Clinical factors associated with death in 3044 COVID-19 patients managed in internal
      medicine wards in Italy: results from the SIMI-COVID-19 study of the Italian Society
      of Internal Medicine (SIMI)

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Abstract

During the COVID-19 2020 outbreak, a large body of data has been provided on general management and outcomes of hospitalized COVID-19 patients. Yet, relatively little is known on characteristics and outcome of patients managed in Internal Medicine Units (IMU). To address this gap, the Italian Society of Internal Medicine has conducted a nationwide cohort multicentre study on death outcome in adult COVID-19 patients admitted and managed in IMU. This study assessed 3044 COVID-19 patients at 41 referral hospitals across Italy from February 3rd to May 8th 2020. Demographics, comorbidities, organ dysfunction, treatment, and outcomes including death were assessed. During the study period, 697 patients (22.9%) were transferred to intensive care units, and 351 died in IMU (death rate 14.9%). At admission, factors independently associated with in-hospital mortality were age (OR 2.46, p = 0.000), productive cough (OR 2.04, p = 0.000), pre-existing chronic heart failure (OR 1.58, p = 0.017) and chronic obstructive pulmonary disease (OR 1.17, p = 0.048), the number of comorbidities (OR 1.34, p = 0.000) and polypharmacy (OR 1.20, p = 0.000). Of note, up to 40% of elderly patients did not report fever at admission. Decreasing PaO ₂/FiO ₂ ratio at admission was strongly inversely associated with survival. The use of conventional oxygen supplementation increased with the number of pre-existing comorbidities, but it did not associate with better survival in patients with PaO ₂/FiO ₂ ratio < 100. The latter, significantly benefited by the early use of non-invasive mechanical ventilation. Our study identified PaO ₂/FiO ₂ ratio at admission and comorbidity as the main alert signs to inform clinical decisions and resource allocation in non-critically ill COVID-19 patients admitted to IMU.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11739-021-02742-8.

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Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report

Mark Peters (2021)

Abstract Background Coronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death. Methods In this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with Covid-19, we randomly assigned patients to receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days or to receive usual care alone. The primary outcome was 28-day mortality. Here, we report the preliminary results of this comparison. Results A total of 2104 patients were assigned to receive dexamethasone and 4321 to receive usual care. Overall, 482 patients (22.9%) in the dexamethasone group and 1110 patients (25.7%) in the usual care group died within 28 days after randomization (age-adjusted rate ratio, 0.83; 95% confidence interval [CI], 0.75 to 0.93; P<0.001). The proportional and absolute between-group differences in mortality varied considerably according to the level of respiratory support that the patients were receiving at the time of randomization. In the dexamethasone group, the incidence of death was lower than that in the usual care group among patients receiving invasive mechanical ventilation (29.3% vs. 41.4%; rate ratio, 0.64; 95% CI, 0.51 to 0.81) and among those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; rate ratio, 0.82; 95% CI, 0.72 to 0.94) but not among those who were receiving no respiratory support at randomization (17.8% vs. 14.0%; rate ratio, 1.19; 95% CI, 0.91 to 1.55). Conclusions In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support. (Funded by the Medical Research Council and National Institute for Health Research and others; RECOVERY ClinicalTrials.gov number, NCT04381936; ISRCTN number, 50189673.)

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Author and article information

Contributors

Antonello Pietrangelo:

ORCID: http://orcid.org/0000-0002-7411-935X

antonello.pietrangelo@unimore.it

Journal

Journal ID (nlm-ta): Intern Emerg Med

Journal ID (iso-abbrev): Intern Emerg Med

Title: Internal and Emergency Medicine

Publisher: Springer International Publishing (Cham )

ISSN (Print): 1828-0447

ISSN (Electronic): 1970-9366

Publication date (Electronic): 24 April 2021

Pages: 1-11

Affiliations

[1 ]GRID grid.413363.0, ISNI 0000 0004 1769 5275, Unit of Internal Medicine, , University Hospital Policlinico di Modena, ; Modena, Italy

[2 ]GRID grid.18147.3b, ISNI 0000000121724807, Department of Medicine and Surgery, , University of Insubria, ; Varese, Italy

[3 ]GRID grid.4708.b, ISNI 0000 0004 1757 2822, Department of Internal Medicine, Luigi Sacco Hospital, , University of Milan, ; Milan, Italy

[4 ]GRID grid.7637.5, ISNI 0000000417571846, Department of Clinical and Experimental Sciences, , University of Brescia-Medicina 2, ASST Spedali Civili Brescia, ; Brescia, Italy

[5 ]GRID grid.5611.3, ISNI 0000 0004 1763 1124, Department of Medicine, Section of Internal Medicine, , University of Verona, ; Verona, Italy

[6 ]GRID grid.16563.37, ISNI 0000000121663741, Internal Medicine Department of Translational Medicine, , University of Piemonte Orientale, ; Novara, Italy

[7 ]GRID grid.8142.f, ISNI 0000 0001 0941 3192, Department of Medical and Surgical Sciences, , Fondazione Policlinico Gemelli IRCCS, Università Cattolica del S. Cuore, ; Rome, Italy

[8 ]GRID grid.5608.b, ISNI 0000 0004 1757 3470, Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine-DIMED, , University of Padova, ; Padua, Italy

[9 ]GRID grid.18887.3e, ISNI 0000000417581884, Unit of Internal Medicine, , IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, ; Milan, Italy

[10 ]GRID grid.5608.b, ISNI 0000 0004 1757 3470, Department of Medicine, , Università degli Studi di Padova, ; Padua, Italy

[11 ]GRID grid.4708.b, ISNI 0000 0004 1757 2822, Dipartimento di Scienze della Salute, , Università degli Studi di Milano, ; Milan, Italy

[12 ]GRID grid.6292.f, ISNI 0000 0004 1757 1758, Division of Internal Medicine, , IRCCS Azienda Ospedaliero, Universitaria di Bologna, ; Bologna, Italy

[13 ]GRID grid.414759.a, ISNI 0000 0004 1760 170X, Department of Internal Medicine, , Fatebenefratelli, ; Milan, Italy

[14 ]GRID grid.419425.f, ISNI 0000 0004 1760 3027, Emergency Department, , Fondazione IRCCS Policlinico San Matteo, ; Pavia, Italy

[15 ]GRID grid.7841.a, Department of Clinical and Molecular Medicine, , Sapienza University, ; Rome, Italy

[16 ]GRID grid.5606.5, ISNI 0000 0001 2151 3065, Department of Internal Medicine, , University of Genoa and Policlinico San Martino, ; Genoa, Italy

[17 ]GRID grid.7605.4, ISNI 0000 0001 2336 6580, Department of Medical Sciences, , University of Turin, ; Turin, Italy

[18 ]GRID grid.5611.3, ISNI 0000 0004 1763 1124, Department of Internal Medicine, , University of Verona, ; Verona, Italy

[19 ]GRID grid.5611.3, ISNI 0000 0004 1763 1124, Department of Medicine, , Policlinico GB Rossi, University of Verona and AOUI Verona, ; Verona, Italy

[20 ]GRID grid.7841.a, Department of Clinical and Molecular Medicine, , Sapienza University of Rome, ; Rome, Italy

[21 ]Department of Internal Medicine, Ospedale di Cattinara, University of Trieste, Trieste, Italy

[22 ]GRID grid.7637.5, ISNI 0000000417571846, Department of Clinical and Experimental Sciences, , Clinica Medica, University of Brescia, ; Brescia, Italy

[23 ]GRID grid.10796.39, ISNI 0000000121049995, Department of Medical and Surgical Sciences, , University of Foggia, ; Foggia, Italy

[24 ]GRID grid.412451.7, ISNI 0000 0001 2181 4941, Department of Medicine and Aging, Clinica Medica, , “G. D’Annunzio” University of Chieti-Pescara, ; Chieti, Italy

[25 ]GRID grid.158820.6, ISNI 0000 0004 1757 2611, Department of Health, Life and Environmental Sciences, , University of L’Aquila, ; L’Aquila, Italy

[26 ]GRID grid.8484.0, ISNI 0000 0004 1757 2064, Department of Medical Sciences, , University of Ferrara, ; Ferrara, Italy

[27 ]GRID grid.416325.7, Internal Medicine Department, , San Carlo Hospital, ; Paderno Dugnano, Milan, Italy

Author information

Antonello Pietrangelo http://orcid.org/0000-0002-7411-935X

Article

Publisher ID: 2742

DOI: 10.1007/s11739-021-02742-8

PMC ID: 8065333

PubMed ID: 33893976

SO-VID: b98add9c-3229-4767-8580-143bdfbc9958

License:

This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

History

Date received : 19 February 2021

Date accepted : 9 April 2021

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