Clinical characteristics, management and in-hospital mortality of patients with COVID-19 In Genoa, Italy

Vena, Antonio; Giacobbe, Daniele Roberto; Di Biagio, Antonio; Mikulska, Malgorzata; Taramasso, Lucia; De Maria, Andrea; Ball, Lorenzo; Brunetti, Iole; Loconte, Maurizio; Patroniti, Nicolò A.; Robba, Chiara; Delfino, Emanuele; Dentone, Chiara; Magnasco, Laura; Nicolini, Laura; Toscanini, Federica; Bavastro, Martina; Cerchiaro, Matteo; Barisione, Emanuela; Giacomini, Mauro; Mora, Sara; Baldi, Federico; Balletto, Elisa; Berruti, Marco; Briano, Federica; Sepulcri, Chiara; Dettori, Silvia; Labate, Laura; Mirabella, Michele; Portunato, Federica; Pincino, Rachele; Russo, Chiara; Tutino, Stefania; Pelosi, Paolo; Bassetti, Matteo

OBJECTIVES: To describe clinical characteristics, management and outcome of COVID-19 patients; and to evaluate risk factors for all-cause in-hospital mortality. METHODS: This retrospective study from a University tertiary care hospital in northern Italy, included hospitalized adult patients with a diagnosis of COVID-19 between February 25(th), 2020 and March 25(th), 2020. RESULTS: Overall, 317 patients were enrolled. Their median age 71 years and 67.2% were males (213/317). The most common underlying diseases were hypertension (149/317; 47.0%), cardiovascular disease (63/317, 19.9%) and diabetes (49/317; 15.5%). Common symptoms at the time of COVID-19 diagnosis included fever (285/317; 89.9%), shortness of breath (167/317; 52.7%) and dry cough (156/317,49.2%). An “atypical” presentation including at least one among mental confusion, diarrhea or nausea and vomiting was observed in 53/317 patients (16.7%). Hypokalemia occurred in 25.8% (78/302) and 18.5% (56/303) had acute kidney injury. During hospitalization, 111/317 patients (35.0%) received non-invasive respiratory support, 65/317 (20.5%) were admitted to the intensive care unit (ICU) and 60/317 (18.5%) required invasive mechanical ventilation. All cause in-hospital mortality, assessed in 275 patients, was 43.6% (120/275). On multivariable analysis, age (per-year increase odds ratio [OR]:1.07; 95% confidence interval [CI] 1.04-1.10, p<0.001), cardiovascular disease (OR:2.58; 95% CI 1.07-6.25; p=0.03), and C-reactive protein levels (per-point increase OR:1.009; 95% CI 1.004-1.014; p=0.001) were independent risk factors for all-cause in-hospital mortality. CONCLUSIONS: COVID-19 mainly affected elderly patients with predisposing conditions and caused severe illness, frequently requiring non-invasive respiratory support or ICU admission. Despite supportive care, COVID-19 remains associated with a substantial risk of all-cause in-hospital mortality.