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Clinical characteristics, management and in-hospital mortality of patients with coronavirus disease 2019 in Genoa, Italy.
Clin Microbiol Infect. 2020 Nov; 26(11):1537-1544.CM

Abstract

OBJECTIVES

To describe clinical characteristics, management and outcome of individuals with coronavirus disease 2019 (COVID-19); and to evaluate risk factors for all-cause in-hospital mortality.

METHODS

This retrospective study from a University tertiary care hospital in northern Italy, included hospitalized adult patients with a diagnosis of COVID-19 between 25 February 2020 and 25 March 2020.

RESULTS

Overall, 317 individuals were enrolled. Their median age was 71 years and 67.2% were male (213/317). The most common underlying diseases were hypertension (149/317; 47.0%), cardiovascular disease (63/317; 19.9%) and diabetes (49/317; 15.5%). Common symptoms at the time of COVID-19 diagnosis included fever (285/317; 89.9%), shortness of breath (167/317; 52.7%) and dry cough (156/317; 49.2%). An 'atypical' presentation including at least one among mental confusion, diarrhoea or nausea and vomiting was observed in 53/317 patients (16.7%). Hypokalaemia occurred in 25.8% (78/302) and 18.5% (56/303) had acute kidney injury. During hospitalization, 111/317 patients (35.0%) received non-invasive respiratory support, 65/317 (20.5%) were admitted to the intensive care unit (ICU) and 60/317 (18.5%) required invasive mechanical ventilation. All-cause in-hospital mortality, assessed in 275 patients, was 43.6% (120/275). On multivariable analysis, age (per-year increase OR 1.07; 95% CI 1.04-1.10; p < 0.001), cardiovascular disease (OR 2.58; 95% CI 1.07-6.25; p 0.03), and C-reactive protein levels (per-point increase OR 1.009; 95% CI 1.004-1.014; p 0.001) were independent risk factors for all-cause in-hospital mortality.

CONCLUSIONS

COVID-19 mainly affected elderly patients with predisposing conditions and caused severe illness, frequently requiring non-invasive respiratory support or ICU admission. Despite supportive care, COVID-19 remains associated with a substantial risk of all-cause in-hospital mortality.

Authors+Show Affiliations

Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy; Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy; Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.Interventional Pulmonology Unit, IRCCS San Martino Hospital, IST National Cancer Research Institute, Genoa, Italy.Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy.Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy.Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; Infectious Diseases Unit, University of Campania Luigi Vanvitelli, Naples, Italy.Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy; Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy. Electronic address: matteo.bassetti@unige.it.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32810610

Citation

Vena, Antonio, et al. "Clinical Characteristics, Management and In-hospital Mortality of Patients With Coronavirus Disease 2019 in Genoa, Italy." Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, vol. 26, no. 11, 2020, pp. 1537-1544.
Vena A, Giacobbe DR, Di Biagio A, et al. Clinical characteristics, management and in-hospital mortality of patients with coronavirus disease 2019 in Genoa, Italy. Clin Microbiol Infect. 2020;26(11):1537-1544.
Vena, A., Giacobbe, D. R., Di Biagio, A., Mikulska, M., Taramasso, L., De Maria, A., Ball, L., Brunetti, I., Loconte, M., Patroniti, N. A., Robba, C., Delfino, E., Dentone, C., Magnasco, L., Nicolini, L., Toscanini, F., Bavastro, M., Cerchiaro, M., Barisione, E., ... Bassetti, M. (2020). Clinical characteristics, management and in-hospital mortality of patients with coronavirus disease 2019 in Genoa, Italy. Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, 26(11), 1537-1544. https://doi.org/10.1016/j.cmi.2020.07.049
Vena A, et al. Clinical Characteristics, Management and In-hospital Mortality of Patients With Coronavirus Disease 2019 in Genoa, Italy. Clin Microbiol Infect. 2020;26(11):1537-1544. PubMed PMID: 32810610.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical characteristics, management and in-hospital mortality of patients with coronavirus disease 2019 in Genoa, Italy. AU - Vena,Antonio, AU - Giacobbe,Daniele Roberto, AU - Di Biagio,Antonio, AU - Mikulska,Malgorzata, AU - Taramasso,Lucia, AU - De Maria,Andrea, AU - Ball,Lorenzo, AU - Brunetti,Iole, AU - Loconte,Maurizio, AU - Patroniti,Nicolò A, AU - Robba,Chiara, AU - Delfino,Emanuele, AU - Dentone,Chiara, AU - Magnasco,Laura, AU - Nicolini,Laura, AU - Toscanini,Federica, AU - Bavastro,Martina, AU - Cerchiaro,Matteo, AU - Barisione,Emanuela, AU - Giacomini,Mauro, AU - Mora,Sara, AU - Baldi,Federico, AU - Balletto,Elisa, AU - Berruti,Marco, AU - Briano,Federica, AU - Sepulcri,Chiara, AU - Dettori,Silvia, AU - Labate,Laura, AU - Mirabella,Michele, AU - Portunato,Federica, AU - Pincino,Rachele, AU - Russo,Chiara, AU - Tutino,Stefania, AU - Pelosi,Paolo, AU - Bassetti,Matteo, AU - ,, Y1 - 2020/08/15/ PY - 2020/04/29/received PY - 2020/07/14/revised PY - 2020/07/16/accepted PY - 2020/8/19/pubmed PY - 2020/11/21/medline PY - 2020/8/19/entrez KW - Acute respiratory distress syndrome KW - Coronavirus disease 2019 KW - Interleukin-6 KW - Mortality KW - Severe acute respiratory syndrome coronavirus 2 SP - 1537 EP - 1544 JF - Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases JO - Clin Microbiol Infect VL - 26 IS - 11 N2 - OBJECTIVES: To describe clinical characteristics, management and outcome of individuals with coronavirus disease 2019 (COVID-19); and to evaluate risk factors for all-cause in-hospital mortality. METHODS: This retrospective study from a University tertiary care hospital in northern Italy, included hospitalized adult patients with a diagnosis of COVID-19 between 25 February 2020 and 25 March 2020. RESULTS: Overall, 317 individuals were enrolled. Their median age was 71 years and 67.2% were male (213/317). The most common underlying diseases were hypertension (149/317; 47.0%), cardiovascular disease (63/317; 19.9%) and diabetes (49/317; 15.5%). Common symptoms at the time of COVID-19 diagnosis included fever (285/317; 89.9%), shortness of breath (167/317; 52.7%) and dry cough (156/317; 49.2%). An 'atypical' presentation including at least one among mental confusion, diarrhoea or nausea and vomiting was observed in 53/317 patients (16.7%). Hypokalaemia occurred in 25.8% (78/302) and 18.5% (56/303) had acute kidney injury. During hospitalization, 111/317 patients (35.0%) received non-invasive respiratory support, 65/317 (20.5%) were admitted to the intensive care unit (ICU) and 60/317 (18.5%) required invasive mechanical ventilation. All-cause in-hospital mortality, assessed in 275 patients, was 43.6% (120/275). On multivariable analysis, age (per-year increase OR 1.07; 95% CI 1.04-1.10; p < 0.001), cardiovascular disease (OR 2.58; 95% CI 1.07-6.25; p 0.03), and C-reactive protein levels (per-point increase OR 1.009; 95% CI 1.004-1.014; p 0.001) were independent risk factors for all-cause in-hospital mortality. CONCLUSIONS: COVID-19 mainly affected elderly patients with predisposing conditions and caused severe illness, frequently requiring non-invasive respiratory support or ICU admission. Despite supportive care, COVID-19 remains associated with a substantial risk of all-cause in-hospital mortality. SN - 1469-0691 UR - https://www.unboundmedicine.com/medline/citation/32810610/Clinical_characteristics_management_and_in_hospital_mortality_of_patients_with_coronavirus_disease_2019_in_Genoa_Italy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1198-743X(20)30484-5 DB - PRIME DP - Unbound Medicine ER -