key: cord-0681991-z58mptax
authors: Vena, Antonio; Giacobbe, Daniele Roberto; Di Biagio, Antonio; Mikulska, Malgorzata; Taramasso, Lucia; De Maria, Andrea; Ball, Lorenzo; Brunetti, Iole; Loconte, Maurizio; Patroniti, Nicolò A.; Robba, Chiara; Delfino, Emanuele; Dentone, Chiara; Magnasco, Laura; Nicolini, Laura; Toscanini, Federica; Bavastro, Martina; Cerchiaro, Matteo; Barisione, Emanuela; Giacomini, Mauro; Mora, Sara; Baldi, Federico; Balletto, Elisa; Berruti, Marco; Briano, Federica; Sepulcri, Chiara; Dettori, Silvia; Labate, Laura; Mirabella, Michele; Portunato, Federica; Pincino, Rachele; Russo, Chiara; Tutino, Stefania; Pelosi, Paolo; Bassetti, Matteo
title: Clinical characteristics, management and in-hospital mortality of patients with COVID-19 In Genoa, Italy
date: 2020-08-15
journal: Clin Microbiol Infect
DOI: 10.1016/j.cmi.2020.07.049
sha: 180286c7e7cf2c2eb11aa211bc033d3c61896a48
doc_id: 681991
cord_uid: z58mptax

OBJECTIVES: To describe clinical characteristics, management and outcome of COVID-19 patients; 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 February 25(th), 2020 and March 25(th), 2020. RESULTS: Overall, 317 patients were enrolled. Their median age 71 years and 67.2% were males (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, diarrhea or nausea and vomiting was observed in 53/317 patients (16.7%). Hypokalemia 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 odds ratio [OR]:1.07; 95% confidence interval [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.

As the incidence of COVID-19 cases has increased [1, 2] , so has the clinical understanding 62 of the disease. However, data on clinical presentation, complications, management and outcome 63 are mainly obtained from relatively small case series [1, [3] [4] [5] [6] [7] [8] [9] , mainly collected from China [1, 3-5, 64 8, 10-17] or including selected groups of critically ill patients [6, 7, [18] [19] [20] . Consequently, they do 65 not necessarily represent the current situation of European hospitals.

The main objective of this study was to describe clinical characteristics, management and 67 outcome of COVID-19 patients admitted to our hospital in Genoa, northern Italy. We also sought to 68 investigate risk factors associated with all-cause in-hospital mortality. 

One-hundred and twenty-two individuals out of 317 (38.5%) were treated with methylprednisolone (64.0%) were treated with intravenous antimicrobials, most commonly a fifth-generation 171 cephalosporin or a third-generation cephalosporin with either a macrolide or a fluoroquinolone.

The majority of patients received oxygen therapy and 111 out of 317 (35.0%) required non-173 invasive respiratory support. Among them, 47.8% (53/111) subsequently required invasive 174 mechanical ventilation (Table 2) 

The findings of the present cohort study conducted in a teaching hospital in northern Italy

can be summarized as follows: 1) COVID-19 is mainly a disease of the elderly, with multiple disease and increased CRP were associated with all-cause in-hospital mortality in our study.

In our series, we observed an uneven age distribution among hospitalized COVID-19 patients, 200 with more than 50% being aged ≥70 years. This percentage is significantly higher than that 

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From Liguria HIV

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Pneumonia in the very old

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COVID-19)

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Outcomes of 445 hydroxycloroquine usage in United States veterans hospitalized with COVID-19

First case of COVID-19 in a patient 465 with multiple myeloma successfully treated with tocilizumab

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Effective treatment of severe COVID-19 patients with tocilizumab

C-reactive protein, mg/L (n=301)

IL-6, ng/L (n=252)

ARDS: Acute Respiratory Distress Syndrome

ICU: Figure 2 All cause in hospital mortality of patients with COVID-19 according to years of age* Median days (interquartile range) after COVID-19 diagnosis in each age group were as follows: 10.5 (1.5-17.8)