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Early predictors of clinical outcomes of COVID-19 outbreak in Milan, Italy.
Clin Immunol. 2020 08; 217:108509.CI

Abstract

BACKGROUND

National health-system hospitals of Lombardy faced a heavy burden of admissions for acute respiratory distress syndromes associated with coronavirus disease (COVID-19). Data on patients of European origin affected by COVID-19 are limited.

METHODS

All consecutive patients aged ≥18 years, coming from North-East of Milan's province and admitted at San Raffaele Hospital with COVID-19, between February 25th and March 24th, were reported, all patients were followed for at least one month. Clinical and radiological features at admission and predictors of clinical outcomes were evaluated.

RESULTS

Of the 500 patients admitted to the Emergency Unit, 410 patients were hospitalized and analyzed: median age was 65 (IQR 56-75) years, and the majority of patients were males (72.9%). Median (IQR) days from COVID-19 symptoms onset was 8 (5-11) days. At hospital admission, fever (≥ 37.5 °C) was present in 67.5% of patients. Median oxygen saturation (SpO2) was 93% (range 60-99), with median PaO2/FiO2 ratio, 267 (IQR 184-314). Median Radiographic Assessment of Lung Edema (RALE) score was 9 (IQR 4-16). More than half of the patients (56.3%) had comorbidities, with hypertension, coronary heart disease, diabetes and chronic kidney failure being the most common. The probability of overall survival at day 28 was 66%. Multivariable analysis showed older age, coronary artery disease, cancer, low lymphocyte count and high RALE score as factors independently associated with an increased risk of mortality.

CONCLUSION

In a large cohort of COVID-19 patients of European origin, main risk factors for mortality were older age, comorbidities, low lymphocyte count and high RALE.

Authors+Show Affiliations

Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address: ciceri.fabio@hsr.it.Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy.Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy.Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy.IRCCS San Raffaele Scientific Institute, Milan, Italy.IRCCS San Raffaele Scientific Institute, Milan, Italy.Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy.Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy.IRCCS San Raffaele Scientific Institute, Milan, Italy.IRCCS San Raffaele Scientific Institute, Milan, Italy.Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy.Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy.IRCCS San Raffaele Scientific Institute, Milan, Italy.IRCCS San Raffaele Scientific Institute, Milan, Italy.IRCCS San Raffaele Scientific Institute, Milan, Italy.IRCCS San Raffaele Scientific Institute, Milan, Italy.IRCCS San Raffaele Scientific Institute, Milan, Italy.IRCCS San Raffaele Scientific Institute, Milan, Italy.IRCCS San Raffaele Scientific Institute, Milan, Italy.IRCCS San Raffaele Scientific Institute, Milan, Italy.IRCCS San Raffaele Scientific Institute, Milan, Italy.Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy.IRCCS San Raffaele Scientific Institute, Milan, Italy.Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy.IRCCS San Raffaele Scientific Institute, Milan, Italy.IRCCS San Raffaele Scientific Institute, Milan, Italy.IRCCS San Raffaele Scientific Institute, Milan, Italy.Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy.Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy.Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy.Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy.Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy.Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Milan, Italy.

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

32535188

Citation

Ciceri, Fabio, et al. "Early Predictors of Clinical Outcomes of COVID-19 Outbreak in Milan, Italy." Clinical Immunology (Orlando, Fla.), vol. 217, 2020, p. 108509.
Ciceri F, Castagna A, Rovere-Querini P, et al. Early predictors of clinical outcomes of COVID-19 outbreak in Milan, Italy. Clin Immunol. 2020;217:108509.
Ciceri, F., Castagna, A., Rovere-Querini, P., De Cobelli, F., Ruggeri, A., Galli, L., Conte, C., De Lorenzo, R., Poli, A., Ambrosio, A., Signorelli, C., Bossi, E., Fazio, M., Tresoldi, C., Colombo, S., Monti, G., Fominskiy, E., Franchini, S., Spessot, M., ... Zangrillo, A. (2020). Early predictors of clinical outcomes of COVID-19 outbreak in Milan, Italy. Clinical Immunology (Orlando, Fla.), 217, 108509. https://doi.org/10.1016/j.clim.2020.108509
Ciceri F, et al. Early Predictors of Clinical Outcomes of COVID-19 Outbreak in Milan, Italy. Clin Immunol. 2020;217:108509. PubMed PMID: 32535188.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early predictors of clinical outcomes of COVID-19 outbreak in Milan, Italy. AU - Ciceri,Fabio, AU - Castagna,Antonella, AU - Rovere-Querini,Patrizia, AU - De Cobelli,Francesco, AU - Ruggeri,Annalisa, AU - Galli,Laura, AU - Conte,Caterina, AU - De Lorenzo,Rebecca, AU - Poli,Andrea, AU - Ambrosio,Alberto, AU - Signorelli,Carlo, AU - Bossi,Eleonora, AU - Fazio,Maria, AU - Tresoldi,Cristina, AU - Colombo,Sergio, AU - Monti,Giacomo, AU - Fominskiy,Efgeny, AU - Franchini,Stefano, AU - Spessot,Marzia, AU - Martinenghi,Carlo, AU - Carlucci,Michele, AU - Beretta,Luigi, AU - Scandroglio,Anna Maria, AU - Clementi,Massimo, AU - Locatelli,Massimo, AU - Tresoldi,Moreno, AU - Scarpellini,Paolo, AU - Martino,Gianvito, AU - Bosi,Emanuele, AU - Dagna,Lorenzo, AU - Lazzarin,Adriano, AU - Landoni,Giovanni, AU - Zangrillo,Alberto, Y1 - 2020/06/12/ PY - 2020/05/25/received PY - 2020/06/07/revised PY - 2020/06/10/accepted PY - 2020/6/15/pubmed PY - 2020/7/22/medline PY - 2020/6/15/entrez KW - ARDS KW - COVID-19 KW - Infection KW - RALE score SP - 108509 EP - 108509 JF - Clinical immunology (Orlando, Fla.) JO - Clin Immunol VL - 217 N2 - BACKGROUND: National health-system hospitals of Lombardy faced a heavy burden of admissions for acute respiratory distress syndromes associated with coronavirus disease (COVID-19). Data on patients of European origin affected by COVID-19 are limited. METHODS: All consecutive patients aged ≥18 years, coming from North-East of Milan's province and admitted at San Raffaele Hospital with COVID-19, between February 25th and March 24th, were reported, all patients were followed for at least one month. Clinical and radiological features at admission and predictors of clinical outcomes were evaluated. RESULTS: Of the 500 patients admitted to the Emergency Unit, 410 patients were hospitalized and analyzed: median age was 65 (IQR 56-75) years, and the majority of patients were males (72.9%). Median (IQR) days from COVID-19 symptoms onset was 8 (5-11) days. At hospital admission, fever (≥ 37.5 °C) was present in 67.5% of patients. Median oxygen saturation (SpO2) was 93% (range 60-99), with median PaO2/FiO2 ratio, 267 (IQR 184-314). Median Radiographic Assessment of Lung Edema (RALE) score was 9 (IQR 4-16). More than half of the patients (56.3%) had comorbidities, with hypertension, coronary heart disease, diabetes and chronic kidney failure being the most common. The probability of overall survival at day 28 was 66%. Multivariable analysis showed older age, coronary artery disease, cancer, low lymphocyte count and high RALE score as factors independently associated with an increased risk of mortality. CONCLUSION: In a large cohort of COVID-19 patients of European origin, main risk factors for mortality were older age, comorbidities, low lymphocyte count and high RALE. SN - 1521-7035 UR - https://www.unboundmedicine.com/medline/citation/32535188/Early_predictors_of_clinical_outcomes_of_COVID_19_outbreak_in_Milan_Italy_ DB - PRIME DP - Unbound Medicine ER -