Trends of COVID-19 Admissions in an Italian Hub during the Pandemic Peak: Large Retrospective Study Focused on Older Subjects

Abstract

Older multimorbid frail subjects have been severely involved in the coronavirus disease-19 (COVID-19) pandemic. The aim of this retrospective study is to compare the clinical features and outcomes of patients admitted in different phases of the outbreak in a COVID-19 hospital hub, with a particular focus on age, multimorbidity, and functional dependency. The clinical records of 1264 patients with clinical and radiological features compatible with COVID-19 pneumonia admitted in February–June, 2020, were analyzed, retrieving demographical, clinical, laboratory data, and outcomes. All variables were compared after stratification by the period of admission (first phase: rising slope of pandemic wave; second phase: plateau and falling slope), age, results of the first reverse transcriptase-polymerase chain reaction (RT-PCR) test for detection of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), multimorbidity (≥2 chronic diseases), and presence of disability. Factors independently associated with hospital mortality were determined by multivariate forward-selection logistic regression. Patients admitted during the second phase were older, more frequently multimorbid, disabled, and of female gender. However, on admission they exhibited milder respiratory impairment (PaO2/FiO2 268, IQR 174–361, vs. 238, IQR 126–327 mmHg, p < 0.001) and lower mortality (22% vs. 27%, p < 0.001). Age, respiratory exchanges, positive RT-PCR test, number of chronic diseases (odds ratio (OR) 1.166, 95% confidence interval (CI) 1.036–1.313, p = 0.011), and disability (OR 1.927, 95% CI 1.027–3.618, p = 0.022) were positively associated with mortality, while admission during the second phase exhibited an inverse association (OR 0.427, 95% CI 0.260–0.700, p = 0.001). In conclusion, older multimorbid patients were mainly hospitalized during the second phase of the pandemic wave. The prognosis was strongly influenced by the COVID-19 phenotype and period of admission, not just by age, multimorbidity, and disability.

Co-Administration of Remdesivir and Azithromycin May Protect against Intensive Care Unit Admission in COVID-19 Pneumonia Requiring Hospitalization: A Real-Life Observational Study

“…However, the majority of severe cases of COVID-19 generally involve older subjects, with several comorbidities and relevant pneumonia extension on chest imaging [ 22 , 34 , 35 ]. Age-related frailty represents a consistent risk factor for adverse outcomes in COVID-19 [ 35 , 36 ], also for the increased risk of bacterial superinfection [ 37 ].…”

“…This was a retrospective, real-life, observational study conducted in the context of the third pandemic wave in Italy in March 2021, which was mainly sustained by the emergence of the alpha SARS-CoV-2 variant [ 20 ]. The setting of the study was the Internal Medicine Unit of the Geriatric-Rehabilitation Department of Parma University-Hospital, which had been identified as the main hub for the hospital care of patients with COVID-19 of the whole Parma Province (>450,000 inhabitants) since the first wave in 2020 [ 21 , 22 ].…”

Patient Characteristics and Clinical Course of COVID-19 Patients Treated at a German Tertiary Center during the First and Second Waves in the Year 2020

“…The extreme straining of many healthcare systems surely has contributed to high mortality rates in some countries especially during the early phases of the pandemic [ 16 , 39 , 40 , 41 ]. Ticinesi et al reported that while COVID-19 patients treated with COVID-19 at an Italian hospital hub during the first weeks of the pandemic were younger and had fewer comorbidities than those admitted between late March and early June 2020, mortality decreased from 27% to 22% [ 42 ]. Likewise, a large retrospective study analyzing the hospital course of 20,736 COVID-19 patients in the US recently demonstrated that in-hospital mortality rates decreased from 19% in March and April 2020 to 11% in September through November 2020 and that this difference persisted after accounting for age, sex, and comorbidities [ 43 ].…”

Association between multimorbidity and hospitalization in older adults: systematic review and meta-analysis

“…Most studies (70%) included in this systematic review were conducted in high-income countries, which reflects the lower support and funding for research in middle- and low-income countries, such as Brazil, where the government does not currently support or encourage science [ 84 ]. It is also important to acknowledge that studies on multimorbidity and hospitalization are increasingly relevant both due to population ageing and the advent of the COVID-19 pandemic, which increases hospitalization and mortality in those with multimorbidity [ 85 , 86 ].…”