Early predictors of clinical outcomes of COVID-19 outbreak in Milan, Italy

Fabio Ciceri, Antonella Castagna, Patrizia Rovere-Querini, Francesco De Cobelli, Annalisa Ruggeri, Laura Galli, Caterina Conte, Rebecca De Lorenzo, Andrea Poli, Alberto Ambrosio, Carlo Signorelli, Eleonora Bossi, Maria Fazio, Cristina Tresoldi, Sergio Colombo, Giacomo Monti, Efgeny Fominskiy, Stefano Franchini, Marzia Spessot, Carlo Martinenghi, Michele Carlucci, Luigi Beretta, Anna Maria Scandroglio, Massimo Clementi, Massimo Locatelli, Moreno Tresoldi, Paolo Scarpellini, Gianvito Martino, Emanuele Bosi, Lorenzo Dagna, Adriano Lazzarin, Giovanni Landoni, Alberto Zangrillo, Fabio Ciceri, Antonella Castagna, Patrizia Rovere-Querini, Francesco De Cobelli, Annalisa Ruggeri, Laura Galli, Caterina Conte, Rebecca De Lorenzo, Andrea Poli, Alberto Ambrosio, Carlo Signorelli, Eleonora Bossi, Maria Fazio, Cristina Tresoldi, Sergio Colombo, Giacomo Monti, Efgeny Fominskiy, Stefano Franchini, Marzia Spessot, Carlo Martinenghi, Michele Carlucci, Luigi Beretta, Anna Maria Scandroglio, Massimo Clementi, Massimo Locatelli, Moreno Tresoldi, Paolo Scarpellini, Gianvito Martino, Emanuele Bosi, Lorenzo Dagna, Adriano Lazzarin, Giovanni Landoni, Alberto Zangrillo

Abstract

Background: National health-system hospitals of Lombardy faced a heavy burden of admissions for acute respiratory distress syndromes associated with coronavirus disease (COVID-19). Data on patients of European origin affected by COVID-19 are limited.

Methods: All consecutive patients aged ≥18 years, coming from North-East of Milan's province and admitted at San Raffaele Hospital with COVID-19, between February 25th and March 24th, were reported, all patients were followed for at least one month. Clinical and radiological features at admission and predictors of clinical outcomes were evaluated.

Results: Of the 500 patients admitted to the Emergency Unit, 410 patients were hospitalized and analyzed: median age was 65 (IQR 56-75) years, and the majority of patients were males (72.9%). Median (IQR) days from COVID-19 symptoms onset was 8 (5-11) days. At hospital admission, fever (≥ 37.5 °C) was present in 67.5% of patients. Median oxygen saturation (SpO2) was 93% (range 60-99), with median PaO2/FiO2 ratio, 267 (IQR 184-314). Median Radiographic Assessment of Lung Edema (RALE) score was 9 (IQR 4-16). More than half of the patients (56.3%) had comorbidities, with hypertension, coronary heart disease, diabetes and chronic kidney failure being the most common. The probability of overall survival at day 28 was 66%. Multivariable analysis showed older age, coronary artery disease, cancer, low lymphocyte count and high RALE score as factors independently associated with an increased risk of mortality.

Conclusion: In a large cohort of COVID-19 patients of European origin, main risk factors for mortality were older age, comorbidities, low lymphocyte count and high RALE.

Keywords: ARDS; COVID-19; Infection; RALE score.

Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

Figures

Fig. 1
Fig. 1
Study Flow chart.
Fig. 2
Fig. 2
Kaplan-Meier estimates on survival by A: age; B: Hypertension; C: Diabetes; D: RALE score (stratified according to best cut-off).
Fig. 3
Fig. 3
Temporal trends in laboratory markers during hospitalization. A: Total Lymphocyte count (109/L), B: Lactate dehydrogenase, (U/L), C: C-reactive protein (mg/L), D: N-terminal prohormone of brain natriuretic peptide, (pg/mL). Solid lines connect median values estimated on raw data; bars are quartiles.

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Source: PubMed

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