A total of 325 adult patients were hospitalised with a confirmed diagnosis of COVID-19 in the study period. 22 patients were excluded because they met the exclusion criterion of being admitted to the ICU or SICU within 12 hours since admission or before to the permanence in the IDU. Therefore, a total of 303 were included in the analysis.
The median age was 62 years (IQR 50-74) and 182 (60.1%) were men. The fatality rate was 6.8%. All deaths were due to respiratory failure. The overall median duration of hospitalization was 9 days (IQR 6-16). 69 patients (22.8%) met the composite outcome. Of those, 15 were transferred to the ICU, 36 to the SICU and 18 to both of the units. The median time from hospital admission to the transfer was 5 days (IQR 2-13.5).
Table 1 summarizes the main demographics characteristics of the sample and the differences between the two groups of patients: group 2 patients were predominantly male (76.8% vs. 55.1%, p<0.01), had a significantly higher fatality rate (14.5% vs. 3.8%, p<0.01) and a longer hospitalization (18 vs. 7 days, p<0.01). The difference between the median age of the two groups did not reach statistical significance (p=0.06).
From the 284 discharged patients, 185 (65.1%) went home, while 7 (2.5%), 32 (11.3%) and 17 (5.9%) were transferred to a nursing home/community healthcare facility, a secondary level hospital or to a rehabilitation institute respectively. Group 2 patients were less likely to be discharged at home (47.5 vs. 69.8%, p=0.02) and were more often transferred to a secondary level hospital (18.6% vs. 9.3%, p=0.03) or to a rehabilitation institute (15.2% vs. 3.5%, p=0.80) compared to Group 1.
Table 1. Demographic characteristics and outcomes of non-ICU/SICU (Group 1) and ICU/SICU (Group 2) patients
|
Available
|
All patients
n.303
|
Group 1
n.234 (77.2%)
|
Group 2
n.69 (22.8%)
|
p
|
Sex male
|
100%
|
182 (60.1%)
|
129 (55.1%)
|
53 (76.8%)
|
<0.01
|
Age, years
|
100%
|
62 (50-74)
|
60 (47-72)
|
68 (56-77)
|
0.06
|
Death
|
100%
|
19 (6.8%)
|
9 (3.8%)
|
10 (14.5%)
|
<0.01
|
Length of hospitalization, days
|
100%
|
9 (6-16)
|
7 (5-12)
|
18 (14-26)
|
<0.01
|
Patients discharged
|
100%
|
284 (93.7%)
|
225 (96.1%)
|
59 (85.5%)
|
|
|
185 (65.1%)
|
157 (69.8%)
|
28 (47.5%)
|
0.02
|
- Transferred to a nursing home, community health facility, hospice
|
7 (2.5%)
|
5 (2.2%)
|
2 (3.4%)
|
0.70
|
- Transferred to a secondary level hospital
|
32 (11.3%)
|
21 (9.3%)
|
11 (18.6%)
|
0.03
|
- Transferred to a rehabilitation facility
|
17 (5.9%)
|
8 (3.5%)
|
9 (15.2%)
|
0.80
|
|
43 (15.1%)
|
34 (15.1%)
|
9 (15.2%)
|
|
Data presented as median (IQR) or as percentage. In the second column data availability is also shown
ICU: Intensive Care Unit; SICU: Sub-intensive Care Unit.
Table 2 shows the clinical presentation at admission and the coexisting medical conditions. Fever (80.2%), dyspnoea (31.7%) and dry cough (30.7%) were the most common symptoms. Fever, which generally is considered being the most important symptom (as confirmed in this study), reached no statistically significant difference between the two groups (p= 0.73), while a significant difference was detected for the presence of dry cough (25.2% vs. 49.3%, p<0.01).
Hypertension (72.4% vs. 44%, p<0.01) and known or newly diagnosed diabetes (31.9% vs. 21%, p=0.04) were more common among patients in Group 2 compared to Group 1. Patients with no comorbidities were less likely to belong to Group 2 (20.3% vs. 37.2%, p=0.03).
Chest X-ray at admission to the IDU showed pulmonary lesions in 63.2% of the patients. No significant statistical differences were found between the two groups. Conversely, Group 2 patients were more likely to develop de novo pathological findings at the chest X-ray during the course of hospitalization (72.7% vs.17.2%, p=0.01).
(Table 2).
Table 2. Clinical, radiological characteristics, treatments and follow-up swabs of Group 1 and Group 2 COVID-19 patients. (To be inserted at line n. 208).
|
Available
|
All patients
n. 303
|
Group 1
n. 234
|
Group 2
n. 69
|
P
|
Co-existing medical conditions
|
100%
|
|
|
|
|
Hypertension
|
|
153 (50.5%)
|
103 (44.0%)
|
50 (72.4%)
|
<0.01
|
Diabetes mellitus
(pre-existing and newly diagnosed)
|
|
71 (23,.4%)
|
49 (21.0%)
|
22 (31.9%)
|
0.04
|
Chronic cardiac disease
|
|
44 (14,5%)
|
36 (15.4%)
|
8 (11.6%)
|
0.65
|
Chronic pulmonary disease
|
|
26 (8.6%)
|
19 (8.1%)
|
7 (11.1%)
|
0.67
|
Chronic gastrointestinal disease
|
|
26 (8.6%)
|
24 (10.3%)
|
2 (2.9%)
|
0.16
|
Active malignancy
|
|
26 (8.6%)
|
21 (9%)
|
5 (7.2%)
|
0.93
|
Transplant
|
|
3 (1.0%)
|
0 (0%)
|
3 (4.3%)
|
0.02
|
Urologic disorders
|
|
36 (11.9%)
|
28 (12%)
|
8 (11.6%)
|
0.90
|
Chronic kidney disease
|
|
15 (4.9%)
|
12 (5.1%)
|
3 (4.3%)
|
0.93
|
Obesity (BMI > 30)
|
|
51 (16.8%)
|
40 (17.1%)
|
11 (16.0%)
|
0.87
|
Overweight (BMI > 25)
|
|
154 (50.8%)
|
119 (50.8%)
|
35 (50.7%)
|
0.80
|
Number of medical conditions
|
100%
|
|
|
|
|
0
|
|
101 (33.4%)
|
87 (37.2%)
|
14 (20.3%)
|
0.03
|
≥ 2
|
|
96 (31.7%)
|
71 (30.3%)
|
25 (36.2%)
|
0.47
|
Symptoms at admission
|
100%
|
|
|
|
|
Fever
|
|
243 (80.2%)
|
187 (79.9%)
|
56 (83.2%)
|
0.73
|
Dry cough
|
|
93 (30.7%)
|
59 (25.2%)
|
34 (49.3%)
|
<0.01
|
Productive cough
|
|
28 (9.2%)
|
24 (10.3%)
|
4 (5.8%)
|
0.54
|
Sore throat
|
|
16 (5.3%)
|
10 (4.3%)
|
6 (8.7%)
|
0.21
|
Dyspnoea
|
|
96 (31.7%)
|
69 (29.5%)
|
27 (39.1%)
|
0.20
|
Conjunctivitis
|
|
3 (1.0%)
|
0
|
3 (4.3%)
|
0.02
|
Diarrhoea
|
|
21 (6.9%)
|
17 (7.3%)
|
4 (5.8%)
|
0.81
|
Myalgia
|
|
23 (7.6%)
|
16 (6.8%)
|
7 (10.1%)
|
0.55
|
Arthralgia
|
|
13 (4.3%)
|
10 (4.3%)
|
3 (4.3%)
|
1
|
Malaise
|
|
41 (13.5%)
|
31 (13.2%)
|
10 (14.5%)
|
0.69
|
Dysgeusia
|
|
49 (16.2%)
|
40 (17.1%)
|
9 (13.0%)
|
0.52
|
Skin rash
|
|
13 (4.3%)
|
12 (5.1%)
|
1 (1.4%)
|
0.33
|
Sat02 <94% in air room at admission
|
100%
|
134 (44.2%)
|
97 (41.4%)
|
37 (53.6%)
|
0.12
|
Positive chest X-ray at admission
|
92.3%
|
177 (63.2%)
|
140 (60.1%)
|
37 (78.7%)
|
0.15
|
Positivization of chest X-ray during hospitalization
|
|
24 (23.1%)
|
16 (17.2%)
|
8 (72.7%)
|
0.01
|
Anti SARS-CoV-2 treatment
|
100%
|
|
|
|
|
Chloroquine or Hydroxychloroquine
|
|
183 (60.3%)
|
149 (63.7%)
|
34 (49.2%)
|
<0.01
|
Lopinavir/ritonavir
|
|
88 (43.3%)
|
63 (26.9%)
|
25 (36.2%)
|
0.01
|
Remdesivir
|
|
19 (6.8%)
|
18 (7.7%)
|
1,0 (1.4%)
|
0.01
|
Tocilizumab
|
|
18 (5.9%)
|
12 (5.1%)
|
6 (8.7%)
|
0.15
|
Azithromycin
|
|
120 (39.6%)
|
99 (42.3%)
|
21 (30.4%)
|
0.01
|
Antibiotic treatment iv
|
100%
|
163 (53.8%)
|
111 (47.4%)
|
52 (75.3%)
|
<0.01
|
0xygen therapy
|
100%
|
|
|
|
|
Low or high flow systems*
|
|
168 (55.4%)
|
99 (42.3%)
|
69 (100%)
|
<0.01
|
NIV
|
|
61 (20.1%)
|
0
|
61 (88.4%)
|
|
MV
|
|
30 (9.9%)
|
0
|
30 (43.4%)
|
|
Negative follow up swab for SARS-CoV-2**
|
93.7%
|
236 (83.1%)
|
182 (80.1%)
|
54 (91.5%)
|
0.70
|
Days from hospitalization to negativization
|
93.7%
|
22 (14-39)
|
20 (13.9-32)
|
35 (20-57)
|
<0.01
|
Data presented as median (IQR) or as percentage. In the second column data availability is also shown.
ICU: Intensive Care Unit; SICU: Sub-intensive Care Unit; IQR: Interquartile Range; BMI: Body Mass Index; Sat02: Oxygen Saturation; iv: intravenous; NIV: Non-Invasive Ventilation; MV: Mechanical Ventilation.
*Nasal cannula, face-mask. **Two negative throat-swabs obtained in consecutive days.
Laboratory findings at the 1st, 3rd and last measurements since admission are shown in Table 3 (see additional file 1). Group 2 patients presented at admission a significantly higher neutrophil count, higher AST and CRP levels. At the 3rd measurement since admission, significant differences were found for white blood cell and neutrophil count, hepatic inflammation markers (AST, ALT, total bilirubin), and CRP. The GFR and the APTT resulted also significantly different between the two groups, but their median values were, in both cases, within the normal ranges. At discharge, Group 2 patients were found to have a significantly lower level of haemoglobin.
None of the patients resulted positive to the laboratory tests for bacterial infections (data not shown).
Table 2 shows data regarding antiviral drugs use. CQ or HCQ, lopinavir/ritonavir and azithromycin were the most common drugs, prescribed during the course of hospitalization to 60.3%, 43.3% and 39.6% of the patients respectively. Group 2 patients were less likely to receive CQ or HCQ (49.2% vs. 63.7%, p<0.01), azithromycin (30.4% vs. 42.3%, p=0.01) and remdesivir (1.4% vs. 7.7%, p=0.01), and more likely to receive lopinavir/ritonavir (36.2% vs. 26.9%, p=0.01).
Among Group 2 patients, 88.4% required NIV and 43.4% MV.
As of June 1, 2020, 83.1% of patient resulted negative for SARS-CoV-2 at the follow-up swabs. The median duration from hospital admission to negativization (considering the date of the second swab) was 22 days. Patients of Group 1 presented a significant shorter duration to negativization compared to Group 2 (20 vs. 35 days, p<0.01) (Table 1).