30-day mortality in patients hospitalized with COVID-19 during the first wave of the Italian epidemic: A prospective cohort study.

Abstract

Italy was the first European country hit by the COVID-19 pandemic and has the highest number of recorded COVID-19 deaths in Europe. This prospective cohort study of the correlates of the risk of death in COVID-19 patients was conducted at the Infectious Diseases and Intensive Care units of Luigi Sacco Hospital, Milan, Italy. The clinical characteristics of all the COVID-19 patients hospitalised in the early days of the epidemic (21 February -19 March 2020) were recorded upon admission, and the time-dependent probability of death was evaluated using the Kaplan-Meier method (censored as of 20 April 2020). Cox proportional hazard models were used to assess the factors independently associated with the risk of death. Forty-eight (20.6 %) of the 233 patients followed up for a median of 40 days (interquartile range 33-47) died during the follow-up. Most were males (69.1 %) and their median age was 61 years (IQR 50-72). The time-dependent probability of death was 19.7 % (95 % CI 14.6-24.9 %) 30 days after hospital admission. Age (adjusted hazard ratio [aHR] 2.08, 95 % CI 1.48-2.92 per ten years more) and obesity (aHR 3.04, 95 % CI 1.42-6.49) were independently associated with an increased risk of death, which was also associated with critical disease (aHR 8.26, 95 % CI 1.41-48.29), C-reactive protein levels (aHR 1.17, 95 % CI 1.02-1.35 per 50 mg/L more) and creatinine kinase levels above 185 U/L (aHR 2.58, 95 % CI 1.37-4.87) upon admission. Case-fatality rate of patients hospitalized with COVID-19 in the early days of the Italian epidemic was about 20 %. Our study adds evidence to the notion that older age, obesity and more advanced illness are factors associated to an increased risk of death among patients hospitalized with COVID-19.

• Authors: Andrea Giacomelli, Anna Lisa Ridolfo, Laura Milazzo, Letizia Oreni, Dario Bernacchia, Matteo Siano, Cecilia Bonazzetti, Alice Covizzi, Marco Schiuma, Matteo Passerini, Marco Piscaglia, Massimo Coen, Guido Gubertini, Giuliano Rizzardini, Chiara Cogliati, Anna Maria Brambilla, Riccardo Colombo, Antonio Castelli, Roberto Rech, Agostino Riva, Alessandro Torre, Luca Meroni, Stefano Rusconi, Spinello Antinori, Massimo Galli
• Journal: Pharmacological research (Pharmacol Res) Vol. 158 Pg. 104931 (08 2020) ISSN: 1096-1186 [Electronic] Netherlands
• PMID: 32446978 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2020 Elsevier Ltd. All rights reserved.

Topics

• Age Factors
• Aged
• Betacoronavirus
• COVID-19
• Coronavirus Infections (mortality)
• Female
• Hospitalization (statistics & numerical data)
• Humans
• Italy (epidemiology)
• Male
• Middle Aged
• Pandemics
• Pneumonia, Viral (mortality)
• Prospective Studies
• Risk Factors
• SARS-CoV-2