Fatality rate and predictors of mortality in a large Italian cohort of hospitalized COVID-19 patients

Abstract

Substantial discrepancies are evident in the clinical features and natural history of coronavirus disease 2019 (COVID-19), among different countries, so we aimed to evaluate the fatality rate and to identify predictors of mortality in a cohort of hospitalized patients. We performed a retrospective multicenter cohort study on medical records of patients admitted between 1st March and 28th April 2020, involving three hospitals in Northern Italy. We included 1697 patients older than 18 years of age and with a confirmed diagnosis of SARS-CoV-2 infection by reverse-transcriptase polymerase chain reaction (RT-PCR). During the study period we observed 504 deaths, with a CFR of 29.7%. We further looked for predictors of mortality in a subset of 486 patients (239 males, 59%); the median age of the study population was 71 [58-80] years. Among demographic and clinical variables considered, age, a diagnosis of cancer, obesity and current smoking independently predicted mortality. When laboratory data were added to the model, age, the diagnosis of cancer, and the baseline PaO2/FiO2 ratio were independent predictors of mortality. During the COVID-19 outbreak, the CFR of hospitalized patients in Northern Italy was high, approaching 30%. The identification of mortality predictors might contribute to better stratification of individual patient risk.

A Retrospective Study on the Outcome of Coronavirus Disease 2019 (COVID-19) Patients Admitted to a District General Hospital and Predictors of High Mortality

“…The viral pathogen is highly virulent and can mutate, resulting in outbreaks worldwide. Patient stratification can be useful to identify patients at a higher risk of deterioration, and several studies have been conducted in this regard [1][2][3][4][5][6][7]. Several studies have assessed mortality predictors in various countries [16][17][18].…”

“…Several studies have assessed mortality predictors in various countries [16][17][18]. The main risk factors for mortality in COVID-19 patients reported by various studies include male sex, advanced age, obesity, HTN, coronary artery disease, DM, and malignancy [1,2]. Additionally, certain biochemical and physical signs are also related to higher mortality, including fever, hemoptysis, loss of consciousness, renal impairment, deranged liver function, and elevated levels of inflammatory biomarkers such as CRP, LDH, and procalcitonin.…”

“…The World Health Organization (WHO) reported a significant difference in the outcomes of patients with COVID-19, and the case fatality rate was far higher in certain parts of the world compared to others. The fatality rate reported in South Europe and the United States is significantly higher compared to China and North Europe [2]. Similarly, the case fatality rate in Italy was far higher than in China and was linked to male sex, older age, and comorbidities [2].…”

“…The fatality rate reported in South Europe and the United States is significantly higher compared to China and North Europe [2]. Similarly, the case fatality rate in Italy was far higher than in China and was linked to male sex, older age, and comorbidities [2]. Other studies have highlighted similar findings and have attributed advanced age, male sex, and comorbidities such as diabetes mellitus (DM), obesity, hypertension (HTN), renal disease, coronary artery disease (CAD), and malignancy to poor outcomes in patients with COVID-19 infections [3][4][5][6][7][8].…”

“…The manifestation can vary from minor asymptomatic illness to fulminant systemic inflammatory syndrome unleashed by a cytokine storm [1]. There is some variation in the data for COVID-19 morbidity and mortality across various regions due to underreporting in some regions because of poor health infrastructure [1,2]. The World Health Organization (WHO) reported a significant difference in the outcomes of patients with COVID-19, and the case fatality rate was far higher in certain parts of the world compared to others.…”