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 Corradini, Paolo Ventura, Walter Ageno, Chiara Beatrice Cogliati, Maria Lorenza Muiesan, Domenico Girelli, Mario Pirisi, Antonio Gasbarrini, Paolo Angeli, Patrizia Rovere Querini, Emanuele Bosi, Moreno Tresoldi, Roberto Vettor, Marco Cattaneo, Fabio Piscaglia, Antonio Luca Brucato, Stefano Perlini, Paolo Martelletti, Roberto Pontremoli, Massimo Porta, Pietro Minuz, Oliviero Olivieri, Giorgio Sesti, Gianni Biolo, Damiano Rizzoni, Gaetano Serviddio, Francesco Cipollone, Davide Grassi, Roberto Manfredini, Guido Luigi Moreo, Antonello Pietrangelo, Elisabetta Tombolini, Thomas Teatini, Pier Ernesto Crisafulli, Pier Paolo Sainaghi, Lorenzo Zileri Dal Verme, Salvatore Piano, Rebecca De Lorenzo, Gaetano Arcidiacono, Marco Podda, Luca Muratori, Claudia Gabiati, Francesco Salinaro, Michelangelo Luciani, Cecilia Barnini, Stefania Morra Di Cella, Andrea Dalbeni, Simonetta Friso, Michelangelo Luciani, Filippo Mearelli, Paolo Malerba, Francesco Cavallone, Damiano D’ardes, Serena Notargiacomo, Alfredo De Giorgi, Marta Mansi, Elena Buzzetti, Andrea Ricci, Francesca Martelli
Internal and Emergency Medicine, doi:10.1007/s11739-021-02742-8
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 PaO 2 /FiO 2 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 PaO 2 /FiO 2 ratio < 100. The latter, significantly benefited by the early use of non-invasive mechanical ventilation. Our study identified PaO 2 /FiO 2 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.
Supplementary Information The online version contains supplementary material available at https:// doi. org/ 10. 1007/ s11739-021-02742-8.
Conflict of interest The authors have no conflicts of interest to declare that are relevant to the content of this article.
Ethics approval The participating centers had the approval from the local ethical committee.
Authors and Affiliations Elena Corradini
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