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

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Vaccines (Basel)


. 2021 Jun 11;9(6):640.
doi: 10.3390/vaccines9060640.
Clinical Course and Risk Factors for In-Hospital Mortality of 205 Patients with SARS-CoV-2 Pneumonia in Como, Lombardy Region, Italy


Mauro Turrini ¹ , Angelo Gardellini ¹ , Livia Beretta ² , Lucia Buzzi ³ , Stefano Ferrario ⁴ , Sabrina Vasile ⁵ , Raffaella Clerici ⁶ , Andrea Colzani ⁴ , Luigi Liparulo ⁷ , Giovanni Scognamiglio ⁸ , Gianni Imperiali ⁹ , Giovanni Corrado ¹⁰ , Antonello Strada ¹¹ , Marco Galletti ¹² , Nunzio Castiglione ¹³ , Claudio Zanon ¹³



Affiliations

• PMID: 34208017
• DOI: 10.3390/vaccines9060640

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.

Keywords: SARS-CoV 2; coronavirus disease 2019; mortality; pneumonia; risk factors; therapy; treatment.