Abstract: Internal and Emergency Medicine (2021) 16:1005–1015 https://doi.org/10.1007/s11739-021-02742-8 IM - ORIGINAL Clinical factors associated with death in 3044 COVID‑19 patients managed in internal medicine wards in Italy: results from the SIMI‑COVID‑19 study of the Italian Society of Internal Medicine (SIMI) Elena Corradini1 · Paolo Ventura1 · Walter Ageno2 · Chiara Beatrice Cogliati3 · Maria Lorenza Muiesan4 · Domenico Girelli5 · Mario Pirisi6 · Antonio Gasbarrini7 · Paolo Angeli8 · Patrizia Rovere Querini9 · Emanuele Bosi9 · Moreno Tresoldi9 · Roberto Vettor10 · Marco Cattaneo11 · Fabio Piscaglia12 · Antonio Luca Brucato13 · Stefano Perlini14 · Paolo Martelletti15 · Roberto Pontremoli16 · Massimo Porta17 · Pietro Minuz18 · Oliviero Olivieri19 · Giorgio Sesti20 · Gianni Biolo21 · Damiano Rizzoni22 · Gaetano Serviddio23 · Francesco Cipollone24 · Davide Grassi25 · Roberto Manfredini26 · Guido Luigi Moreo27 · Antonello Pietrangelo1 · SIMI-COVID-19 Collaborators Received: 19 February 2021 / Accepted: 9 April 2021 / Published online: 24 April 2021 © Società Italiana di Medicina Interna (SIMI) 2021 Abstract During the COVID-19 2020 outbreak, a large body of data has been provided on general management and outcomes of hospitalized COVID-19 patients. Yet, relatively little is known on characteristics and outcome of patients managed in Internal Medicine Units (IMU). To address this gap, the Italian Society of Internal Medicine has conducted a nationwide cohort multicentre study on death outcome in adult COVID-19 patients admitted and managed in IMU. This study assessed 3044 COVID-19 patients at 41 referral hospitals across Italy from February 3rd to May 8th 2020. Demographics, comorbidities, organ dysfunction, treatment, and outcomes including death were assessed. During the study period, 697 patients (22.9%) were transferred to intensive care units, and 351 died in IMU (death rate 14.9%). At admission, factors independently associated with in-hospital mortality were age (OR 2.46, p = 0.000), productive cough (OR 2.04, p = 0.000), pre-existing chronic heart failure (OR 1.58, p = 0.017) and chronic obstructive pulmonary disease (OR 1.17, p = 0.048), the number of comorbidities (OR 1.34, p = 0.000) and polypharmacy (OR 1.20, p = 0.000). Of note, up to 40% of elderly patients did not report fever at admission. Decreasing P ­ aO2/FiO2 ratio at admission was strongly inversely associated with survival. The use of conventional oxygen supplementation increased with the number of pre-existing comorbidities, but it did not associate with better survival in patients with ­PaO2/FiO2 ratio < 100. The latter, significantly benefited by the early use of non-invasive mechanical ventilation. Our study identified ­PaO2/FiO2 ratio at admission and comorbidity as the main alert signs to inform clinical decisions and resource allocation in non-critically ill COVID-19 patients admitted to IMU. Keywords SARS-CoV-2 · Mortality from COVID-19 · Comorbidity · Polypharmacy · Internal medicine Abbreviations ACE Angiotensin-converting enzyme CHF Chronic heart failure Elena Corradini and Paolo Ventura contributed equally to the work. Members of the SIMI COVID-19 Collaborators are listed in the Acknowledgement section at the end of the article. * Antonello Pietrangelo antonello.pietrangelo@unimore.it CKD Chronic kidney disease COPD Chronic obstructive pulmonary disease COVID-19 Coronavirus disease 2019 CPAP Continuous positive air pressure CRF Case report..