Clinical course and risk factors for in-hospital mortality of 205 patients with SARS-CoV-2 pneumonia in Como, Lombardy Region, Italy

Abstract

Importance: With randomized clinical trials ongoing and vaccine still a long distance away, efforts to repurpose old medications used for other diseases provide hope for treatment of COVID−19. Objectives: To examine the risk factors for in−hospital mortality and describe the effectiveness of different treatment strategies in a real−life setting of patients with severe acute respiratory syndrome coronavirus 2 (SARS−CoV−2) pneumonia. Design: Real−life single−center study during the Lombardy COVID−19 outbreak. Setting: Valduce Hospital in Como, Lombardy Region, Italy. Participants: 205 laboratory−confirmed patients presenting with SARS−Cov−2 pneumonia requiring hospitalization. Interventions: All patients received best supportive care and, based on their clinical needs and comorbidities, specific interventions that included the main drugs being tested for repurposing to treat COVID−19, such as hydroxychloroquine, anticoagulation, antiviral drugs, steroids or interleukin−6 pathway inhibitors. Main outcomes and measures: Clinical, laboratory and treatment characteristics were analyzed with univariate and multivariate logistic regression methods to explore their impact on in−hospital mortality and compared with current literature data. Results: Univariate analyses for clinical variables showed prognostic significance for age equal or greater than 70 years (estimated 28−days survival: 21.4 vs 67.4%; p<0.0001), presence of 2 or more relevant comorbidities (35.3 vs 61.8%; p=0.0008), ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F) less than 200 at presentation (21−days survival: 14.7 vs 52.4%;p<0.0001), high levels of lactate dehydrogenase (LDH) (26.4 vs 65.3%; p=0.0001), and elevated C−reactive protein (CRP) values (25.4 vs 74.9%; p=0.0001), while no statistical significance was found for all the other clinical variables tested. At univariate analysis for the different treatment scheduled, prognostic significance for survival was showed for intermediate or therapeutic-dose anticoagulation (estimated 28−days survival: 37.1 vs 23.4%; p=0.0001), hydroxychloroquine (35.7 vs 27.3%; p=0.0029), early antiviral therapy with lopinavir/ritonavir (60.1 vs 22.4%; p<0.0001), late short−course of steroids (47.9 vs 18.2%; p<0.0001) or tocilizumab therapy (69.4 vs 29.4%; p=0.0059). Multivariable regression confirmed increasing odds of in−hospital death associated with age older than 70 years (odds ratio 3.26, 95% CI 1.81 − 5.86; p<0.0001) and showed a reduction in mortality for patients treated with anticoagulant (−0.37, 0.49 − 0.95; p=0.0273), antiviral (−1.22, 0.16 − 0.54; p<0.0001), or steroids (−0.59, 0.35 − 0.87; p=0.0117) therapy.