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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| Format: | Article |
| Language: | English |
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MDPI AG
2020-05-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/5/1548 |
| _version_ | 1797567413777072128 |
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| author | Maurizio Cecconi Daniele Piovani Enrico Brunetta Alessio Aghemo Massimiliano Greco Michele Ciccarelli Claudio Angelini Antonio Voza Paolo Omodei Edoardo Vespa Nicola Pugliese Tommaso Lorenzo Parigi Marco Folci Silvio Danese Stefanos Bonovas |
| author_facet | Maurizio Cecconi Daniele Piovani Enrico Brunetta Alessio Aghemo Massimiliano Greco Michele Ciccarelli Claudio Angelini Antonio Voza Paolo Omodei Edoardo Vespa Nicola Pugliese Tommaso Lorenzo Parigi Marco Folci Silvio Danese Stefanos Bonovas |
| author_sort | Maurizio Cecconi |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-03-10T19:41:30Z |
| format | Article |
| id | doaj.art-231475944be44df4856d101e363b0e4a |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T19:41:30Z |
| publishDate | 2020-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-231475944be44df4856d101e363b0e4a2023-11-20T01:09:14ZengMDPI AGJournal of Clinical Medicine2077-03832020-05-0195154810.3390/jcm9051548Early Predictors of Clinical Deterioration in a Cohort of 239 Patients Hospitalized for Covid-19 Infection in Lombardy, ItalyMaurizio Cecconi0Daniele Piovani1Enrico Brunetta2Alessio Aghemo3Massimiliano Greco4Michele Ciccarelli5Claudio Angelini6Antonio Voza7Paolo Omodei8Edoardo Vespa9Nicola Pugliese10Tommaso Lorenzo Parigi11Marco Folci12Silvio Danese13Stefanos Bonovas14Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, ItalyWe 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.https://www.mdpi.com/2077-0383/9/5/1548SARS-CoV-22019 novel coronavirussevere acute respiratory syndrome coronavirus 22019-nCoVCOVID-19 |
| spellingShingle | Maurizio Cecconi Daniele Piovani Enrico Brunetta Alessio Aghemo Massimiliano Greco Michele Ciccarelli Claudio Angelini Antonio Voza Paolo Omodei Edoardo Vespa Nicola Pugliese Tommaso Lorenzo Parigi Marco Folci Silvio Danese Stefanos Bonovas Early Predictors of Clinical Deterioration in a Cohort of 239 Patients Hospitalized for Covid-19 Infection in Lombardy, Italy Journal of Clinical Medicine SARS-CoV-2 2019 novel coronavirus severe acute respiratory syndrome coronavirus 2 2019-nCoV COVID-19 |
| 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 | SARS-CoV-2 2019 novel coronavirus severe acute respiratory syndrome coronavirus 2 2019-nCoV COVID-19 |
| url | https://www.mdpi.com/2077-0383/9/5/1548 |
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