tetano
Editor, Senior Moderator
J Clin Med
. 2020 May 20;9(5):E1548.
doi: 10.3390/jcm9051548.
Early Predictors of Clinical Deterioration in a Cohort of 239 Patients Hospitalized for Covid-19 Infection in Lombardy, Italy
Maurizio Cecconi[SUP] 1 2 [/SUP], Daniele Piovani[SUP] 1 2 [/SUP], Enrico Brunetta[SUP] 1 2 [/SUP], Alessio Aghemo[SUP] 1 2 [/SUP], Massimiliano Greco[SUP] 1 2 [/SUP], Michele Ciccarelli[SUP] 1 2 [/SUP], Claudio Angelini[SUP] 1 2 [/SUP], Antonio Voza[SUP] 1 2 [/SUP], Paolo Omodei[SUP] 1 2 [/SUP], Edoardo Vespa[SUP] 1 2 [/SUP], Nicola Pugliese[SUP] 1 2 [/SUP], Tommaso Lorenzo Parigi[SUP] 1 2 [/SUP], Marco Folci[SUP] 1 2 [/SUP], Silvio Danese[SUP] 1 2 [/SUP], Stefanos Bonovas[SUP] 1 2 [/SUP]
Affiliations
Abstract
We described features of hospitalized Covid-19 patients and identified predictors of clinical deterioration. We included patients consecutively admitted at Humanitas Research Hospital (Rozzano, Milan, Italy); retrospectively extracted demographic; clinical; laboratory and imaging findings at admission; used survival methods to identify factors associated with clinical deterioration (defined as intensive care unit (ICU) transfer or death), and developed a prognostic index. Overall; we analyzed 239 patients (29.3% females) with a mean age of 63.9 (standard deviation [SD]; 14.0) years. Clinical deterioration occurred in 70 patients (29.3%), including 41 (17.2%) ICU transfers and 36 (15.1%) deaths. The most common symptoms and signs at admission were cough (77.8%) and elevated respiratory rate (34.1%), while 66.5% of patients had at least one coexisting medical condition. Imaging frequently revealed ground-glass opacity (68.9%) and consolidation (23.8%). Age; increased respiratory rate; abnormal blood gas parameters and imaging findings; coexisting coronary heart disease; leukocytosis; lymphocytopenia; and several laboratory parameters (elevated procalcitonin; interleukin-6; serum ferritin; C-reactive protein; aspartate aminotransferase; lactate dehydrogenase; creatinine; fibrinogen; troponin-I; and D-dimer) were significant predictors of clinical deterioration. We suggested a prognostic index to assist risk-stratification (C-statistic; 0.845; 95% CI; 0.802‒0.887). These results could aid early identification and management of patients at risk, who should therefore receive additional monitoring and aggressive supportive care.
Keywords: 2019 novel coronavirus; 2019-nCoV; COVID-19; SARS-CoV-2; severe acute respiratory syndrome coronavirus 2.
. 2020 May 20;9(5):E1548.
doi: 10.3390/jcm9051548.
Early Predictors of Clinical Deterioration in a Cohort of 239 Patients Hospitalized for Covid-19 Infection in Lombardy, Italy
Maurizio Cecconi[SUP] 1 2 [/SUP], Daniele Piovani[SUP] 1 2 [/SUP], Enrico Brunetta[SUP] 1 2 [/SUP], Alessio Aghemo[SUP] 1 2 [/SUP], Massimiliano Greco[SUP] 1 2 [/SUP], Michele Ciccarelli[SUP] 1 2 [/SUP], Claudio Angelini[SUP] 1 2 [/SUP], Antonio Voza[SUP] 1 2 [/SUP], Paolo Omodei[SUP] 1 2 [/SUP], Edoardo Vespa[SUP] 1 2 [/SUP], Nicola Pugliese[SUP] 1 2 [/SUP], Tommaso Lorenzo Parigi[SUP] 1 2 [/SUP], Marco Folci[SUP] 1 2 [/SUP], Silvio Danese[SUP] 1 2 [/SUP], Stefanos Bonovas[SUP] 1 2 [/SUP]
Affiliations
- PMID: 32443899
- DOI: 10.3390/jcm9051548
Abstract
We described features of hospitalized Covid-19 patients and identified predictors of clinical deterioration. We included patients consecutively admitted at Humanitas Research Hospital (Rozzano, Milan, Italy); retrospectively extracted demographic; clinical; laboratory and imaging findings at admission; used survival methods to identify factors associated with clinical deterioration (defined as intensive care unit (ICU) transfer or death), and developed a prognostic index. Overall; we analyzed 239 patients (29.3% females) with a mean age of 63.9 (standard deviation [SD]; 14.0) years. Clinical deterioration occurred in 70 patients (29.3%), including 41 (17.2%) ICU transfers and 36 (15.1%) deaths. The most common symptoms and signs at admission were cough (77.8%) and elevated respiratory rate (34.1%), while 66.5% of patients had at least one coexisting medical condition. Imaging frequently revealed ground-glass opacity (68.9%) and consolidation (23.8%). Age; increased respiratory rate; abnormal blood gas parameters and imaging findings; coexisting coronary heart disease; leukocytosis; lymphocytopenia; and several laboratory parameters (elevated procalcitonin; interleukin-6; serum ferritin; C-reactive protein; aspartate aminotransferase; lactate dehydrogenase; creatinine; fibrinogen; troponin-I; and D-dimer) were significant predictors of clinical deterioration. We suggested a prognostic index to assist risk-stratification (C-statistic; 0.845; 95% CI; 0.802‒0.887). These results could aid early identification and management of patients at risk, who should therefore receive additional monitoring and aggressive supportive care.
Keywords: 2019 novel coronavirus; 2019-nCoV; COVID-19; SARS-CoV-2; severe acute respiratory syndrome coronavirus 2.