Abstract
BackgroundSome studies investigated epidemiological and clinical features of laboratory-confirmed patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) the virus causing coronavirus disease 2019 (COVID-19), but limited attention has been paid to the follow-up of hospitalized patients on the basis of clinical setting and the expertise of clinical management.MethodsIn the present single-centered, retrospective, observational study, we reported findings from 87 consecutive laboratory-confirmed COVID-19 patients with moderate-to-severe acute respiratory syndrome hospitalized in an intermediate Respiratory Intensive Care Unit (RICU), subdividing the patients in two groups according to the admission date (before and after March 29, 2020).ResultsWith improved skills in the clinical management of COVID-19, we observed a significant lower mortality in the T2 group compared with the T1 group and a significantly difference in terms of mortality among the patients transferred in Intensive Care Unit (ICU) from our intermediate RICU (100% in T1 group vs. 33.3% in T2 group). The average length of stay in intermediate RICU of ICU-transferred patients who survived in T1 and T2 was significantly longer than those who died (who died 3.3 ± 2.8 days vs. who survived 6.4 ± 3.3 days). TConclusionsThe present findings suggested that an intermediate level of hospital care may have the potential to modify survival in COVID-19 patients, particularly in the present phase of a more skilled clinical management of the pandemic.
Highlights
Some studies investigated epidemiological and clinical features of laboratory-confirmed patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) the virus causing coronavirus disease 2019 (COVID-19), but limited attention has been paid to the follow-up of hospitalized patients on the basis of clinical setting and the expertise of clinical management
Laboratory-confirmed COVID-19 patients were affected by acute respiratory distress syndrome (ARDS) defined according to the Berlin definition, so a respiratory failure characterized by arterial oxygen partial pressure to fractional inspired oxygen ratio (PaO2/FiO2) < 300 mmHg despite PEEP > 5 cmH2O, associated to bilateral chest opacities with an acute onset, within 1 week of a known clinical insult or new or worsening respiratory symptoms [13]
Mean age of this hospital-based sample was 69.1 ± 14.5 years, men were largely more represented than women (73.6% vs. 26.4%), and both gender groups showed a higher percentage of patients aged > 70 years compared to patients aged < 50 years (41.3% vs. 9.3%)
Summary
Some studies investigated epidemiological and clinical features of laboratory-confirmed patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) the virus causing coronavirus disease 2019 (COVID-19), but limited attention has been paid to the follow-up of hospitalized patients on the basis of clinical setting and the expertise of clinical management. The need to determine the full spectrum and natural history of the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing coronavirus disease 2019 (COVID-19), is to inform clinical management and public health decision making. Siddiqi and Mehra proposed a staged progression model based on observed clinical courses in published studies [9]. This 3-stage clinical classification system suggested that COVID-19 illness may exhibit 3 grades of increasing severity, which correspond with distinct clinical findings, response to therapy, and clinical outcome [9]. Rapid recognition of which stage the patient is and the development of appropriate therapy may have the greatest yield [9]
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