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Open AccessArticle

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

by Maurizio Cecconi 1,2,†, Daniele Piovani 1,2,*,†, Enrico Brunetta 1,2,†, Alessio Aghemo 1,2, Massimiliano Greco 1,2, Michele Ciccarelli 1,2, Claudio Angelini 1,2, Antonio Voza 1,2, Paolo Omodei 1,2, Edoardo Vespa 1,2, Nicola Pugliese 1,2, Tommaso Lorenzo Parigi 1,2, Marco Folci 1,2, Silvio Danese 1,2 and Stefanos Bonovas 1,2,‡ for the Humanitas Covid-19 Task Force
1
Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy
2
Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
*
Author to whom correspondence should be addressed.
The first three authors contributed equally to this manuscript.
A list of investigators in the Humanitas Covid-19 Task Force is provided in the Supplementary Appendix.
J. Clin. Med. 2020, 9(5), 1548; https://doi.org/10.3390/jcm9051548 (registering DOI)
Received: 24 April 2020 / Revised: 14 May 2020 / Accepted: 18 May 2020 / Published: 20 May 2020
(This article belongs to the Special Issue COVID-19: From Pathophysiology to Clinical Practice)
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.
Keywords: SARS-CoV-2; 2019 novel coronavirus; severe acute respiratory syndrome coronavirus 2; 2019-nCoV; COVID-19 SARS-CoV-2; 2019 novel coronavirus; severe acute respiratory syndrome coronavirus 2; 2019-nCoV; COVID-19
MDPI and ACS Style

Cecconi, M.; Piovani, D.; Brunetta, E.; Aghemo, A.; Greco, M.; Ciccarelli, M.; Angelini, C.; Voza, A.; Omodei, P.; Vespa, E.; Pugliese, N.; Parigi, T.L.; Folci, M.; Danese, S.; Bonovas, S., for the Humanitas Covid-19 Task Force; Early Predictors of Clinical Deterioration in a Cohort of 239 Patients Hospitalized for Covid-19 Infection in Lombardy, Italy. J. Clin. Med. 2020, 9, 1548.

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