<p>Survival of Hospitalized COVID-19 Patients in Northern Italy: A Population-Based Cohort Study by the ITA-COVID-19 Network</p>

Abstract

Introduction COVID-19 case fatality rate in hospitalized patients varies across countries and studies. Reliable estimates, specific for age, sex, and comorbidities, are needed to monitor the epidemic, to compare the outcome in different settings, and to correctly design trials for COVID-19 interventions. The aim of this study was to provide population-based survival curves of hospitalized COVID-19 patients. Materials and Methods A cohort study was conducted in three areas of Northern Italy, heavily affected by SARS-CoV-2 infection (Lombardy and Veneto Regions, and Reggio Emilia province), using a loco-regional COVID-19 surveillance system, linked to hospital discharge databases. We included all patients testing positive for SARS-CoV-2 RNA by RT-PCR on nasopharyngeal/throat swab samples who were hospitalized from 21 February to 21 April 2020. Kaplan–Meier survival estimates were calculated at 14 and 30 days for death in any setting, stratifying by age, sex, and the Charlson Index. Results Overall, 42,926 hospitalized COVID-19 patients were identified. Patients’ median age was 69 years (IQR: 57–79), 62.6% were males, and 6.0% had a Charlson Index ≥3. Survival curves showed that 22.0% (95% CI 21.6–22.4) of patients died within 14 days and 27.6% (95% CI 27.2–28.1) within 30 days from hospitalization. Survival was higher in younger patients and in females. The negative impact of comorbidities on survival was more pronounced in younger age groups. Conclusion The high fatality rate observed in the study (28% at 30 days) suggests that studies should focus on death as primary endpoint during a follow-up of at least one month.

Unexpectedly lower mortality rates in COVID-19 patients with and without type 2 diabetes in Istanbul

“…The proportion of severe to critical cases and mortality rate are known to increase in older COVID-19 patients, and men with T2DM were more likely to die. In line with other studies [32] , [35] , [42] , in the T2DM group of the present study, older age and hypertension were associated with increased risk of both hospitalization and mortality. However, male-gender was strongly linked with the risk of mortality but not with hospitalization; whereas, hypertension appeared to increase the likelihood of hospitalization but not mortality.…”

“…COVID-19 mortality is high among hospitalized patients. It was reported 24.5% in New York [11] , 27.8% in Northern Italy [35] . In-hospital mortality is significantly higher in COVID-19 patients with diabetes.…”

“…Although our hospitalization rate was higher than those observed by others [9] , [29] , [37] , the mortality rates in groups with or without T2DM were significantly lower than studies reported across the world, and this is one of the most striking results of our study. Compared with middle-income countries, the mortality of COVID-19 in the US and the wealthiest European countries (i.e., Spain, Germany, Italy, France, UK, Denmark, Norway, Sweden, and The Netherlands) remains quite high [4] , [24] , [35] , [36] , [46] , [49] . This may suggest that public health interventions may be less accessible in these countries, among many other interplaying factors [50] .…”

“…Generally, in studies published on COVID-19, the average patient age has been reported above 60 [10] , [19] , [22] , [23] , [24] , [35] , [36] , [37] , the majority was male [22] , [23] , [24] , [27] , [35] , [36] , [37] , and patients with T2DM tended to be older [17] , [18] , [22] . Unlike most of the studies, the median age of our cohort was younger and the proportion of men was lower in the T2DM group due to the smaller percentage of the elderly population in our society as compared to European countries, e.g.…”

Awareness of influenza and pneumococcal vaccines in diabetic patients

“…Pneumococcal vaccines are known to reduce hospitalization rates for pneumonia in the adult population older than 65 years of age. This is important, as older people are the highest-risk group for death from COVID-19 [ 35 ]. Approximately 10% of deaths from COVID-19 are thought to be caused by pneumococcal superinfection.…”