
2021

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