Declining Mortality Rate of Hospitalised Patients in the Second Wave of the COVID-19 Epidemics in Italy: Risk Factors and the Age-Specific Patterns

D’Arminio Monforte, Antonella; Tavelli, Alessandro; Bai, Francesca; Tomasoni, Daniele; Falcinella, Camilla; Castoldi, Roberto; Barbanotti, Diletta; Mulè, Giovanni; Allegrini, Marina; Suardi, Elisa; Tesoro, Daniele; Tagliaferri, Gianmarco; Mondatore, Debora; Augello, Matteo; Cona, Andrea; Beringheli, Tomaso; Gemignani, Nicole; Sala, Matteo; Varisco, Benedetta; Molà , Francesco; Pettenuzzo, Sofia; Biasioli, Lorenzo; Copes, Alessandro; Gazzola, Lidia; Viganò, Ottavia; Tincati, Camilla; De Bona, Anna; Bini, Teresa; Marchetti, Giulia

Background: Mortality rate from COVID-19 in Italy is among the world’s highest. We aimed to ascertain whether there was any reduction of in-hospital mortality in patients hospitalised for COVID-19 in the second-wave period (October 2020–January 2021) compared to the first one (February–May 2020); further, we verified whether there were clusters of hospitalised patients who particularly benefitted from reduced mortality rate. Methods: Data collected related to in-patients’ demographics, clinical, laboratory, therapies and outcome. Primary end-point was time to in-hospital death. Factors associated were evaluated by uni- and multivariable analyses. A flow diagram was created to determine the rate of in-hospital death according to individual and disease characteristics. Results: A total of 1561 patients were included. The 14-day cumulative incidence of in-hospital death by competing risk regression was of 24.8% (95% CI: 21.3–28.5) and 15.9% (95% CI: 13.7–18.2) in the first and second wave. We observed that the highest relative reduction of death from first to second wave (more than 47%) occurred mainly in the clusters of patients younger than 70 years. Conclusions: Progress in care and supporting therapies did affect population over 70 years to a lesser extent. Preventive and vaccination campaigns should focus on individuals whose risk of death from COVID-19 remains high.