Clinical factors associated with death in 3044 COVID-19 patients managed in internal medicine wards in Italy: results from the SIMI-COVID-19 study of the Italian Society of Internal Medicine (SIMI)

Clinical factors associated with death in 3044 COVID-19 patients managed in internal medicine wards in Italy: comment

“…This was also true but with lower strength for cancer and diabetes, with a definite trend of positive association for a history of myocardial infarction and atrial fibrillation but only in the frame of the univariate analysis. At variance with Corradini et al [ 1 ], COPD was not associated with the mortality risk but this difference may be explained by the size of our cohort that was one third smaller than that based on the whole country. Regarding oxygen supplementation, similarly to the findings from the SIMI-COVID-19 cohort, 69.6% of patients enrolled in our registry was treated with oxygen support during hospitalization and 20.5% received non-invasive ventilation (CPAP, NIV or HFNC).…”

“…Recently in this journal Corradini et al [ 1 ] reported the results of a nationwide registry of 3044 patients (mean age 67 ± 15 years) hospitalized in Italian internal medicine wards during the time period spanning from February 2 to May 8, 2020, when the country was the first in Europe and the second in the world after China to be dramatically hit by the infection with the coronavirus SARS-CoV2 and the dire clinical manifestations of COVID-19. The main results obtained from the registry data collected in 41 medical wards across the country showed that 351 infected patients died during their hospital stay in the medical wards, with an additional 310 cases who died after transferral to intensive care units (ICU), with a total in-hospital mortality rate of 21.7% ( n = 661).…”

“…In the context of these findings, Corradini et al [ 1 ] chose to evaluate which patient features recorded at the time of admission were positively or negatively associated with mortality. First and importantly, age was independently associated with in-hospital death (OR 2.46).…”

“…At variance with the patients reported by Corradini et al [ 1 ] admitted upfront to medical wards, 1018 patients with COVID-19 (mean age 65 ± 16) enrolled in this registry were first screened at the emergency room and found to be positive for SARS-CoV2 RNA by RT-PCR. Then those who, owing to their moderately severe pulmonary involvement, did not need admission to intensive care units were preferentially admitted to pneumology wards, where continuous positive airway pressure (CPAP) non-invasive ventilation (NIV) or high flow-nasal cannula (HFNC) was initiated [ 4 ].…”

“…Both data broadly confirm the primary role of aging and pre-existing chronic diseases in causing the similarly high mortality rate observed in both cohorts. Like Corradini et al [ 1 ], we chose to evaluate the potency of the association with death of variables recorded at admission because a more focused therapeutic approach on the basis of these symptoms and comorbidities may help to better plan and tailor the therapeutic strategies, at a time when specific antiviral agents were not available for COVID-19.…”