Cargando…
Early Predictors of Clinical Deterioration in a Cohort of 239 Patients Hospitalized for Covid-19 Infection in Lombardy, Italy
We described features of hospitalized Covid-19 patients and identified predictors of clinical deterioration. We included patients consecutively admitted at Humanitas Research Hospital (Rozzano, Milan, Italy); retrospectively extracted demographic; clinical; laboratory and imaging findings at admissi...
Autores principales: | , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290833/ https://www.ncbi.nlm.nih.gov/pubmed/32443899 http://dx.doi.org/10.3390/jcm9051548 |
_version_ | 1783545769060466688 |
---|---|
author | Cecconi, Maurizio Piovani, Daniele Brunetta, Enrico Aghemo, Alessio Greco, Massimiliano Ciccarelli, Michele Angelini, Claudio Voza, Antonio Omodei, Paolo Vespa, Edoardo Pugliese, Nicola Parigi, Tommaso Lorenzo Folci, Marco Danese, Silvio Bonovas, Stefanos |
author_facet | Cecconi, Maurizio Piovani, Daniele Brunetta, Enrico Aghemo, Alessio Greco, Massimiliano Ciccarelli, Michele Angelini, Claudio Voza, Antonio Omodei, Paolo Vespa, Edoardo Pugliese, Nicola Parigi, Tommaso Lorenzo Folci, Marco Danese, Silvio Bonovas, Stefanos |
author_sort | Cecconi, Maurizio |
collection | PubMed |
description | We described features of hospitalized Covid-19 patients and identified predictors of clinical deterioration. We included patients consecutively admitted at Humanitas Research Hospital (Rozzano, Milan, Italy); retrospectively extracted demographic; clinical; laboratory and imaging findings at admission; used survival methods to identify factors associated with clinical deterioration (defined as intensive care unit (ICU) transfer or death), and developed a prognostic index. Overall; we analyzed 239 patients (29.3% females) with a mean age of 63.9 (standard deviation [SD]; 14.0) years. Clinical deterioration occurred in 70 patients (29.3%), including 41 (17.2%) ICU transfers and 36 (15.1%) deaths. The most common symptoms and signs at admission were cough (77.8%) and elevated respiratory rate (34.1%), while 66.5% of patients had at least one coexisting medical condition. Imaging frequently revealed ground-glass opacity (68.9%) and consolidation (23.8%). Age; increased respiratory rate; abnormal blood gas parameters and imaging findings; coexisting coronary heart disease; leukocytosis; lymphocytopenia; and several laboratory parameters (elevated procalcitonin; interleukin-6; serum ferritin; C-reactive protein; aspartate aminotransferase; lactate dehydrogenase; creatinine; fibrinogen; troponin-I; and D-dimer) were significant predictors of clinical deterioration. We suggested a prognostic index to assist risk-stratification (C-statistic; 0.845; 95% CI; 0.802–0.887). These results could aid early identification and management of patients at risk, who should therefore receive additional monitoring and aggressive supportive care. |
format | Online Article Text |
id | pubmed-7290833 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-72908332020-06-17 Early Predictors of Clinical Deterioration in a Cohort of 239 Patients Hospitalized for Covid-19 Infection in Lombardy, Italy Cecconi, Maurizio Piovani, Daniele Brunetta, Enrico Aghemo, Alessio Greco, Massimiliano Ciccarelli, Michele Angelini, Claudio Voza, Antonio Omodei, Paolo Vespa, Edoardo Pugliese, Nicola Parigi, Tommaso Lorenzo Folci, Marco Danese, Silvio Bonovas, Stefanos J Clin Med Article We described features of hospitalized Covid-19 patients and identified predictors of clinical deterioration. We included patients consecutively admitted at Humanitas Research Hospital (Rozzano, Milan, Italy); retrospectively extracted demographic; clinical; laboratory and imaging findings at admission; used survival methods to identify factors associated with clinical deterioration (defined as intensive care unit (ICU) transfer or death), and developed a prognostic index. Overall; we analyzed 239 patients (29.3% females) with a mean age of 63.9 (standard deviation [SD]; 14.0) years. Clinical deterioration occurred in 70 patients (29.3%), including 41 (17.2%) ICU transfers and 36 (15.1%) deaths. The most common symptoms and signs at admission were cough (77.8%) and elevated respiratory rate (34.1%), while 66.5% of patients had at least one coexisting medical condition. Imaging frequently revealed ground-glass opacity (68.9%) and consolidation (23.8%). Age; increased respiratory rate; abnormal blood gas parameters and imaging findings; coexisting coronary heart disease; leukocytosis; lymphocytopenia; and several laboratory parameters (elevated procalcitonin; interleukin-6; serum ferritin; C-reactive protein; aspartate aminotransferase; lactate dehydrogenase; creatinine; fibrinogen; troponin-I; and D-dimer) were significant predictors of clinical deterioration. We suggested a prognostic index to assist risk-stratification (C-statistic; 0.845; 95% CI; 0.802–0.887). These results could aid early identification and management of patients at risk, who should therefore receive additional monitoring and aggressive supportive care. MDPI 2020-05-20 /pmc/articles/PMC7290833/ /pubmed/32443899 http://dx.doi.org/10.3390/jcm9051548 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Cecconi, Maurizio Piovani, Daniele Brunetta, Enrico Aghemo, Alessio Greco, Massimiliano Ciccarelli, Michele Angelini, Claudio Voza, Antonio Omodei, Paolo Vespa, Edoardo Pugliese, Nicola Parigi, Tommaso Lorenzo Folci, Marco Danese, Silvio Bonovas, Stefanos Early Predictors of Clinical Deterioration in a Cohort of 239 Patients Hospitalized for Covid-19 Infection in Lombardy, Italy |
title | Early Predictors of Clinical Deterioration in a Cohort of 239 Patients Hospitalized for Covid-19 Infection in Lombardy, Italy |
title_full | Early Predictors of Clinical Deterioration in a Cohort of 239 Patients Hospitalized for Covid-19 Infection in Lombardy, Italy |
title_fullStr | Early Predictors of Clinical Deterioration in a Cohort of 239 Patients Hospitalized for Covid-19 Infection in Lombardy, Italy |
title_full_unstemmed | Early Predictors of Clinical Deterioration in a Cohort of 239 Patients Hospitalized for Covid-19 Infection in Lombardy, Italy |
title_short | Early Predictors of Clinical Deterioration in a Cohort of 239 Patients Hospitalized for Covid-19 Infection in Lombardy, Italy |
title_sort | early predictors of clinical deterioration in a cohort of 239 patients hospitalized for covid-19 infection in lombardy, italy |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290833/ https://www.ncbi.nlm.nih.gov/pubmed/32443899 http://dx.doi.org/10.3390/jcm9051548 |
work_keys_str_mv | AT cecconimaurizio earlypredictorsofclinicaldeteriorationinacohortof239patientshospitalizedforcovid19infectioninlombardyitaly AT piovanidaniele earlypredictorsofclinicaldeteriorationinacohortof239patientshospitalizedforcovid19infectioninlombardyitaly AT brunettaenrico earlypredictorsofclinicaldeteriorationinacohortof239patientshospitalizedforcovid19infectioninlombardyitaly AT aghemoalessio earlypredictorsofclinicaldeteriorationinacohortof239patientshospitalizedforcovid19infectioninlombardyitaly AT grecomassimiliano earlypredictorsofclinicaldeteriorationinacohortof239patientshospitalizedforcovid19infectioninlombardyitaly AT ciccarellimichele earlypredictorsofclinicaldeteriorationinacohortof239patientshospitalizedforcovid19infectioninlombardyitaly AT angeliniclaudio earlypredictorsofclinicaldeteriorationinacohortof239patientshospitalizedforcovid19infectioninlombardyitaly AT vozaantonio earlypredictorsofclinicaldeteriorationinacohortof239patientshospitalizedforcovid19infectioninlombardyitaly AT omodeipaolo earlypredictorsofclinicaldeteriorationinacohortof239patientshospitalizedforcovid19infectioninlombardyitaly AT vespaedoardo earlypredictorsofclinicaldeteriorationinacohortof239patientshospitalizedforcovid19infectioninlombardyitaly AT pugliesenicola earlypredictorsofclinicaldeteriorationinacohortof239patientshospitalizedforcovid19infectioninlombardyitaly AT parigitommasolorenzo earlypredictorsofclinicaldeteriorationinacohortof239patientshospitalizedforcovid19infectioninlombardyitaly AT folcimarco earlypredictorsofclinicaldeteriorationinacohortof239patientshospitalizedforcovid19infectioninlombardyitaly AT danesesilvio earlypredictorsofclinicaldeteriorationinacohortof239patientshospitalizedforcovid19infectioninlombardyitaly AT bonovasstefanos earlypredictorsofclinicaldeteriorationinacohortof239patientshospitalizedforcovid19infectioninlombardyitaly |