Matranga Domenica, Maniscalco Laura, Enea Marco, De Luca Dario, Brancato Davide, La Spada Emanuele, Scorsone Alessandro, Di Carlo Paola
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy.
Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy.
Arch Med Sci. 2021 Mar 18;18(6):1488-1497. doi: 10.5114/aoms/134024. eCollection 2022.
Clinical presentation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in old adults from Southern Italy is little known. This study aims to investigate the mortality risk related to risk factors, therapy and clinical course and to suggest prognostic indicators based on day-to-day follow-up of clinical and laboratory findings.
It was designed as a retrospective longitudinal cohort study of adult SARS-CoV-2 patients admitted at Partinico COVID Hospital in Palermo, Southern Italy. Patients were recruited between 4 March and 25 April and followed up until 31 May 2020, day-to-day until death or hospital discharge. Clinical data, laboratory tests and treatment data were extracted from medical records and epidemiologic information was obtained by clinical history and the medical interview.
Forty-seven patients (median age = 75 IQR: 59.50-86.00) were followed up during a 87 days observation period, accounting for a total of 1,035 person days. At the end of follow-up, 28 (60%) patients were discharged and 19 (40%) died, so that the estimated incidence density rate was 0.018 deaths per day (18 SARS-CoV-2-related deaths per 1,000 patient days). Diabetes (HR = 8.13, 95% CI: 1.91-34.67), chronic kidney failure (HR = 5.86, 95% CI: 1.36-25.21), dementia (HR = 7.84, 95% CI: 1.80-34.20), and neutrophil/lymphocyte ratio > 7 (HR = 10.37, 95% CI: 2.24-48.14) were found as significant prognostic factors.
The joint evaluation of dementia, diabetes, chronic kidney failure and neutrophil/lymphocyte ratio showed an optimal prognostic value already in the first week of follow-up. The day-to-day follow-up provides essential information for clinical monitoring and treatment of the disease in a hospital setting and improves the disease's home management, especially for older patients with frailty.
意大利南部老年人感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的临床表现鲜为人知。本研究旨在调查与风险因素、治疗及临床病程相关的死亡风险，并根据对临床和实验室检查结果的日常随访提出预后指标。
本研究设计为一项对意大利南部巴勒莫的帕尔蒂尼科新冠医院收治的成年SARS-CoV-2患者进行的回顾性纵向队列研究。患者于3月4日至4月25日期间入组，并随访至2020年5月31日，每日随访直至死亡或出院。从病历中提取临床数据、实验室检查及治疗数据，并通过临床病史和医学访谈获取流行病学信息。
在为期87天的观察期内对47例患者（中位年龄 = 75，四分位间距：59.50 - 86.00）进行了随访，总计1035人日。随访结束时，28例（60%）患者出院，19例（40%）死亡，因此估计发病密度率为每日0.018例死亡（每1000患者日有18例与SARS-CoV-2相关的死亡）。发现糖尿病（HR = 8.13，95%置信区间：1.91 - 34.67）、慢性肾衰竭（HR = 5.86，95%置信区间：1.36 - 25.21）、痴呆（HR = 7.84，95%置信区间：1.80 - 34.20）以及中性粒细胞/淋巴细胞比值 > 7（HR = 10.37，95%置信区间：2.24 - 48.14）为显著的预后因素。
痴呆、糖尿病、慢性肾衰竭和中性粒细胞/淋巴细胞比值的联合评估在随访的第一周就显示出了最佳的预后价值。日常随访为医院环境中该疾病的临床监测和治疗提供了重要信息，并改善了疾病的居家管理，尤其是对于体弱的老年患者。
