Prognostic factors and predictors of outcome in patients with COVID-19 and related pneumonia: a retrospective cohort study

Boari, Gianluca E.M.; Chiarini, Giulia; Bonetti, S.; Malerba, Paolo; Bianco, Gianluca; Faustini, Cristina; Braglia-Orlandini, Federico; Turini, Daniele; Guarinoni, Vittoria; Saottini, Michele; Viola, Sara; Ferrari-Toninelli, Giulia; Pasini, Giancarlo; Mascadri, Cristina; Bonzi, B.; Desenzani, Paolo; Tusi, Claudia; Zanotti, Eros; Nardin, Matteo; Rizzoni, Damiano

doi:10.1042/bsr20203455

Cited by 29 publications

(40 citation statements)

References 37 publications

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“…COVID-19 has been associated with a very high mortality rate being interstitial pneumonia with respiratory failure the main cause of death [ 1 , 6 ]. Among COVID-19 patients, about 25% present a severe complication of infection including acute respiratory distress syndrome (ARDS), with a rapid worsening of clinical conditions leading to the need of mechanical or invasive ventilation to support respiratory functions in intensive care units [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…mechanical ventilation) oxygen therapy, according to their needs. For further clinical information see reference [ 1 ].…”

Section: Methodsmentioning

confidence: 99%

“…Coronavirus disease 2019 (COVID-19) pandemic represented, and still represents, a major clinical problem in Lombardy, one of the most affected Italian (and worldwide) regions; a high toll of victims was paid. In our clinical ward, a mortality rate of 25% was observed during the first pandemic outbreak (March–April 2020) [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

“…Predicting factors determining outcome prognosis of patients that develop interstitial pneumonia with respiratory failure have been investigated; among them gender, hypertension, obesity, diabetes and other cardiovascular disorders seems be substantially associated with SARS-CoV-2 infection and with poor outcome [1,[6][7][8][9]. In fact, the severity of the primary respiratory syndrome is increased in patients with pre-existing cardiovascular disease [1,6,7,10,11], as also documented by the association of the Charlson Comorbidity Index with the clinical outcome [7] and with the chance of healing [9].…”

Section: Introductionmentioning

confidence: 99%

“…Also, the severity of the lung involvement may be relevant from a prognostic point of view. The Brixia score is a radiologic score proposed by Borghesi and Maroldi [12] to assess severity of SARS-CoV-2 pneumonia, whose prognostic meaning was clearly demonstrated [1,13,14].…”

Section: Introductionmentioning

confidence: 99%

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Short-Term Consequences of SARS-CoV-2-Related Pneumonia: A Follow Up Study

Boari

Bonetti

Braglia-Orlandini

et al. 2021

High Blood Press Cardiovasc Prev

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The aim of the study was to assess the short-term consequences of SARS-CoV-2-related pneumonia, also in relation to radiologic/laboratory/clinical indices of risk at baseline. This prospective follow-up cohort study included 94 patients with confirmed COVID-19 admitted to a medical ward at the Montichiari Hospital, Brescia, Italy from February 28th to April 30th, 2020. Patients had COVID-19 related pneumonia with respiratory failure. Ninety-four patients out of 193 survivors accepted to be re-evaluated after discharge, on average after 4 months. In ¼ of the patients an evidence of pulmonary fibrosis was detected, as indicated by an altered diffusing capacity of the lung for carbon monoxide (DLCO); in 6–7% of patients the alteration was classified as of moderate/severe degree. We also evaluated quality of life thorough a structured questionnaire: 52% of the patients still lamented fatigue, 36% effort dyspnea, 10% anorexia, 14% dysgeusia or anosmia, 31% insomnia and 21% anxiety. Finally, we evaluated three prognostic indices (the Brixia radiologic score, the Charlson Comorbidity Index and the 4C mortality score) in terms of prediction of the clinical consequences of the disease. All of them significantly predicted the extent of short-term lung involvement. In conclusion, our study demonstrated that SARS-CoV-2-related pneumonia is associated to relevant short-term clinical consequences, both in terms of persistence of symptoms and in terms of impairment of DLCO (indicator of a possible development of pulmonary fibrosis); some severity indices of the disease may predict short-term clinical outcome. Further studies are needed to ascertain whether such manifestations may persist long-term.

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Section: Discussionmentioning

confidence: 99%

“…mechanical ventilation) oxygen therapy, according to their needs. For further clinical information see reference [ 1 ].…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Short-Term Consequences of SARS-CoV-2-Related Pneumonia: A Follow Up Study

Boari

Bonetti

Braglia-Orlandini

et al. 2021

High Blood Press Cardiovasc Prev

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Comparison of the characteristics, morbidity and mortality of COVID-19 between first and second/third wave in a hospital setting in Lombardy: a retrospective cohort study

et al. 2022

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Coronavirus disease 2019 (COVID-19) represents a major health problem in terms of deaths and long-term sequelae. We conducted a retrospective cohort study at Montichiari Hospital (Brescia, Italy) to better understand the determinants of outcome in two different COVID-19 outbreaks. A total of 634 unvaccinated patients admitted from local emergency room to the Internal Medicine ward with a confirmed diagnosis of SARS-CoV-2 infection and a moderate-to-severe COVID-19 were included in the study. A group of 260 consecutive patients during SARS-CoV-2 first wave (from February to May 2020) and 374 consecutive patients during SARS-CoV-2 2nd/3rd wave (from October 2020 to May 2021) were considered. Demographic data were not significantly different between waves, except a lower prevalence of female sex during first wave. Mortality was significantly higher during the 1st wave than in the following periods (24.2% vs. 11%; p < 0.001). Time from symptoms onset to hospital admission was longer during first wave (8 ± 6 vs. 6 ± 4 days; p < 0.001), while in-hospital staying was significantly shorter (10 ± 14 vs. 15 ± 11 days; p < 0.001). Other significant differences were a larger use of corticosteroids and low-molecular weight heparin as well less antibiotic prescription during the second wave. Respiratory, bio-humoral and X-ray scores were significantly poorer at the time of admission in first-wave patients. After a multivariate regression analysis, C-reactive protein and procalcitonin values, % fraction of inspired oxygen on admission to the Internal Medicine ward and length of hospital stay and duration of symptoms were the strongest predictors of outcome. Concomitant anti-hypertensive treatment (including ACE-inhibitors and angiotensin-receptor blockers) did not affect the outcome. In conclusion, our data suggest that earlier diagnosis, timely hospital admission and rational use of the therapeutic options reduced the systemic inflammatory response and were associated to a better outcome during the 2nd/3rd wave.

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Factors associated with poor outcomes among hospitalized patients with COVID-19: Experience from a MERS-CoV referral hospital

Barry¹,

Alotaibi²,

Almohaya³

et al. 2021

Journal of Infection and Public Health

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Background Coronavirus disease 2019 (COVID-19) has resulted in millions of deaths, including more than 6000 deaths in the Kingdom of Saudi Arabia (KSA). Identifying key predictors of intensive care unit (ICU) admission and mortality among infected cases would help in identifying individuals at risk to optimize their care. We aimed to determine factors of poor outcomes in hospitalized patients with COVID-19 in a large academic hospital in Riyadh, KSA that serves as a Middle East Respiratory Syndrome coronavirus (MERS-CoV) referral center. Methods This is a single-center retrospective cohort study of hospitalized patients between March 15 and August 31, 2020. The study was conducted at King Saud University Medical City (KSUMC). COVID-19 infection was confirmed using real-time reverse transcriptase polymerase chain reaction (RT-PCR) for SARS-COV-2. Demographic data, clinical characteristics, laboratory, radiological features, and length of hospital stay were obtained. Poor outcomes were, admission to ICU, need for invasive mechanical ventilation (IMV), and in-hospital all-cause mortality. Results Out of 16,947 individuals tested in KSUMC, 3,480 (20.5%) tested positive for SARS-CoV-2 and of those 743 patients (21%) were hospitalized. There were 62% males, 77% were younger than 65 years. Of all cases, 204 patients (28%) required ICU admission, 104 (14%) required IMV, and 117 (16%) died in hospital. In bivariate analysis, multiple factors were associated with mortality among COVID-19 patients. Further multivariate analysis revealed the following factors were associated with mortality: respiratory rate more than 24/min and systolic blood pressure < 90 mmHg in the first 24 hours of presentation, lymphocyte count <1 × 10 9 /L and aspartate transaminase level > 37 units/L in the first 48 hours of presentation, while a RT-PCR cycle threshold (Ct) value ≤24 was a predictor for IMV. Conclusion Variable factors were identified as predictors of different outcomes among COVID-19 patients. The only predictor of IMV was a low initial Ct values of SARS-CoV-2 PCR. The presence of tachypnea, hypotension, lymphopenia, and elevated AST in the first 48 hours of presentation were independently associated with mortality. This study provides possible independent predictors of mortality and invasive mechanical ventilation. The data may be helpful in the early identification of high-risk COVID-19 patients in areas endemic with MERS-CoV.

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Prognostic factors and predictors of outcome in patients with COVID-19 and related pneumonia: a retrospective cohort study

Cited by 29 publications

References 37 publications

Short-Term Consequences of SARS-CoV-2-Related Pneumonia: A Follow Up Study

Short-Term Consequences of SARS-CoV-2-Related Pneumonia: A Follow Up Study

Comparison of the characteristics, morbidity and mortality of COVID-19 between first and second/third wave in a hospital setting in Lombardy: a retrospective cohort study

Factors associated with poor outcomes among hospitalized patients with COVID-19: Experience from a MERS-CoV referral hospital

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