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At the peak of COVID-19 age and disease severity but not comorbidities are predictors of mortality: COVID-19 burden in Bergamo, Italy

2021; Edizioni Minerva Medica; Volume: 63; Issue: 1 Linguagem: Inglês

10.23736/s0031-0808.20.04063-x

1827-1898

Luca Novelli, Federico Raimondi, Arianna Ghirardi, Dario Pellegrini, Davide Capodanno, Giovanni Sotgiu, Giulio Guagliumi, Michele Senni, Filippo Russo, Ferdinando Luca Lorini, Marco Rizzi, Tiziano Barbui, Alessandro Rambaldi, Roberto Cosentini, Lorenzo Grazioli, Gianmariano Marchesi, Giuseppe Francesco Sferrazza Papa, Simonetta Cesa, M. Colledan, Roberta Civiletti, Caterina Conti, Monica Casati, Francesco Ferri, Stefania Camagni, Maria Sessa, Arianna Masciulli, Antonello Gavazzi, Anna Falanga, L. Da Pozzo, Sabrina Buoro, Giuseppe Remuzzi, Piero Ruggenenti, Annapaola Callegaro, Lorenzo D’Antiga, L. Pasulo, Fabio Pezzoli, Andrea Gianatti, Piercarlo Parigi, Claudio Farina, Antonio Bellasi, Paolo Solidoro, Sandro Sironi, Fabiano Di Marco, S. Fagiuoli,

Long-Term Effects of COVID-19

Background.Findings from February, 2020, indicate that the clinical spectrum of Covid-19 can be heterogeneous, probably due to the infectious dose and viral load of SARS-CoV-2 within the first weeks of the outbreak.The aim of this study was to investigate predictors of overall 28-day mortality at the peak of the Italian outbreak.Methods.Retrospective observational study of all Covid-19 patients admitted to the main hospital of Bergamo, from February 23 to March, 14, 2020.Results.508 patients were hospitalized , predominantly male (72.4%), mean age of 66±15 years; 49.2% were older than 70 years.Most of patients presented with severe respiratory failure (median value [IQR] of PaO2/FiO2 233 [149-281]).Mortality rate at 28 days resulted of 33.7% (N=171).39.0% of patients were treated with continuous positive airway pressure (CPAP), 9.5% with non-invasive ventilation (NIV) and 13.6% with endotracheal intubation.9.5% were admitted to semi-intensive respiratory care unit, and 18.9% to ICU.Risk factors independently associated with 28-day mortality were advanced age (≥78 years: odds ratio, OR, 95% confidence interval [CI] 38.91 [10.67-141.93],p<0.001; 70-77 years: 17.30 [5.40-55.38],p<0.001; 60-69 years: 3.20 [1.00-10.20],p=0.049),PaO2/FiO2 <200 at presentation (3.50 [1.70-7.20],p=0.001), need for CPAP/NIV in the first 24 hours (8.38 [3.63-19.35],p <0.001), and blood urea value at admission (1.01 [1.00-1.02],p=0.015).Conclusions.At the peak of the outbreak, with a probable high infectious dose and viral load, older age, the severity of respiratory failure and renal impairment at presentation, but not comorbidities, are predictors of 28-day mortality in Covid-19.