Sorbonne Université, INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses, Cimi-Paris, équipe 13, Paris, France; APHP, Groupe Hospitalier Universitaire Sorbonne Université, Hôpital Pitié-Salpêtrière, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Paris, France; Infectious Diseases Unit, Piacenza Hospital, Piacenza, Italy.
Research Center Borstel, Borstel, Germany; German Center for Infection Research, Hamburg-Lübeck-Borstel-Riems, Borstel, Germany; International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany.
J Infect Public Health. 2021 Feb;14(2):263-270. doi: 10.1016/j.jiph.2020.11.012. Epub 2020 Dec 9.
Piacenza is the closest city to the first coronavirus disease 2019 (COVID-19) cluster in Italy and has the highest national COVID-19 death rates per population. The objective of this study is to present characteristics and outcomes of patients admitted to medical departments of the Hospital of Piacenza during the first wave of the epidemic.
A total of 218 patients with confirmed or suspect COVID-19 and severe pneumonia were included from February 21st to May 15th, 2020. Routinely-collected clinical and laboratory data were retrospectively retrieved from electronic medical files. A Cox proportional-hazards model was fit to assess the association of treatment and other variables with death.
Median age of patients was 68 years; 150 patients (69%) had comorbidities, mainly hypertension (107, 49%). Overall, 185 (85%) patients had acute respiratory distress syndrome (ARDS) on admission, including 103 (47%) with moderate or severe ARDS. Chest computed tomography scan showed bilateral disease in 201 (98%) and extensive lung involvement in 79 (50%) patients. Most patients received antiviral treatment (187, 86%) and corticosteroids (134, 61%). All patients received respiratory support and 64 (29%) were admitted to intensive care unit. As of June 30th, 100 patients (46%) died, 109 patients (50%) were discharged, and 9 patients (4%) were still hospitalized. In multivariable Cox analysis, age above 65 years, having more than one comorbidity, severe ARDS, low platelet counts, and high LDH levels at admission were associated with mortality, while having diarrhea at admission was associated with survival. The use of antivirals or corticosteroids was not associated with survival.
Overall case fatality rates were high and associated with comorbidities, extensive lung involvement, ARDS at admission, and advanced age. The use of antivirals was not associated with increased survival.
皮亚琴扎是意大利首例 2019 年冠状病毒病（COVID-19）集群所在地，也是全国 COVID-19 死亡率最高的城市。本研究旨在介绍 2020 年 2 月 21 日至 5 月 15 日期间皮亚琴扎医院内科收治的患者的特征和结局。
共纳入 218 例确诊或疑似 COVID-19 且患有严重肺炎的患者。从电子病历中回顾性检索常规收集的临床和实验室数据。使用 Cox 比例风险模型评估治疗和其他变量与死亡的关系。
患者的中位年龄为 68 岁；150 例（69%）有合并症，主要为高血压（107 例，49%）。总体而言，185 例（85%）患者入院时即患有急性呼吸窘迫综合征（ARDS），其中 103 例（47%）为中重度 ARDS。胸部计算机断层扫描显示 201 例（98%）为双侧病变，79 例（50%）为广泛肺部受累。大多数患者接受了抗病毒治疗（187 例，86%）和皮质类固醇治疗（134 例，61%）。所有患者均接受呼吸支持，64 例（29%）收入重症监护病房。截至 6 月 30 日，100 例（46%）患者死亡，109 例（50%）出院，9 例（4%）仍住院。多变量 Cox 分析显示，65 岁以上、有多种合并症、重度 ARDS、入院时血小板计数低和乳酸脱氢酶水平高与死亡率相关，而入院时腹泻与存活率相关。抗病毒药物或皮质类固醇的使用与存活率无关。
总体病死率较高，与合并症、广泛肺部受累、入院时 ARDS 和年龄较大有关。抗病毒药物的使用与生存率增加无关。
