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Di Castelnuovo A, Bonaccio M, Costanzo S, Gialluisi A, Antinori A, Berselli N, Blandi L, Bruno R, Cauda R, Guaraldi G, My I, Menicanti L, Parruti G, Patti G, Perlini S, Santilli F, Signorelli C, Stefanini GG, Vergori A, Abdeddaim A, Ageno W, Agodi A, Agostoni P, Aiello L, Al Moghazi S, Aucella F, Barbieri G, Bartoloni A, Bologna C, Bonfanti P, Brancati S, Cacciatore F, Caiano L, Cannata F, Carrozzi L, Cascio A, Cingolani A, Cipollone F, Colomba C, Crisetti A, Crosta F, Danzi GB, D'Ardes D, de Gaetano Donati K, Di Gennaro F, Di Palma G, Di Tano G, Fantoni M, Filippini T, Fioretto P, Fusco FM, Gentile I, Grisafi L, Guarnieri G, Landi F, Larizza G, Leone A, Maccagni G, Maccarella S, Mapelli M, Maragna R, Marcucci R, Maresca G, Marotta C, Marra L, Mastroianni F, Mengozzi A, Menichetti F, Milic J, Murri R, Montineri A, Mussinelli R, Mussini C, Musso M, Odone A, Olivieri M, Pasi E, Petri F, Pinchera B, Pivato CA, Pizzi R, Poletti V, Raffaelli F, Ravaglia C, Righetti G, Rognoni A, Rossato M, Rossi M, Sabena A, Salinaro F, Sangiovanni V, Sanrocco C, Scarafino A, Scorzolini L, Sgariglia R, Simeone PG, Spinoni E, Torti C, Trecarichi EM, Vezzani F, Veronesi G, Vettor R, Vianello A, Vinceti M, De Caterina R, Iacoviello L. Common cardiovascular risk factors and in-hospital mortality in 3,894 patients with COVID-19: survival analysis and machine learning-based findings from the multicentre Italian CORIST Study. Nutr Metab Cardiovasc Dis 2020; 30:1899-1913. [PMID: 32912793 PMCID: PMC7833278 DOI: 10.1016/j.numecd.2020.07.031] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS There is poor knowledge on characteristics, comorbidities and laboratory measures associated with risk for adverse outcomes and in-hospital mortality in European Countries. We aimed at identifying baseline characteristics predisposing COVID-19 patients to in-hospital death. METHODS AND RESULTS Retrospective observational study on 3894 patients with SARS-CoV-2 infection hospitalized from February 19th to May 23rd, 2020 and recruited in 30 clinical centres distributed throughout Italy. Machine learning (random forest)-based and Cox survival analysis. 61.7% of participants were men (median age 67 years), followed up for a median of 13 days. In-hospital mortality exhibited a geographical gradient, Northern Italian regions featuring more than twofold higher death rates as compared to Central/Southern areas (15.6% vs 6.4%, respectively). Machine learning analysis revealed that the most important features in death classification were impaired renal function, elevated C reactive protein and advanced age. These findings were confirmed by multivariable Cox survival analysis (hazard ratio (HR): 8.2; 95% confidence interval (CI) 4.6-14.7 for age ≥85 vs 18-44 y); HR = 4.7; 2.9-7.7 for estimated glomerular filtration rate levels <15 vs ≥ 90 mL/min/1.73 m2; HR = 2.3; 1.5-3.6 for C-reactive protein levels ≥10 vs ≤ 3 mg/L). No relation was found with obesity, tobacco use, cardiovascular disease and related-comorbidities. The associations between these variables and mortality were substantially homogenous across all sub-groups analyses. CONCLUSIONS Impaired renal function, elevated C-reactive protein and advanced age were major predictors of in-hospital death in a large cohort of unselected patients with COVID-19, admitted to 30 different clinical centres all over Italy.
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Affiliation(s)
| | - Marialaura Bonaccio
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, IS, Italy
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, IS, Italy
| | | | - Andrea Antinori
- UOC Immunodeficienze Virali, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Nausicaa Berselli
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Blandi
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Raffaele Bruno
- Division of Infectious Diseases I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical, Surgical, Diagnostic, and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Roberto Cauda
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore- Dipartimento di Sicurezza e Bioetica Sede di Roma, Italy
| | - Giovanni Guaraldi
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Ilaria My
- Humanitas Clinical and Research Hospital IRCCS, Rozzano-Milano, Italy
| | | | - Giustino Parruti
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Giuseppe Patti
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Stefano Perlini
- Emergency Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy; Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Francesca Santilli
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | | | - Alessandra Vergori
- HIV/AIDS Department, National Institute for Infectious Diseases "Lazzaro Spallanzani"-IRCCS, Roma, Italy
| | - Amina Abdeddaim
- UOC Malattie Infettive-Epatologia, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, AOU Policlinico "G. Rodolico - San Marco", Catania, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Luca Aiello
- UOC Anestesia e Rianimazione. Dipartimento di Chirurgia Generale Ospedale Morgagni-Pierantoni Forlì, Italy
| | - Samir Al Moghazi
- UOC Infezioni Sistemiche dell'Immunodepresso, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Filippo Aucella
- Fondazione I.R.C.C.S "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Greta Barbieri
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, and University of Pisa, Pisa, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | | | - Paolo Bonfanti
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Serena Brancati
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Francesco Cacciatore
- Department of Translational Medical Sciences. University of Naples, Federico II, Naples, Italy
| | - Lucia Caiano
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Francesco Cannata
- Humanitas Clinical and Research Hospital IRCCS, Rozzano-Milano, Italy
| | - Laura Carrozzi
- Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, and University of Pisa, Pisa, Italy
| | - Antonio Cascio
- Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) - University of Palermo, Palermo, Italy
| | - Antonella Cingolani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore- Dipartimento di Sicurezza e Bioetica Sede di Roma, Italy
| | - Francesco Cipollone
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | - Claudia Colomba
- Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) - University of Palermo, Palermo, Italy
| | - Annalisa Crisetti
- Fondazione I.R.C.C.S "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Francesca Crosta
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Gian B Danzi
- Department of Cardiology, Ospedale di Cremona, Cremona, Italy
| | - Damiano D'Ardes
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | | | | | - Gisella Di Palma
- UOC Medicina - PO S. Maria di Loreto Nuovo -ASL Napoli 1 Centro, Napoli, Italy
| | | | - Massimo Fantoni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore- Dipartimento di Sicurezza e Bioetica Sede di Roma, Italy
| | - Tommaso Filippini
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Fioretto
- Clinica Medica 3, Department of Medicine - DIMED, University hospital of Padova, Padova, Italy
| | - Francesco M Fusco
- UOC Infezioni Sistemiche e dell'Immunodepresso, Azienda Ospedaliera dei Colli, Ospedale Cotugno, Napoli, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples "Federico II". Napoli, Italy
| | - Leonardo Grisafi
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Gabriella Guarnieri
- Respiratory Pathophysiology Division, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Francesco Landi
- UOC Anestesia e Rianimazione. Dipartimento di Chirurgia Generale Ospedale Morgagni-Pierantoni Forlì, Italy
| | - Giovanni Larizza
- COVID-19 Unit. EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, BA, Italy
| | - Armando Leone
- UOC di Pneumologia, P.O. San Giuseppe Moscati, Taranto, Italy
| | - Gloria Maccagni
- Department of Cardiology, Ospedale di Cremona, Cremona, Italy
| | - Sandro Maccarella
- ASST Milano Nord - Ospedale Edoardo Bassini, Cinisello Balsamo, Italy
| | - Massimo Mapelli
- Centro Cardiologico Monzino IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Riccardo Maragna
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Giulio Maresca
- Centro Cardiologico Monzino IRCCS, Milano, Italy; UOC Medicina - PO S. Maria di Loreto Nuovo -ASL Napoli 1 Centro, Napoli, Italy
| | | | - Lorenzo Marra
- UOC di Pneumologia, P.O. San Giuseppe Moscati, Taranto, Italy
| | - Franco Mastroianni
- COVID-19 Unit. EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, BA, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, and University of Pisa, Pisa, Italy
| | - Francesco Menichetti
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, and University of Pisa, Pisa, Italy
| | - Jovana Milic
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Rita Murri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore- Dipartimento di Sicurezza e Bioetica Sede di Roma, Italy
| | - Arturo Montineri
- U.O. C. Malattie Infettive e Tropicali, P.O. "San Marco", AOU Policlinico "G. Rodolico - San Marco", Catania, Italy
| | | | - Cristina Mussini
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Musso
- UOC Malattie Infettive-Apparato Respiratorio, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Anna Odone
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Marco Olivieri
- Computer Service, University of Molise, Campobasso, Italy
| | - Emanuela Pasi
- Medicina Interna. Ospedale di Ravenna. AUSL della Romagna, Ravenna, Italy
| | - Francesco Petri
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, University of Naples "Federico II". Napoli, Italy
| | - Carlo A Pivato
- Humanitas Clinical and Research Hospital IRCCS, Rozzano-Milano, Italy
| | - Roberto Pizzi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Venerino Poletti
- UOC Pneumologia, Dipartimento di Malattie Apparato Respiratorio e Torace, Ospedale Morgagni-Pierantoni Forlì, Forlì, Italy
| | | | - Claudia Ravaglia
- UOC Pneumologia, Dipartimento di Malattie Apparato Respiratorio e Torace, Ospedale Morgagni-Pierantoni Forlì, Forlì, Italy
| | - Giulia Righetti
- COVID-19 Unit. EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, BA, Italy
| | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | - Marco Rossato
- Clinica Medica 3, Department of Medicine - DIMED, University hospital of Padova, Padova, Italy
| | - Marianna Rossi
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Anna Sabena
- Emergency Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Francesco Salinaro
- Emergency Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Vincenzo Sangiovanni
- UOC Infezioni Sistemiche e dell'Immunodepresso, Azienda Ospedaliera dei Colli, Ospedale Cotugno, Napoli, Italy
| | - Carlo Sanrocco
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Antonio Scarafino
- COVID-19 Unit. EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, BA, Italy
| | - Laura Scorzolini
- UOC Malattie Infettive ad Alta Intensità di Cura, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | | | - Paola G Simeone
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Enrico Spinoni
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Carlo Torti
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences "Magna Graecia" University, Catanzaro, Italy
| | - Enrico M Trecarichi
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences "Magna Graecia" University, Catanzaro, Italy
| | - Francesca Vezzani
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | - Giovanni Veronesi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Roberto Vettor
- Clinica Medica 3, Department of Medicine - DIMED, University hospital of Padova, Padova, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Marco Vinceti
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Raffaele De Caterina
- Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, and University of Pisa, Pisa, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, IS, Italy; Department of Medicine and Surgery, University of Insubria, Varese, Italy.
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