Early Predictors of Clinical Deterioration in a Cohort of 239 Patients Hospitalized for Covid-19 Infection in Lombardy, Italy

Abstract

We described features of hospitalized Covid-19 patients and identified predictors of clinical deterioration. We included patients consecutively admitted at Humanitas Research Hospital (Rozzano, Milan, Italy); retrospectively extracted demographic; clinical; laboratory and imaging findings at admission; used survival methods to identify factors associated with clinical deterioration (defined as intensive care unit (ICU) transfer or death), and developed a prognostic index. Overall; we analyzed 239 patients (29.3% females) with a mean age of 63.9 (standard deviation [SD]; 14.0) years. Clinical deterioration occurred in 70 patients (29.3%), including 41 (17.2%) ICU transfers and 36 (15.1%) deaths. The most common symptoms and signs at admission were cough (77.8%) and elevated respiratory rate (34.1%), while 66.5% of patients had at least one coexisting medical condition. Imaging frequently revealed ground-glass opacity (68.9%) and consolidation (23.8%). Age; increased respiratory rate; abnormal blood gas parameters and imaging findings; coexisting coronary heart disease; leukocytosis; lymphocytopenia; and several laboratory parameters (elevated procalcitonin; interleukin-6; serum ferritin; C-reactive protein; aspartate aminotransferase; lactate dehydrogenase; creatinine; fibrinogen; troponin-I; and D-dimer) were significant predictors of clinical deterioration. We suggested a prognostic index to assist risk-stratification (C-statistic; 0.845; 95% CI; 0.802–0.887). These results could aid early identification and management of patients at risk, who should therefore receive additional monitoring and aggressive supportive care.

Ferritin in the coronavirus disease 2019 (COVID‐19): A systematic review and meta‐analysis

“…The ferritin level was found related to intensive supportive care in patients with diabetes, including ICU transfer (Figure 7A) and treatment with mechanical ventilation, as demonstrated by Herold et al 33 (Figure 7B), which was in accordance with the study of Cecconi et al 70 Ayanian et al also indicated that high levels of ferritin (≥450 ng/mL) were associated with ICU admission (OR 6.8 (95% CI: 3.4‐13.7), intubation (OR 4.0 (95% CI :1.8‐8.8), and death (5.1 (95% CI :2.6‐10.0) 77 . However, our meta‐analysis result showed no significant difference in the ferritin levels between ICU versus non‐ICU subgroup (WMD 683.95 (95% CI −146.25‐1514.15) although they were significant between ICU versus non‐ICU when the patients suffered of diabetes (Figure 7A).…”

“…Cecconi et al also revealed that ferritin can aid the early identification and management of patients at risk of clinical deterioration leading to ICU transfer or death in hospitalized COVID‐19 patients 70 . Notably, the changes of ferritin levels in the COVID‐19 patients are not only higher in non‐survivors than in survivors, but also increase with the worsening of the disease 6 .…”

Impact of Comorbidities and Glycemia at Admission and Dipeptidyl Peptidase 4 Inhibitors in Patients With Type 2 Diabetes With COVID-19: A Case Series From an Academic Hospital in Lombardy, Italy

“…Some of the enrolled patients have already been involved in other studies evaluating different end points from the current study (20)(21).…”

A validated, real-time prediction model for favorable outcomes in hospitalized COVID-19 patients

“…Most models use more than one variable and most models predict composite outcomes. Of the 30 models, 23 were trained on patients in China , 2 were trained on patients in the United States 30,31 , and 5 were trained on patients in South Korea 32 or Europe [33][34][35][36] . Only 8 of the models underwent validation on either held-out or external datasets 7,10,14,18,19,24,26,36 , and 1 underwent prospective validation .…”