IMT School for Advanced Studies, Lucca, Italy.
Radiology Unit, Ospedale Maggiore di Crema, Crema, Italy.
PLoS One. 2021 Mar 25;16(3):e0248498. doi: 10.1371/journal.pone.0248498. eCollection 2021.
We report onset, course, correlations with comorbidities, and diagnostic accuracy of nasopharyngeal swab in 539 individuals suspected to carry SARS-COV-2 admitted to the hospital of Crema, Italy. All individuals underwent clinical and laboratory exams, SARS-COV-2 reverse transcriptase-polymerase chain reaction on nasopharyngeal swab, and chest X-ray and/or computed tomography (CT). Data on onset, course, comorbidities, number of drugs including angiotensin converting enzyme (ACE) inhibitors and angiotensin-II-receptor antagonists (sartans), follow-up swab, pharmacological treatments, non-invasive respiratory support, ICU admission, and deaths were recorded. Among 411 SARS-COV-2 patients (67.7% males) median age was 70.8 years (range 5-99). Chest CT was performed in 317 (77.2%) and showed interstitial pneumonia in 304 (96%). Fatality rate was 17.5% (74% males), with 6.6% in 60-69 years old, 21.1% in 70-79 years old, 38.8% in 80-89 years old, and 83.3% above 90 years. No death occurred below 60 years. Non-invasive respiratory support rate was 27.2% and ICU admission 6.8%. Charlson comorbidity index and high C-reactive protein at admission were significantly associated with death. Use of ACE inhibitors or sartans was not associated with outcomes. Among 128 swab negative patients at admission (63.3% males) median age was 67.7 years (range 1-98). Chest CT was performed in 87 (68%) and showed interstitial pneumonia in 76 (87.3%). Follow-up swab turned positive in 13 of 32 patients. Using chest CT at admission as gold standard on the entire study population of 539 patients, nasopharyngeal swab had 80% accuracy. Comorbidity network analysis revealed a more homogenous distribution 60-40 aged SARS-COV-2 patients across diseases and a crucial different interplay of diseases in the networks of deceased and survived patients. SARS-CoV-2 caused high mortality among patients older than 60 years and correlated with pre-existing multiorgan impairment.
我们报告了在意大利克雷马医院收治的 539 名疑似携带 SARS-CoV-2 的个体中，鼻咽拭子的发病、病程、与合并症的相关性以及诊断准确性。所有个体均接受了临床和实验室检查、鼻咽拭子的 SARS-CoV-2 逆转录酶-聚合酶链反应、胸部 X 线和/或计算机断层扫描（CT）。记录了发病、病程、合并症、包括血管紧张素转换酶（ACE）抑制剂和血管紧张素-II 受体拮抗剂（沙坦）在内的药物数量、随访拭子、药物治疗、无创性呼吸支持、入住 ICU 和死亡等数据。在 411 名 SARS-CoV-2 患者（67.7%为男性）中，中位年龄为 70.8 岁（范围为 5-99 岁）。317 名患者（77.2%为男性）进行了胸部 CT 检查，304 名患者（96%）显示间质性肺炎。死亡率为 17.5%（67%为男性），60-69 岁为 6.6%，70-79 岁为 21.1%，80-89 岁为 38.8%，90 岁以上为 83.3%。60 岁以下无死亡病例。无创性呼吸支持率为 27.2%，入住 ICU 率为 6.8%。入院时的 Charlson 合并症指数和高 C 反应蛋白与死亡显著相关。使用 ACE 抑制剂或沙坦类药物与结局无关。在 128 名入院时拭子阴性的患者（63.3%为男性）中，中位年龄为 67.7 岁（范围为 1-98 岁）。87 名患者（68%）进行了胸部 CT 检查，76 名患者（87.3%）显示间质性肺炎。32 名患者中有 13 名的随访拭子转为阳性。在整个 539 名患者的研究人群中，以入院时的胸部 CT 作为金标准，鼻咽拭子的准确率为 80%。合并症网络分析显示，60-40 岁 SARS-CoV-2 患者在疾病之间的分布更为均匀，而死亡和存活患者网络中疾病的相互作用则截然不同。SARS-CoV-2 导致 60 岁以上患者的死亡率较高，与预先存在的多器官损害有关。
