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6. Effect of Corticosteroids on Mortality in Hospitalized COVID‐19 Patients Not Receiving Invasive Mechanical Ventilation

Author

Roberto Stellini, Antonio Rosano, Federica Fusina, Tony Sabatini, P Terragnoli, Mohammed Abu Hilal, Angelo Meloni, Filippo Albani, Giuseppe Natalini, Renzo Rozzini, Enza Granato, and Intensive care medicine

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Lower risk, 030226 pharmacology & pharmacy, Article, law.invention, 03 medical and health sciences, Sex Factors, 0302 clinical medicine, Adrenal Cortex Hormones, law, Internal medicine, medicine, Humans, Pharmacology (medical), Hospital Mortality, Prospective Studies, Prospective cohort study, Dexamethasone, Aged, Retrospective Studies, Aged, 80 and over, Pharmacology, Mechanical ventilation, SARS-CoV-2, business.industry, Research, COVID-19, Retrospective cohort study, Articles, Odds ratio, Middle Aged, Respiration, Artificial, Intensive care unit, Confidence interval, COVID-19 Drug Treatment, Intensive Care Units, 030220 oncology & carcinogenesis, Female, business, medicine.drug
Abstract

The most beneficial effect of corticosteroid therapy in COVID-19 patients has been shown in subjects receiving invasive mechanical ventilation (IMV), corresponding to a score of 6 on the World Health Organization (WHO) COVID-19 Ordinal Scale for Clinical Improvement (OSCI). The aim of this observational, single-center, prospective study was to assess the association between corticosteroids and hospital mortality in coronavirus disease 2019 (COVID-19) patients who did not receive IMV (OSCI 3-5). Included were 1,311 COVID-19 patients admitted to nonintensive care wards, and they were divided in two cohorts: (i) 480 patients who received corticosteroid therapy and (ii) 831 patients who did not. The median daily dose was of 8 mg of dexamethasone or equivalent, with a mean therapy duration of 5 (3-9) days. The indication to administer or withhold corticosteroids was given by the treating physician. In-hospital mortality was similar between the two cohorts after adjusting for possible confounders (adjusted odds ratio (ORadj) 1.04, 95% confidence interval (CI), 0.81-1.34, P = 0.74). There was also no difference in Intensive Care Unit (ICU) admission (ORadj 0.81, 95% CI, 0.56-1.17, P = 0.26). COVID-19 patients with noninvasive mechanical ventilation (NIMV) had a lower risk for ICU admission if they received steroid therapy (ORadj 0.58, 95% CI, 0.35-0.94, P = 0.03). In conclusion, corticosteroids were overall not associated with a difference in hospital mortality for patients with COVID-19 with OSCI 3-5. In the subgroup of patients with NIMV (OSCI 5), corticosteroids reduced ICU admission, whereas the effect on mortality requires further studies.

Published
2021

7. Predicting poor outcome in patients with suspected COVID-19 presenting to the Emergency Department (COVERED) - Development, internal and external validation of a prediction model

Author

K, Azijli, Awe, Lieveld, Sfb, van der Horst, N, de Graaf, R S, Kootte, M W, Heijmans, P M, van de Ven, Ejg, Peters, J, Heijmans, P, Terragnoli, G, Natalini, M, Abu Hilal, T, de Rooij, and Pwb, Nanayakkara

Subjects
SARS-CoV-2, COVID-19, Humans, Multicenter Studies as Topic, Prospective Studies, Emergency Service, Hospital, Prognosis, Netherlands, Retrospective Studies
Abstract

A recent systematic review recommends against the use of any of the current COVID-19 prediction models in clinical practice. To enable clinicians to appropriately profile and treat suspected COVID-19 patients at the emergency department (ED), externally validated models that predict poor outcome are desperately needed.Our aims were to identify predictors of poor outcome, defined as mortality or ICU admission within 30 days, in patients presenting to the ED with a clinical suspicion of COVID-19, and to develop and externally validate a prediction model for poor outcome.In this prospective, multi-center study, we enrolled suspected COVID-19 patients presenting at the EDs of two hospitals in the Netherlands. We used backward logistic regression to develop a prediction model. We used the area under the curve (AUC), Brier score and pseudo-R2 to assess model performance. The model was externally validated in an Italian cohort.We included 1193 patients between March 12 and May 27 2020, of whom 196 (16.4%) had a poor outcome. We identified 10 predictors of poor outcome: current malignancy (OR 2.774; 95%CI 1.682-4.576), systolic blood pressure (OR 0.981; 95%CI 0.964-0.998), heart rate (OR 1.001; 95%CI 0.97-1.028), respiratory rate (OR 1.078; 95%CI 1.046-1.111), oxygen saturation (OR 0.899; 95%CI 0.850-0.952), body temperature (OR 0.505; 95%CI 0.359-0.710), serum urea (OR 1.404; 95%CI 1.198-1.645), C-reactive protein (OR 1.013; 95%CI 1.001-1.024), lactate dehydrogenase (OR 1.007; 95%CI 1.002-1.013) and SARS-CoV-2 PCR result (OR 2.456; 95%CI 1.526-3.953). The AUC was 0.86 (95%CI 0.83-0.89), with a Brier score of 0.32 and, and R2 of 0.41. The AUC in the external validation in 500 patients was 0.70 (95%CI 0.65-0.75).The COVERED risk score showed excellent discriminatory ability, also in an external validation. It may aid clinical decision making, and improve triage at the ED in health care environments with high patient throughputs.

Published
2021

8. Predicting poor outcome in patients with suspected COVID-19 presenting to the Emergency Department (COVERED) - Development, internal and external validation of a prediction model

Author

Kaoutar Azijli, Giuseppe Natalini, Sfb van der Horst, J Heijmans, T de Rooij, P. M. van de Ven, Pwb Nanayakkara, P Terragnoli, M W Heijmans, Ejg Peters, M. Abu Hilal, Awe Lieveld, N. de Graaf, Ruud S. Kootte, Internal medicine, Surgery, Dermatology, Epidemiology and Data Science, APH - Methodology, APH - Personalized Medicine, AII - Infectious diseases, AMS - Rehabilitation & Development, Hematology, Anesthesiology, APH - Quality of Care, APH - Digital Health, ACS - Diabetes & metabolism, and ACS - Heart failure & arrhythmias

Subjects
medicine.medical_specialty, Framingham Risk Score, business.industry, Retrospective cohort study, General Medicine, Emergency department, Critical Care and Intensive Care Medicine, Logistic regression, Triage, Brier score, Emergency medicine, Cohort, Emergency Medicine, Internal Medicine, medicine, Prospective cohort study, business
Abstract

BACKGROUND: A recent systematic review recommends against the use of any of the current COVID-19 prediction models in clinical practice. To enable clinicians to appropriately profile and treat suspected COVID-19 patients at the emergency department (ED), externally validated models that predict poor outcome are desperately needed.OBJECTIVE: Our aims were to identify predictors of poor outcome, defined as mortality or ICU admission within 30 days, in patients presenting to the ED with a clinical suspicion of COVID-19, and to develop and externally validate a prediction model for poor outcome.METHODS: In this prospective, multi-center study, we enrolled suspected COVID-19 patients presenting at the EDs of two hospitals in the Netherlands. We used backward logistic regression to develop a prediction model. We used the area under the curve (AUC), Brier score and pseudo-R2 to assess model performance. The model was externally validated in an Italian cohort.RESULTS: We included 1193 patients between March 12 and May 27 2020, of whom 196 (16.4%) had a poor outcome. We identified 10 predictors of poor outcome: current malignancy (OR 2.774; 95%CI 1.682-4.576), systolic blood pressure (OR 0.981; 95%CI 0.964-0.998), heart rate (OR 1.001; 95%CI 0.97-1.028), respiratory rate (OR 1.078; 95%CI 1.046-1.111), oxygen saturation (OR 0.899; 95%CI 0.850-0.952), body temperature (OR 0.505; 95%CI 0.359-0.710), serum urea (OR 1.404; 95%CI 1.198-1.645), C-reactive protein (OR 1.013; 95%CI 1.001-1.024), lactate dehydrogenase (OR 1.007; 95%CI 1.002-1.013) and SARS-CoV-2 PCR result (OR 2.456; 95%CI 1.526-3.953). The AUC was 0.86 (95%CI 0.83-0.89), with a Brier score of 0.32 and, and R2 of 0.41. The AUC in the external validation in 500 patients was 0.70 (95%CI 0.65-0.75).CONCLUSION: The COVERED risk score showed excellent discriminatory ability, also in an external validation. It may aid clinical decision making, and improve triage at the ED in health care environments with high patient throughputs.

Published
2021

9. Leukocytes and creatinine may predict severity and guide management of ischemic colitis

Author

Guido De Marco, Cesare Hassan, Cristiano Spada, Paola Cesaro, Giulio Antonelli, N. Olivari, Tony Sabatini, P Terragnoli, SM Milluzzo, and Loredana Correale

Subjects
Univariate analysis, Creatinine, medicine.medical_specialty, Lower gastrointestinal bleeding, medicine.diagnostic_test, business.industry, Gastroenterology, Ischemic colitis, lower gastrointestinal bleeding, Colonoscopy, Odds ratio, medicine.disease, Confidence interval, chemistry.chemical_compound, chemistry, colonoscopy, Internal medicine, medicine, Original Article, Leukocytosis, medicine.symptom, business
Abstract

Background Ischemic colitis (IC) is caused by a transient hypo-perfusion of the colon leading to mucosal ulcerations, inflammation, and hemorrhage. The primary aim was to identify predictive factors of endoscopic severity of IC. Secondary endpoints were to show epidemiology, clinical presentation, endoscopic findings, and outcomes of IC. Methods In this single-center retrospective analysis, IC was scored according to endoscopy as: grade 1 (hyperemia, 1 cm superficial, partially confluent ulcers); and grade 3 (deep or diffuse ulcers or necrosis). Then, IC was grouped into low- (grade 1) and high-grade (grades 2 and 3). Significant (P≤0.1) independent factor of severe IC at univariate analysis were entered into multivariate analysis and considered significant at P

Published
2021

11. RISK FACTORS FOR ENDOSCOPICALLY SEVERE ISCHEMIC COLITIS (IC)

Author

SM Milluzzo, P Cesaro, N. Olivari, Cesare Hassan, Cristiano Spada, G DeMarco, and P Terragnoli

Subjects
medicine.medical_specialty, business.industry, Internal medicine, medicine, medicine.disease, business, Gastroenterology, Ischemic colitis
Published
2020

12. T06.02.12 RISK FACTORS FOR ENDOSCOPICALLY SEVERE ISCHEMIC COLITIS

Author

G. De Marco, Cesare Hassan, SM Milluzzo, P Terragnoli, N. Olivari, Paola Cesaro, and Cristiano Spada

Subjects
medicine.medical_specialty, Hepatology, business.industry, Internal medicine, Gastroenterology, Medicine, business, medicine.disease, Ischemic colitis
Published
2020

13. Three-year National report from the Gruppo Italiano di Ortogeriatria (GIOG) in the management of hip-fractured patients

Author

Ferrara, Maria Cristina, Andreano, Anita, Tassistro, Elena, Rapazzini, Piero, Zurlo, Amedeo, Volpato, Stefano, Mussi, Chiara, Corsi, Maurizio, Lunardelli, Maria Lia, Martini, Emilio, Castoldi, Giuseppe, De Filippi, Francesco, Pizzonia, Monica, Monacelli, Fiammetta, Barone, Antonella, Pilotto, Alberto, March, Albert, Ungar, Andrea, Capelli, Roberto, Galmarini, Valter, Franzoni, Simone, Terragnoli, Flavio, Bianchetti, Angelo, Cazzulani, Ilaria, Gandossi, Chiara, Valsecchi, Maria Grazia, and Bellelli, Giuseppe

Abstract

Background: Hip fractures (HF) are a major issue worldwide. We aimed at evaluating the practices in delivering care to patients with HF among several Italian Orthogeriatric centers. Methods: The study took place from February 2016 to July 2018. Seven performance indicators (pre-surgical cognitive assessment, surgery performed ≤ 48 h from fracture, removal of urinary catheter/absence of delirium/start of physiotherapy on the first post-operative day, prescription of bone protection at discharge, and discharge toward rehabilitation) were collected. Results: The 14 participating hospitals totally recruited 3.017 patients. Patients were old (median age 86 years; Inter Quartile Range [IQR] 80–90), mostly females (77%). Nearly 55% of them were already impaired in mobility and about 10% were nursing home residents. Median time-to-surgery was 41 h (IQR 23–62). Models of care greatly varied among centers, only 49.3% of patients being co-managed by geriatricians and orthopedics. There was high variability across centers in four indicators (“pre-surgical cognitive assessment”, “bone protection prescription”, “use of urinary catheter” and “start of physiotherapy”), moderate in two indicators (“surgery performed ≤ 48 h from fracture” and “discharge toward rehabilitation” and low in one (“absence of delirium on day following surgery”). Comparison with international studies suggests very different ways of providing care to HF Italian patients. Conclusions: The study results suggest high inter-center variability in the key-performance indicators, and different approaches in providing care to our HF patients in comparison to other countries. A National debate on the topic is required in Italy to harmonize practices of orthogeriatric care.

Published
2020
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15. POSTOPERATIVE DELIRIUM IS ASSOCIATED WITH MARKERS OF NEURODEGENERATION BUT NO BRAIN AMYLOIDOSIS.

Author

Rolandi, Elena, Cavedo, Enrica, Pievani, Michela, Galluzzi, Samantha, Ribaldi, Federica, Buckley, Chris J., Cunningham, Colm, Guerra, Ugo Paolo, Musarra, Monica, Morzenti, Sabrina, Magnaldi, Silvia, Patassini, Mirko, Terragnoli, Flavio, Matascioli, Luca, Franzoni, Simone, Annoni, Giorgio, Carnevali, Lucio, Bellelli, Giuseppe, and Frisoni, Giovanni B.

Published
2017
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16. What it's all about.

Author

Torrens, Jr., Rafael A., Terragnoli, Andrew, and Huff, Merlin

Subjects
LETTERS to the editor, PERIODICALS, STORMS, NATURAL disasters, DISASTER relief
Abstract

Several letters to the editor in response to articles in previous issues including "Shelter from the Storm," in the October 2005 issue, " It's Sprawl or Nothing," in the November 2005 issue, and "It's about people" are presented.

Published
2005

17. Effect of Corticosteroids on Mortality in Hospitalized COVID-19 Patients Not Receiving Invasive Mechanical Ventilation.

Author

Fusina F, Albani F, Granato E, Meloni A, Rozzini R, Sabatini T, Stellini R, Terragnoli P, Rosano A, Abu Hilal M, and Natalini G

Subjects
Adrenal Cortex Hormones administration & dosage, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Prospective Studies, Retrospective Studies, SARS-CoV-2, Sex Factors, Adrenal Cortex Hormones therapeutic use, COVID-19 mortality, Hospital Mortality trends, Intensive Care Units statistics & numerical data, Respiration, Artificial statistics & numerical data, COVID-19 Drug Treatment
Abstract

The most beneficial effect of corticosteroid therapy in COVID-19 patients has been shown in subjects receiving invasive mechanical ventilation (IMV), corresponding to a score of 6 on the World Health Organization (WHO) COVID-19 Ordinal Scale for Clinical Improvement (OSCI). The aim of this observational, single-center, prospective study was to assess the association between corticosteroids and hospital mortality in coronavirus disease 2019 (COVID-19) patients who did not receive IMV (OSCI 3-5). Included were 1,311 COVID-19 patients admitted to nonintensive care wards, and they were divided in two cohorts: (i) 480 patients who received corticosteroid therapy and (ii) 831 patients who did not. The median daily dose was of 8 mg of dexamethasone or equivalent, with a mean therapy duration of 5 (3-9) days. The indication to administer or withhold corticosteroids was given by the treating physician. In-hospital mortality was similar between the two cohorts after adjusting for possible confounders (adjusted odds ratio (ORadj) 1.04, 95% confidence interval (CI), 0.81-1.34, P = 0.74). There was also no difference in Intensive Care Unit (ICU) admission (ORadj 0.81, 95% CI, 0.56-1.17, P = 0.26). COVID-19 patients with noninvasive mechanical ventilation (NIMV) had a lower risk for ICU admission if they received steroid therapy (ORadj 0.58, 95% CI, 0.35-0.94, P = 0.03). In conclusion, corticosteroids were overall not associated with a difference in hospital mortality for patients with COVID-19 with OSCI 3-5. In the subgroup of patients with NIMV (OSCI 5), corticosteroids reduced ICU admission, whereas the effect on mortality requires further studies., (© 2021 The Authors. Clinical Pharmacology & Therapeutics © 2021 American Society for Clinical Pharmacology and Therapeutics.)

Published
2021
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18. Predicting poor outcome in patients with suspected COVID-19 presenting to the Emergency Department (COVERED) - Development, internal and external validation of a prediction model.

Author

Azijli K, Lieveld A, van der Horst S, de Graaf N, Kootte RS, Heijmans MW, van de Ven PM, Peters E, Heijmans J, Terragnoli P, Natalini G, Abu Hilal M, de Rooij T, and Nanayakkara P

Subjects
Emergency Service, Hospital, Humans, Multicenter Studies as Topic, Netherlands, Prognosis, Prospective Studies, Retrospective Studies, SARS-CoV-2, COVID-19
Abstract

Background: A recent systematic review recommends against the use of any of the current COVID-19 prediction models in clinical practice. To enable clinicians to appropriately profile and treat suspected COVID-19 patients at the emergency department (ED), externally validated models that predict poor outcome are desperately needed., Objective: Our aims were to identify predictors of poor outcome, defined as mortality or ICU admission within 30 days, in patients presenting to the ED with a clinical suspicion of COVID-19, and to develop and externally validate a prediction model for poor outcome., Methods: In this prospective, multi-center study, we enrolled suspected COVID-19 patients presenting at the EDs of two hospitals in the Netherlands. We used backward logistic regression to develop a prediction model. We used the area under the curve (AUC), Brier score and pseudo-R2 to assess model performance. The model was externally validated in an Italian cohort., Results: We included 1193 patients between March 12 and May 27 2020, of whom 196 (16.4%) had a poor outcome. We identified 10 predictors of poor outcome: current malignancy (OR 2.774; 95%CI 1.682-4.576), systolic blood pressure (OR 0.981; 95%CI 0.964-0.998), heart rate (OR 1.001; 95%CI 0.97-1.028), respiratory rate (OR 1.078; 95%CI 1.046-1.111), oxygen saturation (OR 0.899; 95%CI 0.850-0.952), body temperature (OR 0.505; 95%CI 0.359-0.710), serum urea (OR 1.404; 95%CI 1.198-1.645), C-reactive protein (OR 1.013; 95%CI 1.001-1.024), lactate dehydrogenase (OR 1.007; 95%CI 1.002-1.013) and SARS-CoV-2 PCR result (OR 2.456; 95%CI 1.526-3.953). The AUC was 0.86 (95%CI 0.83-0.89), with a Brier score of 0.32 and, and R2 of 0.41. The AUC in the external validation in 500 patients was 0.70 (95%CI 0.65-0.75)., Conclusion: The COVERED risk score showed excellent discriminatory ability, also in an external validation. It may aid clinical decision making, and improve triage at the ED in health care environments with high patient throughputs.

Published
2021

19. Leukocytes and creatinine may predict severity and guide management of ischemic colitis.

Author

Milluzzo SM, Correale L, Marco G, Antonelli G, Cesaro P, Olivari N, Terragnoli P, Sabatini T, Hassan C, and Spada C

Abstract

Background: Ischemic colitis (IC) is caused by a transient hypo-perfusion of the colon leading to mucosal ulcerations, inflammation, and hemorrhage. The primary aim was to identify predictive factors of endoscopic severity of IC. Secondary endpoints were to show epidemiology, clinical presentation, endoscopic findings, and outcomes of IC., Methods: In this single-center retrospective analysis, IC was scored according to endoscopy as: grade 1 (hyperemia, <1 cm erosions and non-confluent ulcers); grade 2 (>1 cm superficial, partially confluent ulcers); and grade 3 (deep or diffuse ulcers or necrosis). Then, IC was grouped into low- (grade 1) and high-grade (grades 2 and 3). Significant (P≤0.1) independent factor of severe IC at univariate analysis were entered into multivariate analysis and considered significant at P<0.05., Results: 227 patients (male:female 60:167; mean age 72.7±16.2 years) were included. IC was scored as grade 1 in 137/227 (60.4%), grade 2 in 62/227 (27.3%), and grade 3 in 28/227 (12.3%) patients. At univariate analysis, age (74.9 vs. 71.3 years; P=0.09), diabetes (14.4% vs. 12.4%; P=0.09), and leukocytosis or creatinine elevation (74.4% vs. 60.6%; P=0.032) were associated with endoscopic high-grade IC. At multivariate analysis, leukocytosis and creatinine levels remained associated with high-grade IC (44.7% vs. 29.9%; odds ratio 1.92, 95% confidence interval 1.07-3.52; P=0.030)., Conclusions: Although confounding factors cannot be excluded due to study design and patients' characteristics, leukocytosis and/or creatinine elevation at hospital admission were significantly related with endoscopic high-grade IC and might be used to stratify patients for the need of endoscopy., Competing Interests: Conflict of Interest: None, (Copyright: © 2021 Hellenic Society of Gastroenterology.)

Published
2021
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