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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...

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Autores principales: 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
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
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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.
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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
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