Clinical Characteristics of Severe COVID-19 Patients Admitted to an Intensive Care Unit in Lombardy During the Italian Pandemic

Abstract

Italy was one of the worst affected European countries during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. More than 50% of Italian cases occurred in the northern region of Lombardy, where the saturation of health services between March and April 2020 forced hospitals to allocate patients according to available resources. Eighteen severe coronavirus disease 2019 (COVID-19) patients were admitted to our hospital needing intensive support. Given the disease fatality, we investigated the patients' characteristics to identify mortality predictors. We counted seven deaths from multiple organ failure, two from septic shock, and two from collapsed lungs. The maximum case fatality was observed in patients who contracted SARS-CoV-2 in hospitals. The fatal outcome was associated with the following baseline characteristics: polymorbidity (OR 2.519, p = 0.048), low body mass index (OR 2.288, p = 0.031), low hemoglobin (OR 3.012, p = 0.046), and antithrombin III (OR 1.172, p = 0.048), along with a worsening of PaO2/FiO2 ratio in the first 72 h after admission (OR 1.067, p = 0.031). The occurrence of co-infections during hospitalization was associated with a longer need for intensive care (B = 4.511, p = 0.001). More information is needed to inform intensive care for patients with severe COVID-19, but our findings would certainly contribute to shed some light on this unpredictable and multifaceted disease.

Antithrombin and Its Role in Host Defense and Inflammation

“…The predictive value of AT for mortality in a population of critically ill patients was demonstrated earlier [23]. AT levels are more frequently aberrated in critically ill patients and were suggested as an indicator to advanced stages of COVID-19 [20,21].…”

“…Certain coagulation parameters were found to be increased, i.e., fibrinogen, D-Dimer, factor VIII, von Willebrand factor antigen, and protein C levels, whereas others were found to be decreased: AT and free protein S levels [19]. There are reports that linked mortality and decreased AT levels in COVID-19 patients [20,21]. However, decreased levels of AT are typical in severe infections, sepsis, and DIC [22].…”

COVID-19 Intelligence-Driven Operational Response Platform: Experience of a Large Tertiary Multihospital System in the Middle East

“…An early alignment among various groups on needs, goals, and expectations is essential before starting the development process. This is very challenging, yet crucial, for comprehending COVID-19 care demands in a multihospital system due to several reasons: (1) Lack of established guidelines or recommendations for handling COVID-19 patients, (2) Need to interview a large group of individuals at various levels of power and interest with potential conflicting requirements within the system, and (3) Hard to avoid redundant interviews with stakeholders of same exact role but on different hospital locations [ 19 , 20 , 21 ]. For this work, a quick stakeholder analysis exercise was conducted by interviewing the members of the enterprise-wide COVID-19 Command and Control Center to clarify the project scope and impacted end users.…”

Research on SARS-COV-2 pandemic: a narrative review focused on the Italian contribution

“…Leucocytes show a peculiar pattern in moderate-to-severe infection from SARS-CoV-2. This pattern is characterized by leukocytosis accompanied by a major increase in neutrophils count [ 49 ] and a relevant lymphopenia [ 44 , 50 ].…”