1
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Douda L, Hasnat H, Schwank J, Nassar S, Jackson NM, Flynn JC, Gardiner J, Misra DP, Sankari A. Predictors of Intensive Care Unit Admissions in Patients Presenting with Coronavirus Disease 2019. Avicenna J Med 2024; 14:45-53. [PMID: 38694135 PMCID: PMC11057900 DOI: 10.1055/s-0043-1778068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Abstract
Background Increased mortality rates among coronavirus disease 2019 (COVID-19) positive patients admitted to intensive care units (ICUs) highlight a compelling need to establish predictive criteria for ICU admissions. The aim of our study was to identify criteria for recognizing patients with COVID-19 at elevated risk for ICU admission. Methods We identified patients who tested positive for COVID-19 and were hospitalized between March and May 2020. Patients' data were manually abstracted through review of electronic medical records. An ICU admission prediction model was derived from a random sample of half the patients using multivariable logistic regression. The model was validated with the remaining half of the patients using c-statistic. Results We identified 1,094 patients; 204 (18.6%) were admitted to the ICU. Correlates of ICU admission were age, body mass index (BMI), quick Sequential Organ Failure Assessment (qSOFA) score, arterial oxygen saturation to fraction of inspired oxygen ratio, platelet count, and white blood cell count. The c-statistic in the derivation subset (0.798, 95% confidence interval [CI]: 0.748, 0.848) and the validation subset (0.764, 95% CI: 0.706, 0.822) showed excellent comparability. At 22% predicted probability for ICU admission, the derivation subset estimated sensitivity was 0.721, (95% CI: 0.637, 0.804) and specificity was 0.763, (95% CI: 0.722, 0.804). Our pilot predictive model identified the combination of age, BMI, qSOFA score, and oxygenation status as significant predictors for ICU admission. Conclusion ICU admission among patients with COVID-19 can be predicted by age, BMI, level of hypoxia, and severity of illness.
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Affiliation(s)
- Lahib Douda
- Department of Medical Education, Ascension Providence Hospital/Michigan State University College of Human Medicine, Southfield, Michigan, United States
| | - Heraa Hasnat
- Department of Medical Education, Ascension Providence Hospital/Michigan State University College of Human Medicine, Southfield, Michigan, United States
| | - Jennifer Schwank
- Department of Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, United States
| | - Sarien Nassar
- Department of Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, United States
| | - Nancy M. Jackson
- Department of Medical Education, Ascension Providence Hospital/Michigan State University College of Human Medicine, Southfield, Michigan, United States
| | - Jeffrey C. Flynn
- Department of Medical Education, Ascension Providence Hospital/Michigan State University College of Human Medicine, Southfield, Michigan, United States
| | - Joseph Gardiner
- Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, East Lansing, Michigan, United States
| | - Dawn P. Misra
- Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, East Lansing, Michigan, United States
| | - Abdulghani Sankari
- Department of Medical Education, Ascension Providence Hospital/Michigan State University College of Human Medicine, Southfield, Michigan, United States
- Department of Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, United States
- Department of Medicine, Wayne State University, Detroit, Michigan, United States
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2
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De Vito A, Colpani A, Saderi L, Puci M, Zauli B, Meloni MC, Fois M, Bitti A, Di Castri C, Fiore V, Maida I, Babudieri S, Sotgiu G, Madeddu G. Is the 4C Score Still a Valid Item to Predict In-Hospital Mortality in People with SARS-CoV-2 Infections in the Omicron Variant Era? Life (Basel) 2023; 13:life13010183. [PMID: 36676132 PMCID: PMC9863404 DOI: 10.3390/life13010183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/10/2023] Open
Abstract
Since the start of the SARS-CoV-2 pandemic, several scores have been proposed to identify infected individuals at a higher risk of progression and death. The most famous is the 4C score. However, it was developed in early 2020. Our study aimed to evaluate the accuracy of the 4C score during the wave in which the Omicron variant was prevalent. An observational study was conducted at an Italian University Hospital between 1 January and 31 July 2022. A receiver operating characteristic (ROC) curve analysis was performed to evaluate the ability of the 4C score to predict mortality. Overall, 1186 people were recruited, of which 160 (13.5%) died. According to the 4C score, 177 (11.6%) were classified as having a low risk of mortality, 302 (25.5%) were intermediate, 596 (50.3%) were high, and 151 (12.7%) were very high. The ROC curve of the 4C score showed an AUC (95% CI) value of 0.78 (0.74−0.82). At the criterion value of > 10, the sensitivity was 76.2% and the specificity was 62.67%. Similar to previous studies, the 4C mortality score performed well in our sample, and it is still a useful tool for clinicians to identify patients with a high risk of progression. However, clinicians must be aware that the mortality rate reported in the original studies was higher than that observed in our study.
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Affiliation(s)
- Andrea De Vito
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
- Correspondence: ; Tel.: +39-34-0470-4834
| | - Agnese Colpani
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Mariangela Puci
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Beatrice Zauli
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Maria Chiara Meloni
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Marco Fois
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Alessandra Bitti
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Cosimo Di Castri
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Vito Fiore
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Ivana Maida
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Sergio Babudieri
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
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3
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Lenti MV, Uderzo S, Rossi CM, Melazzini F, Klersy C, Ferretti VV, Di Sabatino A. Determinants of COVID-19-related mortality in an internal medicine setting. Intern Emerg Med 2022; 17:2169-2173. [PMID: 35906347 PMCID: PMC9520996 DOI: 10.1007/s11739-022-03057-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/15/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Marco Vincenzo Lenti
- University of Pavia, First Department of Internal Medicine, Clinica Medica, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Stefano Uderzo
- University of Pavia, First Department of Internal Medicine, Clinica Medica, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Carlo Maria Rossi
- University of Pavia, First Department of Internal Medicine, Clinica Medica, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Federica Melazzini
- University of Pavia, First Department of Internal Medicine, Clinica Medica, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Catherine Klersy
- Clinical Epidemiology and Biometry, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Virginia Valeria Ferretti
- Clinical Epidemiology and Biometry, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- University of Pavia, First Department of Internal Medicine, Clinica Medica, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy.
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4
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Zuin M, Mugnai G, Zamboni A, Zakja E, Valle R, Turiano G, Themistoclakis S, Scarpa D, Saccà S, Roncon L, Rizzetto F, Purita P, Polo A, Pantano I, Mugnolo A, Molon G, Meneghin S, Mancuso D, Lia M, Grassi G, Cutolo A, Chirillo F, Bozzini P, Bonapace S, Anselmi M, Rigatelli G, Bilato C. Decline of Admission for Acute Coronary Syndromes and Acute Cardiovascular Conditions during COVID-19 Pandemic in Veneto Region. Viruses 2022; 14:v14091925. [PMID: 36146731 DOI: 10.3390/v1409192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/22/2022] [Accepted: 08/27/2022] [Indexed: 05/27/2023] Open
Abstract
Background: The present study aimed to examine longitudinal trends in hospitalizations for acute coronary syndrome (ACS) before and during the COVID-19 pandemic, by reviewing the data from 13 hospitals of the Veneto Region, in the north-east of Italy. Methods: We performed a multicenter, retrospective analysis including all the consecutive patients presenting with ACS and other acute cardiovascular (CV) conditions (defined as heart failure, arrhythmias, cardiac arrest and venous thromboembolism) hospitalized in 13 different hospitals of the Veneto Region covering a population of 2,554,818 inhabitants, during the first (between 15 March 2020 and 30 April 2020) and second (between 15 November 2020 and 30 December 2020) COVID-19 pandemic waves (the 2020 cohort). Data were compared with those obtained at the same time-windows of years 2018 and 2019 (the historical cohorts). Results: Compared to the historical cohorts, a significant decrease in the number of ACS cases was observed in 2020 (−27.3%, p = 0.01 and −32%, p < 0.001, comparing 2018 versus 2020 and 2019 and 2020, respectively). The proportion of patients hospitalized for acute CV conditions decreased during the first and second wave COVID-19 pandemic when compared to the historical cohorts (−36.5%, p < 0.001 and −40.6%, p < 0.001, comparing 2018 versus 2020 and 2019 and 2020, respectively). Pearson’s correlation evidenced a significant inverse relationship between the number of COVID-19 cases and both ACS hospital admissions (r = −0.881, p = 0.005) and hospitalizations for acute CV conditions (r = −0.738, p = 0.01), respectively. Conclusions: The decrease in hospitalizations for ACS and other acute CV conditions will strongly affect future patients’ management since undiagnosed nonfatal CV events represent a source of increased (and unknown) CV morbidity and mortality.
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Affiliation(s)
- Marco Zuin
- Division of Cardiology, West Vicenza General Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy
| | - Giacomo Mugnai
- Division of Cardiology, West Vicenza General Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy
| | - Alberto Zamboni
- Division of Cardiology, Legnago General Hospital, 37045 Legnago, Verona, Italy
| | - Edlira Zakja
- Division of Cardiology, San Donà General Hospital, 30027 San Donà di Piave, Venezia, Italy
| | - Roberto Valle
- Division of Cardiology, Chioggia General Hospital, 30015 Chioggia, Venezia, Italy
| | - Giovanni Turiano
- Division of Cardiology, San Donà General Hospital, 30027 San Donà di Piave, Venezia, Italy
| | | | - Daniele Scarpa
- Division of Cardiology, Santi Giovanni & Paolo Hospital, 30122 Venezia, Venezia, Italy
| | - Salvatore Saccà
- Division of Cardiology, Mirano General Hospital, 30035 Mirano, Venezia, Italy
| | - Loris Roncon
- Department of Cardiology, Rovigo General Hospital, 45100 Rovigo, Rovigo, Italy
| | - Francesca Rizzetto
- Division of Cardiology, Verona University Hospital, 37100 Verona, Verona, Italy
| | - Paola Purita
- Division of Cardiology, Mirano General Hospital, 30035 Mirano, Venezia, Italy
| | - Angela Polo
- Division of Cardiology, San Bassiano Hospital, 36061 Bassano, Vicenza, Italy
| | - Ivan Pantano
- Division of Cardiology, Chioggia General Hospital, 30015 Chioggia, Venezia, Italy
| | - Antonio Mugnolo
- Division of Cardiology, Legnago General Hospital, 37045 Legnago, Verona, Italy
| | - Giulio Molon
- Division of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Verona, Italy
| | - Samuele Meneghin
- Division of Cardiology, Padua University Hospital, 35128 Padova, Padova, Italy
| | - Daniela Mancuso
- Division of Cardiology, Padua University Hospital, 35128 Padova, Padova, Italy
| | - Micaela Lia
- Division of Cardiology, Verona University Hospital, 37100 Verona, Verona, Italy
| | - Giuseppe Grassi
- Division of Cardiology, Santi Giovanni & Paolo Hospital, 30122 Venezia, Venezia, Italy
| | - Ada Cutolo
- Division of Cardiology, All'Angelo Hospital, 30174 Mestre, Venezia, Italy
| | - Fabio Chirillo
- Division of Cardiology, San Bassiano Hospital, 36061 Bassano, Vicenza, Italy
| | - Paolo Bozzini
- Division of Cardiology, Fracastoro Hospital, 37020 San Bonifacio, Verona, Italy
| | - Stefano Bonapace
- Division of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Verona, Italy
| | - Maurizio Anselmi
- Division of Cardiology, Fracastoro Hospital, 37020 San Bonifacio, Verona, Italy
| | - Gianluca Rigatelli
- Division of Cardiology, Madre Teresa Hospital, 35043 Padova, Schiavonia, Italy
| | - Claudio Bilato
- Division of Cardiology, West Vicenza General Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy
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5
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Zuin M, Mugnai G, Zamboni A, Zakja E, Valle R, Turiano G, Themistoclakis S, Scarpa D, Saccà S, Roncon L, Rizzetto F, Purita P, Polo A, Pantano I, Mugnolo A, Molon G, Meneghin S, Mancuso D, Lia M, Grassi G, Cutolo A, Chirillo F, Bozzini P, Bonapace S, Anselmi M, Rigatelli G, Bilato C. Decline of Admission for Acute Coronary Syndromes and Acute Cardiovascular Conditions during COVID-19 Pandemic in Veneto Region. Viruses 2022; 14:v14091925. [PMID: 36146731 PMCID: PMC9502380 DOI: 10.3390/v14091925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/22/2022] [Accepted: 08/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The present study aimed to examine longitudinal trends in hospitalizations for acute coronary syndrome (ACS) before and during the COVID-19 pandemic, by reviewing the data from 13 hospitals of the Veneto Region, in the north-east of Italy. Methods: We performed a multicenter, retrospective analysis including all the consecutive patients presenting with ACS and other acute cardiovascular (CV) conditions (defined as heart failure, arrhythmias, cardiac arrest and venous thromboembolism) hospitalized in 13 different hospitals of the Veneto Region covering a population of 2,554,818 inhabitants, during the first (between 15 March 2020 and 30 April 2020) and second (between 15 November 2020 and 30 December 2020) COVID-19 pandemic waves (the 2020 cohort). Data were compared with those obtained at the same time-windows of years 2018 and 2019 (the historical cohorts). Results: Compared to the historical cohorts, a significant decrease in the number of ACS cases was observed in 2020 (−27.3%, p = 0.01 and −32%, p < 0.001, comparing 2018 versus 2020 and 2019 and 2020, respectively). The proportion of patients hospitalized for acute CV conditions decreased during the first and second wave COVID-19 pandemic when compared to the historical cohorts (−36.5%, p < 0.001 and −40.6%, p < 0.001, comparing 2018 versus 2020 and 2019 and 2020, respectively). Pearson’s correlation evidenced a significant inverse relationship between the number of COVID-19 cases and both ACS hospital admissions (r = −0.881, p = 0.005) and hospitalizations for acute CV conditions (r = −0.738, p = 0.01), respectively. Conclusions: The decrease in hospitalizations for ACS and other acute CV conditions will strongly affect future patients’ management since undiagnosed nonfatal CV events represent a source of increased (and unknown) CV morbidity and mortality.
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Affiliation(s)
- Marco Zuin
- Division of Cardiology, West Vicenza General Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy
- Correspondence: (M.Z.); (C.B.); Tel.: +39-0444-479106 (C.B.); Fax: +39-0444-931163 (C.B.)
| | - Giacomo Mugnai
- Division of Cardiology, West Vicenza General Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy
| | - Alberto Zamboni
- Division of Cardiology, Legnago General Hospital, 37045 Legnago, Verona, Italy
| | - Edlira Zakja
- Division of Cardiology, San Donà General Hospital, 30027 San Donà di Piave, Venezia, Italy
| | - Roberto Valle
- Division of Cardiology, Chioggia General Hospital, 30015 Chioggia, Venezia, Italy
| | - Giovanni Turiano
- Division of Cardiology, San Donà General Hospital, 30027 San Donà di Piave, Venezia, Italy
| | | | - Daniele Scarpa
- Division of Cardiology, Santi Giovanni & Paolo Hospital, 30122 Venezia, Venezia, Italy
| | - Salvatore Saccà
- Division of Cardiology, Mirano General Hospital, 30035 Mirano, Venezia, Italy
| | - Loris Roncon
- Department of Cardiology, Rovigo General Hospital, 45100 Rovigo, Rovigo, Italy
| | - Francesca Rizzetto
- Division of Cardiology, Verona University Hospital, 37100 Verona, Verona, Italy
| | - Paola Purita
- Division of Cardiology, Mirano General Hospital, 30035 Mirano, Venezia, Italy
| | - Angela Polo
- Division of Cardiology, San Bassiano Hospital, 36061 Bassano, Vicenza, Italy
| | - Ivan Pantano
- Division of Cardiology, Chioggia General Hospital, 30015 Chioggia, Venezia, Italy
| | - Antonio Mugnolo
- Division of Cardiology, Legnago General Hospital, 37045 Legnago, Verona, Italy
| | - Giulio Molon
- Division of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Verona, Italy
| | - Samuele Meneghin
- Division of Cardiology, Padua University Hospital, 35128 Padova, Padova, Italy
| | - Daniela Mancuso
- Division of Cardiology, Padua University Hospital, 35128 Padova, Padova, Italy
| | - Micaela Lia
- Division of Cardiology, Verona University Hospital, 37100 Verona, Verona, Italy
| | - Giuseppe Grassi
- Division of Cardiology, Santi Giovanni & Paolo Hospital, 30122 Venezia, Venezia, Italy
| | - Ada Cutolo
- Division of Cardiology, All’Angelo Hospital, 30174 Mestre, Venezia, Italy
| | - Fabio Chirillo
- Division of Cardiology, San Bassiano Hospital, 36061 Bassano, Vicenza, Italy
| | - Paolo Bozzini
- Division of Cardiology, Fracastoro Hospital, 37020 San Bonifacio, Verona, Italy
| | - Stefano Bonapace
- Division of Cardiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Negrar, Verona, Italy
| | - Maurizio Anselmi
- Division of Cardiology, Fracastoro Hospital, 37020 San Bonifacio, Verona, Italy
| | - Gianluca Rigatelli
- Division of Cardiology, Madre Teresa Hospital, 35043 Padova, Schiavonia, Italy
| | - Claudio Bilato
- Division of Cardiology, West Vicenza General Hospital, Via del Parco 1, 36071 Arzignano, Vicenza, Italy
- Correspondence: (M.Z.); (C.B.); Tel.: +39-0444-479106 (C.B.); Fax: +39-0444-931163 (C.B.)
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6
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Butkiewicz S, Zaczyński A, Hampel M, Pańkowski I, Gałązkowski R, Rzońca P. Analysis of Risk Factors for In-Hospital Death Due to COVID-19 in Patients Hospitalised at the Temporary Hospital Located at the National Stadium in Warsaw: A Retrospective Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073932. [PMID: 35409617 PMCID: PMC8998082 DOI: 10.3390/ijerph19073932] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 02/04/2023]
Abstract
The outbreak of the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic has affected all aspects of social life and brought massive changes to the healthcare sector. The aim of this study was to identify the factors affecting the mortality of COVID-19 patients at a temporary hospital in Warsaw (Poland). The present study was conducted based on a retrospective analysis of the medical records of patients hospitalised at the temporary hospital located at the National Stadium in Warsaw between 1 March 2020 and 30 April 2021. The study included all cases of patients who were brought directly or transferred to the National Hospital from other hospitals for further treatment. With regard to comorbidities, the analysis found that five comorbidities—namely, diabetes (OR = 1.750, 95% CI: 1.009−2.444, p < 0.05), stroke history (OR = 2.408, 95% CI: 1.208−4.801, p < 0.05), renal failure (OR = 2.141, 95% CI: 1.052−4.356, p < 0.05), chronic obstructive pulmonary disease (OR = 2.044, 95% CI: 1.133−3.690, p < 0.05) and heart failure (OR = 1.930, 95% CI: 1.154−3.227, p < 0.05)—had a significant impact on the survival of COVID-19 patients. The analysis identified 14 factors that had a significant impact on the prognosis and mortality of the COVID-19 patients studied.
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Affiliation(s)
- Sławomir Butkiewicz
- Emergency Department, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, 137 Wołoska St., 02-004 Warsaw, Poland; (S.B.); (I.P.)
| | - Artur Zaczyński
- Clinical Department of Neurosurgery, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, 137 Wołoska St., 02-004 Warsaw, Poland;
| | - Michał Hampel
- Department of Gastroenterological and Transplant Surgery, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, 137 Wołoska St., 02-004 Warsaw, Poland;
| | - Igor Pańkowski
- Emergency Department, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, 137 Wołoska St., 02-004 Warsaw, Poland; (S.B.); (I.P.)
| | - Robert Gałązkowski
- Department of Emergency Medical Services, Faculty of Health Sciences, Medical University of Warsaw, 14/16 Litewska St., 00-575 Warsaw, Poland;
| | - Patryk Rzońca
- Department of Human Anatomy, Faculty of Health Sciences, Medical University of Warsaw, 5 Chałubińskiego St., 02-004 Warsaw, Poland
- Correspondence: ; Tel.: +48-22-629-98-92
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