Severe COVID-19 pneumonia in Piacenza, Italy — A cohort study of the first pandemic wave
Lorenzo Guglielmetti, Irina Kontsevaya, Maria C Leoni, Patrizia Ferrante, Elisa Fronti, Laura Gerna, Caterina Valdatta, Alessandra Donisi, Alberto Faggi, Franco Paolillo, Giovanna Ratti, Alessandro Ruggieri, Marta Scotti, Daria Sacchini, Gloria Taliani, Mauro Codeluppi
Journal of Infection and Public Health, doi:10.1016/j.jiph.2020.11.012
Background: Piacenza is the closest city to the first coronavirus disease 2019 (COVID-19) cluster in Italy and has the highest national COVID-19 death rates per population. The objective of this study is to present characteristics and outcomes of patients admitted to medical departments of the Hospital of Piacenza during the first wave of the epidemic. Methods: A total of 218 patients with confirmed or suspect COVID-19 and severe pneumonia were included from February 21st to May 15th, 2020. Routinely-collected clinical and laboratory data were retrospectively retrieved from electronic medical files. A Cox proportional-hazards model was fit to assess the association of treatment and other variables with death. Results: Median age of patients was 68 years; 150 patients (69%) had comorbidities, mainly hypertension (107, 49%). Overall, 185 (85%) patients had acute respiratory distress syndrome (ARDS) on admission, including 103 (47%) with moderate or severe ARDS. Chest computed tomography scan showed bilateral disease in 201 (98%) and extensive lung involvement in 79 (50%) patients. Most patients received antiviral treatment (187, 86%) and corticosteroids (134, 61%). All patients received respiratory support and 64 (29%) were admitted to intensive care unit. As of June 30th, 100 patients (46%) died, 109 patients (50%) were discharged, and 9 patients (4%) were still hospitalized. In multivariable Cox analysis, age above 65 years, having more than one comorbidity, severe ARDS, low platelet counts, and high LDH levels at admission were associated with mortality, while having diarrhea at admission was associated with survival. The use of antivirals or corticosteroids was not associated with survival.
Competing interests None declared.
Ethics approval The study was approved by the local Ethics Committee (Area Vasta Emilia Nord). Requirement for informed consent was waived by the Ethics Committee.
Author contributions LG made a substantial contribution to the conception and design of the work, to the acquisition, analysis and interpretation of data for the work, performed statistical analysis, wrote the manuscript, critically revised the manuscript for important intellectual content, gave final approval of the current version to be published, and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. IK made a substantial contribution to the analysis and interpretation of data for the work, wrote the manuscript, critically revised the manuscript for important intellectual content, gave final approval of the current version to be published, and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. GT and MC made a substantial contribution to the conception and design of the work, to the analysis and interpretation of data for the work, critically revised the manuscript for important intellectual content, gave final approval of the current version to be published, and agree to be accountable for all aspects of the..
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