Abstract
The aim of this study is to explore risk factors for in-hospital mortality and describe the effectiveness of different treatment strategies of 205 laboratory-confirmed cases infected with SARS-CoV-2 during the Lombardy outbreak. All patients received the best supportive care and specific interventions that included the main drugs being tested for repurposing to treat COVID-19, such as hydroxychloroquine, anticoagulation and antiviral drugs, steroids, and interleukin-6 pathway inhibitors. Clinical, laboratory, and treatment characteristics were analyzed with univariate and multivariate logistic regression methods to explore their impact on in-hospital mortality. Univariate analyses showed prognostic significance for age greater than 70 years, the presence of two or more relevant comorbidities, a P/F ratio less than 200 at presentation, elevated LDH (lactate dehydrogenase) and CRP (C-reactive protein) values, intermediate- or therapeutic-dose anticoagulation, hydroxychloroquine, early antiviral therapy with lopinavir/ritonavir, short courses of steroids, and tocilizumab therapy. Multivariable regression confirmed increasing odds of in-hospital death associated with age older than 70 years (OR 3.26) and a reduction in mortality for patients treated with anticoagulant (−0.37), antiviral lopinavir/ritonavir (−1.22), or steroid (−0.59) therapy. In contrast, hydroxychloroquine and tocilizumab have not been confirmed to have a significant effect in the treatment of SARS-CoV-2 pneumonia. Results from this real-life single-center experience are in agreement and confirm actual literature data on SARS-CoV-2 pneumonia in terms of both clinical risk factors for in-hospital mortality and the effectiveness of the different therapies proposed for the management of COVID19 disease.
Highlights
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), represents a viral disease infecting millions of individuals all over the world and has emerged as a major public health emergency of international concern
Blood chemistry variables were recorded as both value at presentation and maximum value achieved during hospitalization, while interleukin 6 (IL6) values were recorded only in 29 patient candidates for tocilizumab therapy
In a modeling study based on Chinese data, the hospitalization rate for COVID-19 increased with age, with an 11.8% rate for those 60 to years old, 16.6% rate for those to 79 years old, and
Summary
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), represents a viral disease infecting millions of individuals all over the world and has emerged as a major public health emergency of international concern. COVID-19 a pandemic disease because of widespread infectivity and high contagion rates. Full-genome sequencing indicated that COVID-19 is a betacoronavirus in the same subgenus as the severe acute respiratory syndrome (SARS) virus. Direct person-to-person transmission is the primary means of transmission of SARS-CoV-2, mainly through close-range contact via respiratory droplets or by transfer to mucous membranes after coming into contact with contaminated surfaces; 2 and 12 days are the lower and upper extremes of the incubation period for COVID-19, with most cases occurring approximately 4 to 5 days after exposure [2,3]. Several studies describing the clinical features of COVID-19 have been performed on hospitalized populations [4,5,6]
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