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Caneiro-Queija B, Raposeiras-Roubin S, Adamo M, Freixa X, Arzamendi D, Benito-González T, Montefusco A, Pascual I, Nombela-Franco L, Rodes-Cabau J, Shuvy M, Portolés-Hernández A, Godino C, Haberman D, Lupi L, Regueiro A, Li CH, Fernández-Vázquez F, Frea S, Avanzas P, Tirado-Conte G, Paradis JM, Peretz A, Moñivas V, Baz JA, Galasso M, Branca L, Sanchís L, Asmarats L, Garrote-Coloma C, Angelini F, León V, de Agustín JA, Alperi A, Beeri R, Maccagni G, Sabaté M, Fernández-Peregrina E, Gualis J, Bocchino PP, Curello S, Íñiguez-Romo A, Estévez-Loureiro R. Prognostic Impact of Nutritional Status After Transcatheter Edge-to-Edge Mitral Valve Repair: The MIVNUT Registry. J Am Heart Assoc 2022; 11:e023121. [PMID: 36216434 DOI: 10.1161/jaha.121.023121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Malnutrition is associated with poor prognosis in several cardiovascular diseases. However, its prognostic impact in patients undergoing transcatheter edge-to-edge mitral valve repair (TEER) is not well known. This study sought to assess the prevalence, clinical associations, and prognostic consequences of malnutrition in patients undergoing TEER. Methods and Results A total of 892 patients undergoing TEER from the international MIVNUT (Mitral Valve Repair and Nutritional Status) registry were studied. Malnutrition status was assessed with the Controlling Nutritional Status score. The association of nutritional status with mortality was analyzed with multivariable Cox regression models, whereas the association with heart failure admission was assessed by Fine-Gray models, with death as a competing risk. According to the Controlling Nutritional Status score, 74.4% of patients with TEER had any degree of malnutrition at the time of TEER (75.1% in patients with body mass index <25 kg/m2, 72.1% in those with body mass index ≥25 kg/m2). However, only 20% had moderate-severe malnutrition. TEER was successful in most of patients (94.2%). During a median follow-up of 1.6 years (interquartile range, 0.6-3.0), 267 (29.9%) patients died and 256 patients (28.7%) were admitted for heart failure after TEER. Compared with normal nutritional status moderate-severe malnutrition resulted a strong predictor of mortality (adjusted hazard ratio [HR], 2.1 [95% CI, 1.1-2.4]; P<0.001) and heart failure admission (adjusted subdistribution HR, 1.6 [95% CI, 1.1-2.4]; P=0.015). Conclusions Malnutrition is common among patients submitted to TEER, and moderate-severe malnutrition is strongly associated with increased mortality and heart failure readmission. Assessment of nutritional status in these patients may help to improve risk stratification.
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Affiliation(s)
| | | | - Marianna Adamo
- Cardiac Catheteterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia Brescia Italy
| | | | - Dabit Arzamendi
- Interventional Cardiology Unit, Hospital Sant Pau i Santa Creu Barcelona Spain
| | | | - Antonio Montefusco
- Division of Cardiology, Department of Medical Science University of Turin Città della Salute e Della Scienza Torino Italy
| | - Isaac Pascual
- Interventional Cardiology Unit, Hospital Universitario Central de Asturias Oviedo Spain
| | | | - Josep Rodes-Cabau
- Cardiology Department, Quebec Heart and Lung Institute Laval University Quebec City Canada
| | - Mony Shuvy
- Heart Institute Hadassah-Hebrew University Medical Center Jerusalem Israel
| | | | - Cosmo Godino
- Clinical Cardiology Unit, Faculty of Medicine IRCCS San Raffaele Scientific Institute Milan Italy
| | | | - Laura Lupi
- Cardiac Catheteterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia Brescia Italy
| | | | - Chin Hion Li
- Interventional Cardiology Unit, Hospital Sant Pau i Santa Creu Barcelona Spain
| | | | - Simone Frea
- Division of Cardiology, Department of Medical Science University of Turin Città della Salute e Della Scienza Torino Italy
| | - Pablo Avanzas
- Interventional Cardiology Unit, Hospital Universitario Central de Asturias Oviedo Spain
| | | | - Jean-Michel Paradis
- Cardiology Department, Quebec Heart and Lung Institute Laval University Quebec City Canada
| | - Alona Peretz
- Heart Institute Hadassah-Hebrew University Medical Center Jerusalem Israel
| | - Vanessa Moñivas
- Cardiology Department Hospital Universitario Puerta de Hierro Madrid Spain
| | - Jose A Baz
- Hospital Álvaro Cunqueiro and Instituto de Investigación Sanitaria Galicia Sur Vigo Spain
| | - Michele Galasso
- Hospital Álvaro Cunqueiro and Instituto de Investigación Sanitaria Galicia Sur Vigo Spain
| | - Luca Branca
- Cardiac Catheteterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia Brescia Italy
| | | | - Lluís Asmarats
- Interventional Cardiology Unit, Hospital Sant Pau i Santa Creu Barcelona Spain
| | | | - Filippo Angelini
- Division of Cardiology, Department of Medical Science University of Turin Città della Salute e Della Scienza Torino Italy
| | - Victor León
- Interventional Cardiology Unit, Hospital Universitario Central de Asturias Oviedo Spain
| | - José A de Agustín
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC Madrid Spain
| | - Alberto Alperi
- Cardiology Department, Quebec Heart and Lung Institute Laval University Quebec City Canada
| | - Ronen Beeri
- Heart Institute Hadassah-Hebrew University Medical Center Jerusalem Israel
| | - Gloria Maccagni
- Cardiac Catheteterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia Brescia Italy
| | | | | | - Javier Gualis
- Complejo Asistencial Universitario de León León Spain
| | - Pier Paolo Bocchino
- Division of Cardiology, Department of Medical Science University of Turin Città della Salute e Della Scienza Torino Italy
| | - Salvatore Curello
- Cardiac Catheteterization Laboratory, Cardiothoracic Department, Spedali Civili Brescia Brescia Italy
| | - Andrés Íñiguez-Romo
- Hospital Álvaro Cunqueiro and Instituto de Investigación Sanitaria Galicia Sur Vigo Spain
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Adamo M, Maccagni G, Fiorina C, Giannini C, Angelillis M, Costa G, Trani C, Burzotta F, Bruschi G, Merlanti B, Poli A, Ferrara E, Fineschi M, Iadanza A, Chizzola G, Metra M. Prognostic value of right ventricle to pulmonary artery coupling in transcatheter aortic valve implantation recipients. J Cardiovasc Med (Hagerstown) 2022; 23:615-622. [PMID: 35994710 DOI: 10.2459/jcm.0000000000001336] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS To investigate the impact of the right ventricle to pulmonary artery (RV-PA) coupling on the outcome of patients undergoing transcatheter aortic valve intervention (TAVI), and to describe changes in right ventricular function, pulmonary hypertension, and their ratio after TAVI. METHODS Three hundred and seventy-seven patients from the Italian ClinicalService Project, who underwent TAVI between February 2011 and August 2020, were included. Tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio was retrospectively calculated as a surrogate of RV-PA coupling. The population was stratified according to TAPSE/PASP using a cut-off of 0.36 mm/mmHg derived from a receiving operating characteristic (ROC) curve. The primary end point was 6-month all-cause death. RESULTS Compared with patients with a TAPSE/PASP ratio ≥0.36 mm/mmHg (81%), those with TAPSE/PASP ratio <0.36 mm/mmHg (19%) had more comorbidities and were more symptomatic.Moreover, they were more likely to receive general anesthesia and an old generation device. Device success was similar between the two groups. A TAPSE/PASP ratio <0.36 mm/mmHg was associated with a higher risk of all-cause death at 6-months (17.3% versus 5.3%; adjusted HR 2.66; P = 0.041). The prognostic impact of the TAPSE/PASP ratio was stronger than the impact of TAPSE and PASP as separate parameters and was independent of the surgical risk score. Both TAPSE, PASP, and their ratio improved from baseline to 1 month and 6 months after TAVI. CONCLUSIONS A TAPSE/PASP ratio <0.36 mm/mmHg is strongly associated with an increased risk of mortality after TAVI. Providing a left ventricle unloading, TAVI is associated with improvement of both TAPSE, PASP, and their ratio.
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Affiliation(s)
- Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Cividi di Brescia, Brescia
| | - Gloria Maccagni
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Cividi di Brescia, Brescia
| | - Claudia Fiorina
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Cividi di Brescia, Brescia
| | - Cristina Giannini
- Cardio Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa
| | - Marco Angelillis
- Cardio Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa
| | - Giulia Costa
- Cardio Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa
| | - Carlo Trani
- U.O.C. di Interventistica Cardiologica e Diagnostica Invasiva, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome
| | - Francesco Burzotta
- U.O.C. di Interventistica Cardiologica e Diagnostica Invasiva, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome
| | - Giuseppe Bruschi
- 'A. De Gasperis' Cardiothoracovascular Department, ASST Niguarda General Hospital, Milan
| | - Bruno Merlanti
- 'A. De Gasperis' Cardiothoracovascular Department, ASST Niguarda General Hospital, Milan
| | - Arnaldo Poli
- Cardiologia Interventistica, Asst Ovest Milanese Legnano Hospital, Legnano
| | - Erica Ferrara
- Cardiologia Interventistica, Asst Ovest Milanese Legnano Hospital, Legnano
| | - Massimo Fineschi
- UOSA Cardiologia - Emodinamica, Azienda Ospedaliera Universitaria Policlinico Le Scotte, Siena, Italy
| | - Alessandro Iadanza
- UOSA Cardiologia - Emodinamica, Azienda Ospedaliera Universitaria Policlinico Le Scotte, Siena, Italy
| | - Giuliano Chizzola
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Cividi di Brescia, Brescia
| | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Cividi di Brescia, Brescia
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Vezzoli M, Inciardi RM, Oriecuia C, Paris S, Murillo NH, Agostoni P, Ameri P, Bellasi A, Camporotondo R, Canale C, Carubelli V, Carugo S, Catagnano F, Danzi G, Dalla Vecchia L, Giovinazzo S, Gnecchi M, Guazzi M, Iorio A, La Rovere MT, Leonardi S, Maccagni G, Mapelli M, Margonato D, Merlo M, Monzo L, Mortara A, Nuzzi V, Pagnesi M, Piepoli M, Porto I, Pozzi A, Provenzale G, Sarullo F, Senni M, Sinagra G, Tomasoni D, Adamo M, Volterrani M, Maroldi R, Metra M, Lombardi CM, Specchia C. Machine learning for prediction of in-hospital mortality in coronavirus disease 2019 patients: results from an Italian multicenter study. J Cardiovasc Med (Hagerstown) 2022; 23:439-446. [PMID: 35763764 DOI: 10.2459/jcm.0000000000001329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Several risk factors have been identified to predict worse outcomes in patients affected by SARS-CoV-2 infection. Machine learning algorithms represent a novel approach to identifying a prediction model with a good discriminatory capacity to be easily used in clinical practice. The aim of this study was to obtain a risk score for in-hospital mortality in patients with coronavirus disease infection (COVID-19) based on a limited number of features collected at hospital admission. METHODS AND RESULTS We studied an Italian cohort of consecutive adult Caucasian patients with laboratory-confirmed COVID-19 who were hospitalized in 13 cardiology units during Spring 2020. The Lasso procedure was used to select the most relevant covariates. The dataset was randomly divided into a training set containing 80% of the data, used for estimating the model, and a test set with the remaining 20%. A Random Forest modeled in-hospital mortality with the selected set of covariates: its accuracy was measured by means of the ROC curve, obtaining AUC, sensitivity, specificity and related 95% confidence interval (CI). This model was then compared with the one obtained by the Gradient Boosting Machine (GBM) and with logistic regression. Finally, to understand if each model has the same performance in the training and test set, the two AUCs were compared using the DeLong's test. Among 701 patients enrolled (mean age 67.2 ± 13.2 years, 69.5% male individuals), 165 (23.5%) died during a median hospitalization of 15 (IQR, 9-24) days. Variables selected by the Lasso procedure were: age, oxygen saturation, PaO2/FiO2, creatinine clearance and elevated troponin. Compared with those who survived, deceased patients were older, had a lower blood oxygenation, lower creatinine clearance levels and higher prevalence of elevated troponin (all P < 0.001). The best performance out of the samples was provided by Random Forest with an AUC of 0.78 (95% CI: 0.68-0.88) and a sensitivity of 0.88 (95% CI: 0.58-1.00). Moreover, Random Forest was the unique model that provided similar performance in sample and out of sample (DeLong test P = 0.78). CONCLUSION In a large COVID-19 population, we showed that a customizable machine learning-based score derived from clinical variables is feasible and effective for the prediction of in-hospital mortality.
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Affiliation(s)
- Marika Vezzoli
- Department of Molecular and Translational Medicine, University of Brescia, Italy
| | - Riccardo Maria Inciardi
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Chiara Oriecuia
- Department of Molecular and Translational Medicine, University of Brescia, Italy
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Sara Paris
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Natalia Herrera Murillo
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Department of Clinical Sciences and Community Health, University of Milano, Milan
- Department of Clinical Sciences and Community Health, University of Milano, Milan
| | - Pietro Ameri
- IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Genova
| | - Antonio Bellasi
- Innovation and Brand Reputation Unit, Papa Giovanni XXIII Hospital, Bergamo
| | - Rita Camporotondo
- Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia
| | - Claudia Canale
- IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Genova
| | - Valentina Carubelli
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Stefano Carugo
- Division of Cardiology, Ospedale San Paolo, ASST Santi Paolo E Carlo, University of Milano, Milan
| | - Francesco Catagnano
- Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia
- Cardiology Department, Policlinico Di Monza, Monza
| | | | - Laura Dalla Vecchia
- Department of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Istituto Scientifico Di Milano, Milan
| | - Stefano Giovinazzo
- IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Genova
| | | | - Marco Guazzi
- Heart Failure Unit, Cardiology Department, IRCCS San Donato Hospital, University of Milan, Milan
| | - Anita Iorio
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital-Bergamo, Bergamo
| | - Maria Teresa La Rovere
- Department of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Istituto Scientifico Di Pavia, Pavia
| | - Sergio Leonardi
- Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia
| | - Gloria Maccagni
- Heart Failure Unit, Cardiology Department, IRCCS San Donato Hospital, University of Milan, Milan
| | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Department of Clinical Sciences and Community Health, University of Milano, Milan
- Department of Clinical Sciences and Community Health, University of Milano, Milan
| | - Davide Margonato
- Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia
- Cardiology Department, Policlinico Di Monza, Monza
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Trieste
| | - Luca Monzo
- Istituto Clinico Casal Palocco, Rome
- Policlinico Casilino, Rome
| | | | - Vincenzo Nuzzi
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Trieste
| | - Matteo Pagnesi
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Massimo Piepoli
- Heart Failure Unit, G da Saliceto Hospital, AUSL Piacenza, Piacenza
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa
| | - Italo Porto
- IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Genova
| | - Andrea Pozzi
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital-Bergamo, Bergamo
| | - Giovanni Provenzale
- Division of Cardiology, Ospedale San Paolo, ASST Santi Paolo E Carlo, University of Milano, Milan
| | - Filippo Sarullo
- Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo
| | - Michele Senni
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital-Bergamo, Bergamo
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Trieste
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Maurizio Volterrani
- Department of Medical Sciences, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) San Raffaele Pisana
| | - Roberto Maroldi
- Radiology ASST Spedali Civili di Brescia and Department of Medical and Surgical, Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Carlo Mario Lombardi
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Claudia Specchia
- Department of Molecular and Translational Medicine, University of Brescia, Italy
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Frattini S, Maccagni G, Danzi G. P211 LONG–TERM OUTCOME OF PATIENTS WITH STEMI AND CARDIOGENIC SHOCK TREATED BY PPCI. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
There is little data on the long–term outcome of patients with cardiogenic shock (CS) treated with primary angioplasty (PPCI) in the setting of acute ST–segment elevation myocardial infarction (STEMI). The aim of this study was to assess long–term mortality among hospital STEMI survivors who received a PPCI procedure, based on the presence of acute–phase CS.
Methods
We analyzed long–term follow–up data in a series of consecutive patients admitted to our institution for STEMI from 2009 to 2019 who were treated with PPCI.
Results
Of the 1288 patients who presented with STEMI, 1137 received a PPCI procedure. CS occurred in 111 (9.8%) of these patients. The in–hospital mortality rate was 5.6%; 2.9% in patients without and 30.6% in those with shock (P < 0.001)). The 1073 patients who survived the acute phase were followed up for 9 + 5 years. Survivors with CS had a more severe clinical profile and more frequent concomitant hospital complications. Long–term survival was 75.6% in patients with shock versus 84.0% in those without shock (P < 0.05). Patients with complete revascularization at the index procedure had similar survival compared to other patients with CS (survival rate 75% vs 75.4%; P = ns).
Conclusions
CS carries an increased risk of death during the hospital phase and at long–term follow–up: complete revascularization at the index procedure does not appear to offer any additional benefit on outcome
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Affiliation(s)
- S Frattini
- UO CARDIOLOGIA ASST CREMONA– OSPEDALE DI CREMONA, CREMONA
| | - G Maccagni
- UO CARDIOLOGIA ASST CREMONA– OSPEDALE DI CREMONA, CREMONA
| | - G Danzi
- UO CARDIOLOGIA ASST CREMONA– OSPEDALE DI CREMONA, CREMONA
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5
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Lombardi CM, Specchia C, Conforti F, Rovere MTL, Carubelli V, Agostoni P, Carugo S, Danzi GB, Guazzi M, Mortara A, Piepoli M, Porto I, Sinagra G, Volterrani M, Ameri P, Gnecchi M, Leonardi S, Merlo M, Iorio A, Bellasi A, Canale C, Camporotondo R, Catagnano F, Dalla Vecchia LA, Di Pasquale M, Giovinazzo S, Maccagni G, Mapelli M, Margonato D, Monzo L, Nuzzi V, Oriecuia C, Pala L, Peveri G, Pozzi A, Provenzale G, Sarullo F, Adamo M, Tomasoni D, Inciardi RM, Senni M, Metra M. Sex-related differences in patients with coronavirus disease 2019: results of the Cardio-COVID-Italy multicentre study. J Cardiovasc Med (Hagerstown) 2022; 23:254-263. [PMID: 35287158 PMCID: PMC10484185 DOI: 10.2459/jcm.0000000000001261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/30/2021] [Accepted: 09/08/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The role of sex compared to comorbidities and other prognostic variables in patients with coronavirus disease (COVID-19) is unclear. METHODS This is a retrospective observational study on patients with COVID-19 infection, referred to 13 cardiology units. The primary objective was to assess the difference in risk of death between the sexes. The secondary objective was to explore sex-based heterogeneity in the association between demographic, clinical and laboratory variables, and patients' risk of death. RESULTS Seven hundred and one patients were included: 214 (30.5%) women and 487 (69.5%) men. During a median follow-up of 15 days, deaths occurred in 39 (18.2%) women and 126 (25.9%) men. In a multivariable Cox regression model, men had a nonsignificantly higher risk of death vs. women (P = 0.07).The risk of death was more than double in men with a low lymphocytes count as compared with men with a high lymphocytes count [overall survival hazard ratio (OS-HR) 2.56, 95% confidence interval (CI) 1.72-3.81]. In contrast, lymphocytes count was not related to death in women (P = 0.03).Platelets count was associated with better outcome in men (OS-HR for increase of 50 × 103 units: 0.88 95% CI 0.78-1.00) but not in women. The strength of association between higher PaO2/FiO2 ratio and lower risk of death was larger in women (OS-HR for increase of 50 mmHg/%: 0.72, 95% CI 0.59-0.89) vs. men (OS-HR: 0.88, 95% CI 0.80-0.98; P = 0.05). CONCLUSIONS Patients' sex is a relevant variable that should be taken into account when evaluating risk of death from COVID-19. There is a sex-based heterogeneity in the association between baseline variables and patients' risk of death.
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Affiliation(s)
- Carlo Mario Lombardi
- Department of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
| | - Claudia Specchia
- Department of Molecular and Translational Medicine, University of Brescia, Brescia
| | - Fabio Conforti
- Division of Melanoma, Sarcoma and Rare Tumors, European Institute of Oncology, Milan
| | - Maria Teresa La Rovere
- Istituti Clinici Scientifici Maugeri, IRCCS, Dipartimento di Cardiologia, Istituto Scientifico Montescano, Pavia
| | - Valentina Carubelli
- Department of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan
- Department of Clinical Sciences and Community Health
| | - Stefano Carugo
- Division of Cardiology, Ospedale San Paolo, ASST Santi Paolo e Carlo, University of Milan, Milan
| | | | - Marco Guazzi
- Heart Failure Unit, Cardiology Department, University of Milan
- IRCCS San Donato Hospital, Milan
| | | | - Massimo Piepoli
- Heart Failure Unit, Guglielmo da Saliceto Hospital, AUSL Piacenza, Piacenza
- Institute of Life Sciences, Sant’Anna School of Advanced Studies, Pisa
| | - Italo Porto
- IRCCS Ospedale Policlinico San Martino – IRCCS Italian Cardiovascular Network, Department of Internal Medicine, University of Genova, Genova
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), and Department of Medical Surgical and Health Sciences, University of Trieste, Trieste
| | - Maurizio Volterrani
- Department of Cardiovascular and Respiratory Sciences, IRCCS, San Raffaele Pisana Rome, Rome
| | - Pietro Ameri
- IRCCS Ospedale Policlinico San Martino – IRCCS Italian Cardiovascular Network, Department of Internal Medicine, University of Genova, Genova
| | - Massimiliano Gnecchi
- Intensive Cardiac Care Unit, Fondazione IRCCS Policlinico S. Matteo
- Department of Molecular Medicine, Cardiology Unit, University of Pavia, Pavia
| | - Sergio Leonardi
- Intensive Cardiac Care Unit, Fondazione IRCCS Policlinico S. Matteo
- Department of Molecular Medicine, Cardiology Unit, University of Pavia, Pavia
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), and Department of Medical Surgical and Health Sciences, University of Trieste, Trieste
| | - Annamaria Iorio
- Cardiology Unit, Cardiovascular Department, Papa Giovanni XXIII Hospital-Bergamo
| | - Antonio Bellasi
- Innovation and Brand Reputation Unit, Papa Giovanni XXIII Hospital, Bergamo
| | - Claudia Canale
- IRCCS Ospedale Policlinico San Martino – IRCCS Italian Cardiovascular Network, Department of Internal Medicine, University of Genova, Genova
| | | | | | | | - Mattia Di Pasquale
- Department of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
| | - Stefano Giovinazzo
- IRCCS Ospedale Policlinico San Martino – IRCCS Italian Cardiovascular Network, Department of Internal Medicine, University of Genova, Genova
| | - Gloria Maccagni
- Department of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
| | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan
- Department of Clinical Sciences and Community Health
| | - Davide Margonato
- Cardiology Department, Policlinico di Monza, Monza
- Department of Cardiology, University of Pavia, Pavia
| | - Luca Monzo
- Istituto Clinico Casal Palocco
- Policlinico Casilino, Rome
| | - Vincenzo Nuzzi
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), and Department of Medical Surgical and Health Sciences, University of Trieste, Trieste
| | - Chiara Oriecuia
- Department of Molecular and Translational Medicine, University of Brescia, Brescia
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia
| | - Laura Pala
- Division of Melanoma, Sarcoma and Rare Tumors, European Institute of Oncology, Milan
| | - Giulia Peveri
- Department of Molecular and Translational Medicine, University of Brescia, Brescia
- Department of Clinical Sciences and Community Health
| | - Andrea Pozzi
- Cardiology Unit, Cardiovascular Department, Papa Giovanni XXIII Hospital-Bergamo
| | - Giovanni Provenzale
- Division of Cardiology, Ospedale San Paolo, ASST Santi Paolo e Carlo, University of Milan, Milan
| | - Filippo Sarullo
- Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo
| | - Marianna Adamo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia and Cardiac Catheterization Laboratory and Cardiology, Cardio-thoracic Department ASST Spedali Civili, Brescia, Italy
| | - Daniela Tomasoni
- Department of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
| | - Riccardo Maria Inciardi
- Department of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
| | - Michele Senni
- Cardiology Unit, Cardiovascular Department, Papa Giovanni XXIII Hospital-Bergamo
| | - Marco Metra
- Department of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
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6
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Iorio A, Lombardi CM, Specchia C, Merlo M, Nuzzi V, Ferraro I, Peveri G, Oriecuia C, Pozzi A, Inciardi RM, Carubelli V, Bellasi A, Canale C, Camporotondo R, Catagnano F, Dalla Vecchia L, Giovinazzo S, Maccagni G, Mapelli M, Margonato D, Monzo L, Provenzale G, Sarullo F, Tomasoni D, Ameri P, Gnecchi M, Leonardi S, Agostoni P, Carugo S, Danzi GB, Guazzi M, La Rovere MT, Mortara A, Piepoli M, Porto I, Volterrani M, Sinagra G, Senni M, Metra M. Combined Role of Troponin and Natriuretic Peptides Measurements in Patients With Covid-19 (from the Cardio-COVID-Italy Multicenter Study). Am J Cardiol 2022; 167:125-132. [PMID: 35063263 PMCID: PMC8767953 DOI: 10.1016/j.amjcard.2021.11.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/27/2021] [Accepted: 11/30/2021] [Indexed: 12/14/2022]
Abstract
Data concerning the combined prognostic role of natriuretic peptide (NP) and troponin in patients with COVID-19 are lacking. The aim of the study is to evaluate the combined prognostic value of NPs and troponin in hospitalized COVID-19 patients. From March 1, 2020 to April 9, 2020, consecutive patients with COVID-19 and available data on cardiac biomarkers at admission were recruited. Patients admitted for acute coronary syndrome were excluded. Troponin levels were defined as elevated when greater than the 99th percentile of normal values. NPs were considered elevated if above the limit for ruling in acute heart failure (HF). A total of 341 patients were included in this study, mean age 68 ± 13 years, 72% were men. During a median follow-up period of 14 days, 81 patients (24%) died. In the Cox regression analysis, patients with elevated both NPs and troponin levels had higher risk of death compared with those with normal levels of both (hazard ratio 2.94; 95% confidence interval 1.31 to 6.64; p = 0.009), and this remained significant after adjustment for age, gender, oxygen saturation, HF history, and chronic kidney disease. Interestingly, NPs provided risk stratification also in patients with normal troponin values (hazard ratio 2.86; 95% confidence interval 1.21 to 6.72; p = 0.016 with high NPs levels). These data show the combined prognostic role of troponin and NPs in COVID-19 patients. NPs value may be helpful in identifying patients with a worse prognosis among those with normal troponin values. Further, NPs’ cut-point used for diagnosis of acute HF has a predictive role in patients with COVID-19.
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7
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Paris S, Inciardi RM, Specchia C, Vezzoli M, Oriecuia C, Lombardi CM, Murillo NH, Pagnesi M, Tomasoni D, Ameri P, Carubelli V, Agostoni P, Canale C, Carugo S, Danzi G, Pasquale MD, Sarullo F, Rovere MTL, Mortara A, Piepoli M, Porto I, Sinagra G, Volterrani M, Gnecchi M, Leonardi S, Merlo M, Iorio A, Giovinazzo S, Bellasi A, Zaccone G, Camporotondo R, Catagnano F, Vecchia LD, Maccagni G, Mapelli M, Margonato D, Monzo L, Nuzzi V, Pozzi A, Provenzale G, Tedino C, Guazzi M, Senni M, Metra M. 554 Machine learning for prediction of in-hospital mortality in COVID-19 patients: results from an Italian multicentre study. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab135.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Several risk factors have been identified to predict worse outcomes in patients affected by SARS-CoV-2 infection. Prediction models are needed to optimize clinical management and to early stratify patients at a higher mortality risk. Machine learning (ML) algorithms represent a novel approach to identify a prediction model with a good discriminatory capacity to be easily used in clinical practice.
Methods and results
The Cardio-COVID is a multicentre observational study that involved a cohort of consecutive adult Caucasian patients with laboratory-confirmed COVID-19 [by real time reverse transcriptase—polymerase chain reaction (RT-PCR)] who were hospitalized in 13 Italian cardiology units from 1 March to 9 April 2020. Patients were followed-up after the COVID-19 diagnosis and all causes in-hospital mortality or discharge were ascertained until 23 April 2020. Variables with more than 20% of missing values were excluded. The Lasso procedure was used with a λ = 0.07 for reducing the covariates number. Mortality was estimated by means of a Random Forest (RF). The dataset was randomly divided in two subsamples with the same percentage of death/alive people of the entire sample: training set contained 80% of the data and test set the remaining 20%. The training set was used in the calibration procedure where a RF models in-hospital mortality with the covariates selected by Lasso. Its accuracy was measured by means of the ROC curve, obtaining AUC, sensitivity, specificity, and related 95% confidence interval (CI) computed with 10 000 stratified bootstrap replicates. From the RF the relative Variable Importance Measure (relVIM) was extracted to understand which of the selected variables had the greatest impact on outcome, providing a ranking from the most (relVIM = 100) to the less important variable. The model obtained was compared with the Gradient Boosting Machine (GBM) and with the logistic regression, where the predictions were cross validated. Finally, to understand if each model has the same performance in sample (training) and out of sample (test), the two AUCs were compared by means of the DeLong’s test. Among 701 patients enrolled (mean age 67.2 ± 13.2 years, 69.5% males), 165 (23.5%) died during a median hospitalization of 15 (IQR, 9–24) days. Variables selected by the Lasso were: age, Oxygen saturation, PaO2/FiO2, Creatinine Clearance and elevated Troponin. Compared with those who survived, deceased patients were older, had a lower blood oxygenation, a lower creatinine clearance levels and higher prevalence of elevated Troponin (all P < 0.001). Training set included 561 patients and test set 140 patients. The best performance out of sample was provided by the RF with an AUC of 0.78 (95% CI: 0.68–0.88) and a sensitivity of 0.88 (95% CI: 0.58–1.00). Moreover, RF is the unique methodology that provided similar performance in sample and out of sample (DeLong test P = 0.78). On the contrary, prediction model was less accurate by using GBM and logistic regression. The relVIM ranked the variables from the most to the less important in predicting the outcome as follows: clearance creatinine, PaO2/FiO2, age, oxygen saturation, and elevated Troponin.
Conclusions
In a large COVID-19 population, we showed that a customizable ML-based score derived from clinical variables, is feasible and effective for the prediction of in-hospital mortality.
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Affiliation(s)
- Sara Paris
- Cardiologia, ASST Spedali Civili di Brescia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi di Brescia, Italy
| | - Riccardo Maria Inciardi
- Cardiologia, ASST Spedali Civili di Brescia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi di Brescia, Italy
| | - Claudia Specchia
- Cardiologia, ASST Spedali Civili di Brescia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi di Brescia, Italy
| | - Marika Vezzoli
- Cardiologia, ASST Spedali Civili di Brescia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi di Brescia, Italy
| | - Chiara Oriecuia
- Cardiologia, ASST Spedali Civili di Brescia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi di Brescia, Italy
| | - Carlo Mario Lombardi
- Cardiologia, ASST Spedali Civili di Brescia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi di Brescia, Italy
| | - Natalia Herrera Murillo
- Cardiologia, ASST Spedali Civili di Brescia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi di Brescia, Italy
| | - Matteo Pagnesi
- Cardiologia, ASST Spedali Civili di Brescia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi di Brescia, Italy
| | - Daniela Tomasoni
- Cardiologia, ASST Spedali Civili di Brescia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi di Brescia, Italy
| | - Pietro Ameri
- Dipartimento di Medicina Interna, IRCCS Ospedale Policlinico San Martino, Università di Genova, Italy
| | - Valentina Carubelli
- Cardiologia, ASST Spedali Civili di Brescia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi di Brescia, Italy
| | | | - Claudia Canale
- Dipartimento di Medicina Interna, IRCCS Ospedale Policlinico San Martino, Università di Genova, Italy
| | - Stefano Carugo
- Divisione di Cardiologia, Ospedale San Paolo, ASST Santi Paolo e Carlo, Università di Milano, Italy
| | | | - Mattia Di Pasquale
- Cardiologia, ASST Spedali Civili di Brescia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi di Brescia, Italy
| | - Filippo Sarullo
- Unità di Riabilitazione Cardiologica, Buccheri la Ferla Ospedale Fatebenefratelli, Palermo, Italy
| | - Maria Teresa La Rovere
- Dipartimento di Cardiologia, Istituti Clinici Scientifici Maugeri, IRCCS, Istituto Scientifico di Pavia, Italy
| | - Andrea Mortara
- Dipartimento di Cardiologia, Policlinico di Monza, Italy
| | - Massimo Piepoli
- Heart Failure Unit, Ospedale G. da Saliceto, AUSL Piacenza, Italy
- Sant Anna School of Advanced Studies, Institute of Life Sciences, Pisa, Italy
| | - Italo Porto
- Dipartimento di Medicina Interna, IRCCS Ospedale Policlinico San Martino, Università di Genova, Italy
| | - Gianfranco Sinagra
- Dipartimento di Cardiologia, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | | | - Massimiliano Gnecchi
- Divisione di Cardiologia, Dipartimento di Scienze Mediche e Malattie Infettive, Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Italy
| | - Sergio Leonardi
- Divisione di Cardiologia, Dipartimento di Scienze Mediche e Malattie Infettive, Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Italy
| | - Marco Merlo
- Dipartimento di Cardiologia, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Annamaria Iorio
- Dipartimento Cardiovascolare, Unità di Cardiologia, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Giovinazzo
- Dipartimento di Medicina Interna, IRCCS Ospedale Policlinico San Martino, Università di Genova, Italy
| | - Antonio Bellasi
- Unità di Innovazione e Brand Reputation, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Gregorio Zaccone
- Cardiologia, ASST Spedali Civili di Brescia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi di Brescia, Italy
| | - Rita Camporotondo
- Divisione di Cardiologia, Dipartimento di Scienze Mediche e Malattie Infettive, Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Italy
| | - Francesco Catagnano
- Dipartimento di Cardiologia, Policlinico di Monza, Italy
- Divisione di Cardiologia, Dipartimento di Scienze Mediche e Malattie Infettive, Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Italy
| | - Laura Dalla Vecchia
- Dipartimento di Cardiologia, Istituti Clinici Scientifici Maugeri, IRCCS, Istituto Scientifico di Milano, Italy
| | - Gloria Maccagni
- Cardiologia, ASST Spedali Civili di Brescia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi di Brescia, Italy
| | - Massimo Mapelli
- Divisione di Cardiologia, Centro Cardiologico Monzino, Università di Milano, Italy
| | - Davide Margonato
- Dipartimento di Cardiologia, Policlinico di Monza, Italy
- Dipartimento di Cardiologia, Istituti Clinici Scientifici Maugeri, IRCCS, Istituto Scientifico di Milano, Italy
| | - Luca Monzo
- Dipartimento di Cardiologia, Istituto Clinico Casal Palocco, Policlinico Casilino, Roma, Italy
| | - Vincenzo Nuzzi
- Dipartimento di Cardiologia, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Andrea Pozzi
- Dipartimento Cardiovascolare, Unità di Cardiologia, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Giovanni Provenzale
- Divisione di Cardiologia, Ospedale San Paolo, ASST Santi Paolo e Carlo, Università di Milano, Italy
| | - Chiara Tedino
- Cardiologia, ASST Spedali Civili di Brescia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi di Brescia, Italy
| | - Marco Guazzi
- Heart Failure Unit, Dipartimento di Cardiologia, Università di Milano, IRCCS Ospedale San Donato, Italy
| | - Michele Senni
- Dipartimento Cardiovascolare, Unità di Cardiologia, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Metra
- Cardiologia, ASST Spedali Civili di Brescia, Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi di Brescia, Italy
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8
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Paris S, Inciardi RM, Lombardi CM, Tomasoni D, Ameri P, Carubelli V, Agostoni P, Canale C, Carugo S, Danzi G, Di Pasquale M, Sarullo F, La Rovere MT, Mortara A, Piepoli M, Porto I, Sinagra G, Volterrani M, Gnecchi M, Leonardi S, Merlo M, Iorio A, Giovinazzo S, Bellasi A, Zaccone G, Camporotondo R, Catagnano F, Dalla Vecchia L, Maccagni G, Mapelli M, Margonato D, Monzo L, Nuzzi V, Pozzi A, Provenzale G, Specchia C, Tedino C, Guazzi M, Senni M, Metra M. Implications of atrial fibrillation on the clinical course and outcomes of hospitalized COVID-19 patients: results of the Cardio-COVID-Italy multicentre study. Europace 2021; 23:1603-1611. [PMID: 34297833 PMCID: PMC8344555 DOI: 10.1093/europace/euab146] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/18/2021] [Indexed: 01/08/2023] Open
Abstract
AIMS To assess the clinical relevance of a history of atrial fibrillation (AF) in hospitalized patients with coronavirus disease 2019 (COVID-19). METHODS AND RESULTS We enrolled 696 consecutive patients (mean age 67.4 ± 13.2 years, 69.7% males) admitted for COVID-19 in 13 Italian cardiology centres between 1 March and 9 April 2020. One hundred and six patients (15%) had a history of AF and the median hospitalization length was 14 days (interquartile range 9-24). Patients with a history of AF were older and with a higher burden of cardiovascular risk factors. Compared to patients without AF, they showed a higher rate of in-hospital death (38.7% vs. 20.8%; P < 0.001). History of AF was associated with an increased risk of death after adjustment for clinical confounders related to COVID-19 severity and cardiovascular comorbidities, including history of heart failure (HF) and increased plasma troponin [adjusted hazard ratio (HR): 1.73; 95% confidence interval (CI) 1.06-2.84; P = 0.029]. Patients with a history of AF also had more in-hospital clinical events including new-onset AF (36.8% vs. 7.9%; P < 0.001), acute HF (25.3% vs. 6.3%; P < 0.001), and multiorgan failure (13.9% vs. 5.8%; P = 0.010). The association between AF and worse outcome was not modified by previous or concomitant use of anticoagulants or steroid therapy (P for interaction >0.05 for both) and was not related to stroke or bleeding events. CONCLUSION Among hospitalized patients with COVID-19, a history of AF contributes to worse clinical course with a higher mortality and in-hospital events including new-onset AF, acute HF, and multiorgan failure. The mortality risk remains significant after adjustment for variables associated with COVID-19 severity and comorbidities.
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Affiliation(s)
- Sara Paris
- Cardiology; ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili, 125123 Brescia, Italy
| | - Riccardo M Inciardi
- Cardiology; ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili, 125123 Brescia, Italy
| | - Carlo Mario Lombardi
- Cardiology; ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili, 125123 Brescia, Italy
| | - Daniela Tomasoni
- Cardiology; ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili, 125123 Brescia, Italy
| | - Pietro Ameri
- Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino-IRCCS Italian Cardiovascular Network, University of Genova, Genova, Italy
| | - Valentina Carubelli
- Cardiology; ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili, 125123 Brescia, Italy
| | - Piergiuseppe Agostoni
- Division of Cardiology, Department of Clinical Sciences and Community Health, Centro Cardiologico Monzino, University of Milan, Milan, Italy
| | - Claudia Canale
- Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino-IRCCS Italian Cardiovascular Network, University of Genova, Genova, Italy
| | - Stefano Carugo
- Division of Cardiology, Ospedale San Paolo, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | | | - Mattia Di Pasquale
- Cardiology; ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili, 125123 Brescia, Italy
| | - Filippo Sarullo
- Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
| | - Maria Teresa La Rovere
- Istituti Clinici Scientifici Maugeri, IRCCS, Dipartimento di Cardiologia, Istituto Scientifico di Pavia, Pavia, Italy
| | - Andrea Mortara
- Cardiology Department, Policlinico di Monza, Monza, Italy
| | - Massimo Piepoli
- Heart Failure Unit, G da Saliceto Hospital, AUSL Piacenza, Piacenza, Italy.,Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Italo Porto
- Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino-IRCCS Italian Cardiovascular Network, University of Genova, Genova, Italy
| | - Gianfranco Sinagra
- Department of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Maurizio Volterrani
- Department of Medical Sciences, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Pisana Rome, Rome, Italy
| | - Massimiliano Gnecchi
- Division of Cardiology, Dipartimento Scienze mediche e malattie infettive, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - Sergio Leonardi
- Division of Cardiology, Dipartimento Scienze mediche e malattie infettive, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - Marco Merlo
- Department of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Annamaria Iorio
- Cardiovascular Department, Cardiology Unit, Papa Giovanni XXIII Hospital-Bergamo, Piazza OMS, 1, 24127 Bergamo, Italy
| | - Stefano Giovinazzo
- Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino-IRCCS Italian Cardiovascular Network, University of Genova, Genova, Italy
| | - Antonio Bellasi
- Innovation and Brand Reputation Unit, Papa Giovanni XXIII Hospital, Bergamo Research, Bergamo, Italy
| | - Gregorio Zaccone
- Cardiology; ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili, 125123 Brescia, Italy
| | - Rita Camporotondo
- Division of Cardiology, Dipartimento Scienze mediche e malattie infettive, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - Francesco Catagnano
- Cardiology Department, Policlinico di Monza, Monza, Italy.,Division of Cardiology, Dipartimento Scienze mediche e malattie infettive, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - Laura Dalla Vecchia
- Istituti Clinici Scientifici Maugeri, IRCCS, Dipartimento di Cardiologia, Istituto Scientifico di Milan, Milan, Italy
| | - Gloria Maccagni
- Division of Cardiology, Ospedale Maggiore di Cremona, Cremona, Italy
| | - Massimo Mapelli
- Division of Cardiology, Department of Clinical Sciences and Community Health, Centro Cardiologico Monzino, University of Milan, Milan, Italy
| | - Davide Margonato
- Cardiology Department, Policlinico di Monza, Monza, Italy.,Istituti Clinici Scientifici Maugeri, IRCCS, Dipartimento di Cardiologia, Istituto Scientifico di Milan, Milan, Italy
| | - Luca Monzo
- Department of Cardiology, Istituto Clinico Casal Palocco, Policlinico Casilino, Rome, Italy
| | - Vincenzo Nuzzi
- Cardiology; ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili, 125123 Brescia, Italy
| | - Andrea Pozzi
- Cardiovascular Department, Cardiology Unit, Papa Giovanni XXIII Hospital-Bergamo, Piazza OMS, 1, 24127 Bergamo, Italy
| | - Giovanni Provenzale
- Division of Cardiology, Ospedale San Paolo, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Claudia Specchia
- Cardiology; ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili, 125123 Brescia, Italy
| | - Chiara Tedino
- Cardiology; ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili, 125123 Brescia, Italy
| | - Marco Guazzi
- Heart Failure Unit, Cardiology Department, University of Milan, IRCCS San Donato Hospital, Milan, Italy
| | - Michele Senni
- Cardiovascular Department, Cardiology Unit, Papa Giovanni XXIII Hospital-Bergamo, Piazza OMS, 1, 24127 Bergamo, Italy
| | - Marco Metra
- Cardiology; ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili, 125123 Brescia, Italy
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9
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Nuzzi V, Merlo M, Specchia C, Lombardi CM, Carubelli V, Iorio A, Inciardi RM, Bellasi A, Canale C, Camporotondo R, Catagnano F, Dalla Vecchia LA, Giovinazzo S, Maccagni G, Mapelli M, Margonato D, Monzo L, Oriecuia C, Peveri G, Pozzi A, Provenzale G, Sarullo F, Tomasoni D, Ameri P, Gnecchi M, Leonardi S, Agostoni P, Carugo S, Danzi GB, Guazzi M, La Rovere MT, Mortara A, Piepoli M, Porto I, Volterrani M, Senni M, Metra M, Sinagra G. The prognostic value of serial troponin measurements in patients admitted for COVID-19. ESC Heart Fail 2021; 8:3504-3511. [PMID: 34236135 PMCID: PMC8426962 DOI: 10.1002/ehf2.13462] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/14/2021] [Accepted: 05/23/2021] [Indexed: 01/06/2023] Open
Abstract
Aims Myocardial injury (MI) in coronavirus disease‐19 (COVID‐19) is quite prevalent at admission and affects prognosis. Little is known about troponin trajectories and their prognostic role. We aimed to describe the early in‐hospital evolution of MI and its prognostic impact. Methods and results We performed an analysis from an Italian multicentre study enrolling COVID‐19 patients, hospitalized from 1 March to 9 April 2020. MI was defined as increased troponin level. The first troponin was tested within 24 h from admission, the second one between 24 and 48 h. Elevated troponin was defined as values above the 99th percentile of normal values. Patients were divided in four groups: normal, normal then elevated, elevated then normal, and elevated. The outcome was in‐hospital death. The study population included 197 patients; 41% had normal troponin at both evaluations, 44% had elevated troponin at both assessments, 8% had normal then elevated troponin, and 7% had elevated then normal troponin. During hospitalization, 49 (25%) patients died. Patients with incident MI, with persistent MI, and with MI only at admission had a higher risk of death compared with those with normal troponin at both evaluations (P < 0.001). At multivariable analysis, patients with normal troponin at admission and MI injury on Day 2 had the highest mortality risk (hazard ratio 3.78, 95% confidence interval 1.10–13.09, P = 0.035). Conclusions In patients admitted for COVID‐19, re‐test MI on Day 2 provides a prognostic value. A non‐negligible proportion of patients with incident MI on Day 2 is identified at high risk of death only by the second measurement.
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Affiliation(s)
- Vincenzo Nuzzi
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Via Valdoni 7, Trieste, 34100, Italy
| | - Marco Merlo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Via Valdoni 7, Trieste, 34100, Italy
| | - Claudia Specchia
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Carlo Mario Lombardi
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Valentina Carubelli
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Annamaria Iorio
- Cardiology Unit, Cardiovascular Department, Papa Giovanni XXIII Hospital-Bergamo, Bergamo, Italy
| | - Riccardo Maria Inciardi
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Antonio Bellasi
- Innovation and Brand Reputation Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Claudia Canale
- Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino-IRCCS Italian Cardiovascular Network, University of Genova, Genoa, Italy
| | - Rita Camporotondo
- Intensive Cardiac Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | | | - Laura Adelaide Dalla Vecchia
- Dipartimento di Cardiologia, Istituti Clinici Scientifici Maugeri, IRCCS, Istituto Scientifico di Milano, Milan, Italy
| | - Stefano Giovinazzo
- Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino-IRCCS Italian Cardiovascular Network, University of Genova, Genoa, Italy
| | - Gloria Maccagni
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Division of Cardiology, Ospedale di Cremona, Cremona, Italy
| | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Luca Monzo
- Istituto Clinico Casal Palocco, Rome, Italy.,Policlinico Casilino, Rome, Italy
| | - Chiara Oriecuia
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giulia Peveri
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Andrea Pozzi
- Cardiology Unit, Cardiovascular Department, Papa Giovanni XXIII Hospital-Bergamo, Bergamo, Italy
| | - Giovanni Provenzale
- Division of Cardiology, Ospedale San Paolo, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Filippo Sarullo
- Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Pietro Ameri
- Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino-IRCCS Italian Cardiovascular Network, University of Genova, Genoa, Italy
| | - Massimiliano Gnecchi
- Intensive Cardiac Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.,Department of Molecular Medicine, Cardiology Unit, University of Pavia, Pavia, Italy
| | - Sergio Leonardi
- Intensive Cardiac Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.,Department of Molecular Medicine, Cardiology Unit, University of Pavia, Pavia, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Stefano Carugo
- Division of Cardiology, Ospedale San Paolo, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | | | - Marco Guazzi
- Heart Failure Unit, Cardiology Department, University of Milan, Milan, Italy.,IRCCS Policlinico San Donato, Milan, Italy
| | - Maria Teresa La Rovere
- Dipartimento di Cardiologia, Istituti Clinici Scientifici Maugeri, IRCCS, Istituto Scientifico di Montescano, Pavia, Italy
| | - Andrea Mortara
- Cardiology Department, Policlinico di Monza, Monza, Italy
| | - Massimo Piepoli
- Heart Failure Unit, Guglielmo da Saliceto Hospital, AUSL Piacenza, Piacenza, Italy.,Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Italo Porto
- Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino-IRCCS Italian Cardiovascular Network, University of Genova, Genoa, Italy
| | - Maurizio Volterrani
- Department of Cardiovascular and Respiratory Sciences, IRCCS, San Raffaele Pisana Rome, Rome, Italy
| | - Michele Senni
- Cardiology Unit, Cardiovascular Department, Papa Giovanni XXIII Hospital-Bergamo, Bergamo, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Via Valdoni 7, Trieste, 34100, Italy
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10
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Ameri P, Inciardi RM, Di Pasquale M, Agostoni P, Bellasi A, Camporotondo R, Canale C, Carubelli V, Carugo S, Catagnano F, Danzi G, Dalla Vecchia L, Giovinazzo S, Gnecchi M, Guazzi M, Iorio A, La Rovere MT, Leonardi S, Maccagni G, Mapelli M, Margonato D, Merlo M, Monzo L, Mortara A, Nuzzi V, Piepoli M, Porto I, Pozzi A, Provenzale G, Sarullo F, Sinagra G, Tedino C, Tomasoni D, Volterrani M, Zaccone G, Lombardi CM, Senni M, Metra M. Pulmonary embolism in patients with COVID-19: characteristics and outcomes in the Cardio-COVID Italy multicenter study. Clin Res Cardiol 2021; 110:1020-1028. [PMID: 33141251 PMCID: PMC7607374 DOI: 10.1007/s00392-020-01766-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/15/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Pulmonary embolism (PE) has been described in coronavirus disease 2019 (COVID-19) critically ill patients, but the evidence from more heterogeneous cohorts is limited. METHODS Data were retrospectively obtained from consecutive COVID-19 patients admitted to 13 Cardiology Units in Italy, from March 1st to April 9th, 2020, and followed until in-hospital death, discharge, or April 23rd, 2020. The association of baseline variables with computed tomography-confirmed PE was investigated by Cox hazards regression analysis. The relationship between D-dimer levels and PE incidence was evaluated using restricted cubic splines models. RESULTS The study included 689 patients (67.3 ± 13.2 year-old, 69.4% males), of whom 43.6% were non-invasively ventilated and 15.8% invasively. 52 (7.5%) had PE over 15 (9-24) days of follow-up. Compared with those without PE, these subjects had younger age, higher BMI, less often heart failure and chronic kidney disease, more severe cardio-pulmonary involvement, and higher admission D-dimer [4344 (1099-15,118) vs. 818.5 (417-1460) ng/mL, p < 0.001]. They also received more frequently darunavir/ritonavir, tocilizumab and ventilation support. Furthermore, they faced more bleeding episodes requiring transfusion (15.6% vs. 5.1%, p < 0.001) and non-significantly higher in-hospital mortality (34.6% vs. 22.9%, p = 0.06). In multivariate regression, only D-dimer was associated with PE (HR 1.72, 95% CI 1.13-2.62; p = 0.01). The relation between D-dimer concentrations and PE incidence was linear, without inflection point. Only two subjects had a baseline D-dimer < 500 ng/mL. CONCLUSIONS PE occurs in a sizable proportion of hospitalized COVID-19 patients. The implications of bleeding events and the role of D-dimer in this population need to be clarified.
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Affiliation(s)
- Pietro Ameri
- IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Genova, Italy
| | - Riccardo M Inciardi
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Mattia Di Pasquale
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Antonio Bellasi
- Innovation and Brand Reputation Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Rita Camporotondo
- Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia, Italy
| | - Claudia Canale
- IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Genova, Italy
| | - Valentina Carubelli
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Carugo
- Division of Cardiology, Ospedale San Paolo, ASST Santi Paolo E Carlo, University of Milano, Milan, Italy
| | - Francesco Catagnano
- Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia, Italy
- Cardiology Department, Policlinico Di Monza, Monza, Italy
| | | | - Laura Dalla Vecchia
- Dipartimento Di Cardiologia, Istituti Clinici Scientifici Maugeri, IRCCS, Istituto Scientifico Di Milano, Milan, Italy
| | - Stefano Giovinazzo
- IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Genova, Italy
| | | | - Marco Guazzi
- Heart Failure Unit, Cardiology Department, IRCCS San Donato Hospital, University of Milan, Milan, Italy
| | - Anita Iorio
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital-Bergamo, Piazza OMS, 1, 24127, Bergamo, Italy
| | - Maria Teresa La Rovere
- Dipartimento Di Cardiologia, Istituti Clinici Scientifici Maugeri, IRCCS, Istituto Scientifico Di Pavia, Pavia, Italy
| | - Sergio Leonardi
- Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia, Italy
| | - Gloria Maccagni
- Division of Cardiology, Ospedale Maggiore Di Cremona, Cremona, Italy
| | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Davide Margonato
- Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia, Italy
- Cardiology Department, Policlinico Di Monza, Monza, Italy
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Luca Monzo
- Istituto Clinico Casal Palocco, Rome, Italy
- Policlinico Casilino, Rome, Italy
| | - Andrea Mortara
- Cardiology Department, Policlinico Di Monza, Monza, Italy
| | - Vincenzo Nuzzi
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Massimo Piepoli
- Heart Failure Unit, G da Saliceto Hospital, AUSL Piacenza, Piacenza, Italy
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Italo Porto
- IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Genova, Italy
| | - Andrea Pozzi
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital-Bergamo, Piazza OMS, 1, 24127, Bergamo, Italy
| | - Giovanni Provenzale
- Division of Cardiology, Ospedale San Paolo, ASST Santi Paolo E Carlo, University of Milano, Milan, Italy
| | - Filippo Sarullo
- Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Chiara Tedino
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Maurizio Volterrani
- Department of Medical Sciences, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) San Raffaele Pisana, Rome, Italy
| | - Gregorio Zaccone
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Carlo Mario Lombardi
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Michele Senni
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital-Bergamo, Piazza OMS, 1, 24127, Bergamo, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
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11
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Di Castelnuovo A, Costanzo S, Antinori A, Berselli N, Blandi L, Bonaccio M, Bruno R, Cauda R, Gialluisi A, Guaraldi G, Menicanti L, Mennuni M, My I, Parruti A, Patti G, Perlini S, Santilli F, Signorelli C, Stefanini GG, Vergori A, Ageno W, Aiello L, Agostoni P, Al Moghazi S, Arboretti R, Aucella F, Barbieri G, Barchitta M, Bartoloni A, Bologna C, Bonfanti P, Caiano L, Carrozzi L, Cascio A, Castiglione G, Chiarito M, Ciccullo A, Cingolani A, Cipollone F, Colomba C, Colombo C, Crosta F, Dalena G, Dal Pra C, Danzi GB, D'Ardes D, de Gaetano Donati K, Di Gennaro F, Di Tano G, D'Offizi G, Filippini T, Maria Fusco F, Gaudiosi C, Gentile I, Gini G, Grandone E, Guarnieri G, Lamanna GLF, Larizza G, Leone A, Lio V, Losito AR, Maccagni G, Maitan S, Mancarella S, Manuele R, Mapelli M, Maragna R, Marra L, Maresca G, Marotta C, Mastroianni F, Mazzitelli M, Mengozzi A, Menichetti F, Milic J, Minutolo F, Molena B, Mussinelli R, Mussini C, Musso M, Odone A, Olivieri M, Pasi E, Perroni A, Petri F, Pinchera B, Pivato CA, Poletti V, Ravaglia C, Rossato M, Rossi M, Sabena A, Salinaro F, Sangiovanni V, Sanrocco C, Scorzolini L, Sgariglia R, Simeone PG, Spinicci M, Trecarichi EM, Veronesi G, Vettor R, Vianello A, Vinceti M, Visconti E, Vocciante L, De Caterina R, Iacoviello L. Lopinavir/Ritonavir and Darunavir/Cobicistat in Hospitalized COVID-19 Patients: Findings From the Multicenter Italian CORIST Study. Front Med (Lausanne) 2021; 8:639970. [PMID: 34179035 PMCID: PMC8221239 DOI: 10.3389/fmed.2021.639970] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/05/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Protease inhibitors have been considered as possible therapeutic agents for COVID-19 patients. Objectives: To describe the association between lopinavir/ritonavir (LPV/r) or darunavir/cobicistat (DRV/c) use and in-hospital mortality in COVID-19 patients. Study Design: Multicenter observational study of COVID-19 patients admitted in 33 Italian hospitals. Medications, preexisting conditions, clinical measures, and outcomes were extracted from medical records. Patients were retrospectively divided in three groups, according to use of LPV/r, DRV/c or none of them. Primary outcome in a time-to event analysis was death. We used Cox proportional-hazards models with inverse probability of treatment weighting by multinomial propensity scores. Results: Out of 3,451 patients, 33.3% LPV/r and 13.9% received DRV/c. Patients receiving LPV/r or DRV/c were more likely younger, men, had higher C-reactive protein levels while less likely had hypertension, cardiovascular, pulmonary or kidney disease. After adjustment for propensity scores, LPV/r use was not associated with mortality (HR = 0.94, 95% CI 0.78 to 1.13), whereas treatment with DRV/c was associated with a higher death risk (HR = 1.89, 1.53 to 2.34, E-value = 2.43). This increased risk was more marked in women, in elderly, in patients with higher severity of COVID-19 and in patients receiving other COVID-19 drugs. Conclusions: In a large cohort of Italian patients hospitalized for COVID-19 in a real-life setting, the use of LPV/r treatment did not change death rate, while DRV/c was associated with increased mortality. Within the limits of an observational study, these data do not support the use of LPV/r or DRV/c in COVID-19 patients.
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Affiliation(s)
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Andrea Antinori
- UOC Immunodeficienze Virali, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Roma, Italy
| | - Nausicaa Berselli
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena, 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, Roma, Italy
| | | | - Giovanni Guaraldi
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Marco Mennuni
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Ilaria My
- Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy
| | - Agostino 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
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Luca Aiello
- UOC, Anestesia e Rianimazione, Dipartimento di Chirurgia Generale Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino IRCCS, Milano, Italy
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milano, Milano, Italy
| | - Samir Al Moghazi
- UOC Infezioni Sistemiche dell'Immunodepresso, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Rosa Arboretti
- Department of Civil Environmental and Architectural Engineering, University of Padova, Padova, Italy
| | - Filippo Aucella
- Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Greta Barbieri
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, 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
| | - Lucia Caiano
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Laura Carrozzi
- Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, 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
| | - Giacomo Castiglione
- Servizio di Anestesia e Rianimazione II UO Rianimazione Ospedale San Marco, AOU Policlinico-Vittorio Emanuele, Catania, Italy
| | - Mauro Chiarito
- Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy
| | - Arturo Ciccullo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Antonella Cingolani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore- Dipartimento di Sicurezza e Bioetica Sede di Roma, 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
| | - Crizia Colombo
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Francesco Crosta
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Giovanni Dalena
- COVID-19 Unit, EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, Italy
| | - Chiara Dal Pra
- Clinica Medica 3, Department of Medicine - DIMED, University Hospital of Padova, Padova, Italy
| | | | - Damiano D'Ardes
- Department of Medicine and Aging, Clinica Medica, SS. Annunziata Hospital and University of Chieti, Chieti, Italy
| | | | | | | | - Gianpiero D'Offizi
- UOC Malattie Infettive-Epatologia, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Roma, Italy
| | - Tommaso Filippini
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena, Modena, Italy
| | - Francesco Maria 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
| | - Giancarlo Gini
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Elvira Grandone
- Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Gabriella Guarnieri
- Respiratory Pathophysiology Division, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | | | - Giovanni Larizza
- COVID-19 Unit, EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, Italy
| | - Armando Leone
- UOC di Pneumologia, P.O. San Giuseppe Moscati, Taranto, Italy
| | - Veronica Lio
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | | | - Gloria Maccagni
- Department of Cardiology, Ospedale di Cremona, Cremona, Italy
| | - Stefano Maitan
- UOC, Anestesia e Rianimazione, Dipartimento di Chirurgia Generale Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Sandro Mancarella
- ASST Milano Nord - Ospedale Edoardo Bassini Cinisello Balsamo, Milan, Italy
| | - Rosa Manuele
- UOC Malattie Infettive e Tropicali, P.O. San Marco, AOU Policlinico-Vittorio Emanuele, Catania, Italy
| | - Massimo Mapelli
- Centro Cardiologico Monzino IRCCS, Milano, Italy
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milano, Milano, Italy
| | - Riccardo Maragna
- Centro Cardiologico Monzino IRCCS, Milano, Italy
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milano, Milano, Italy
| | - Lorenzo Marra
- UOC di Pneumologia, P.O. San Giuseppe Moscati, Taranto, Italy
| | - Giulio Maresca
- UOC di Medicina - Presidio Ospedaliero S.Maria di Loreto Nuovo, Napoli, Italy
| | | | - Franco Mastroianni
- COVID-19 Unit, EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, Italy
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Francesco Menichetti
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, 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
| | | | - Beatrice Molena
- Respiratory Pathophysiology Division, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - R. Mussinelli
- Department of Internal Medicine, University of Pavia, Pavia, 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, Roma, 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
| | - Annalisa Perroni
- Department of Medicine and Aging, Clinica Medica, SS. Annunziata Hospital and University of Chieti, Chieti, 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, Italy
| | - Venerino Poletti
- UOC Pneumologia, Dipartimento di Malattie Apparato Respiratorio e Torace, Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Claudia Ravaglia
- UOC Pneumologia, Dipartimento di Malattie Apparato Respiratorio e Torace, Ospedale Morgagni-Pierantoni, Forlì, 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
| | - Laura Scorzolini
- UOC Malattie Infettive ad Alta Intensità di Cura, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | | | - Paola Giustina Simeone
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Enrico Maria Trecarichi
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, 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, Modena, Italy
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Elena Visconti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Laura Vocciante
- UOC di Medicina - Presidio Ospedaliero S.Maria di Loreto Nuovo, Napoli, Italy
| | - Raffaele De Caterina
- Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
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12
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Pagnesi M, Inciardi RM, Lombardi CM, Agostoni P, Ameri P, Barbieri L, Bellasi A, Camporotondo R, Canale C, Carubelli V, Carugo S, Catagnano F, Dalla Vecchia LA, Danzi GB, Di Pasquale M, Gaudenzi M, Giovinazzo S, Gnecchi M, Guazzi M, Iorio A, La Rovere MT, Leonardi S, Maccagni G, Mapelli M, Margonato D, Merlo M, Monzo L, Mortara A, Nuzzi V, Piepoli M, Porto I, Pozzi A, Sarullo F, Sinagra G, Tedino C, Tomasoni D, Volterrani M, Zaccone G, Senni M, Metra M. Determinants of the protective effect of glucocorticoids on mortality in hospitalized patients with COVID-19: Insights from the Cardio-COVID-Italy multicenter study. Int J Infect Dis 2021; 108:270-273. [PMID: 34052406 PMCID: PMC8159705 DOI: 10.1016/j.ijid.2021.05.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 12/29/2022] Open
Abstract
Background Glucocorticoid therapy has emerged as an effective therapeutic option in hospitalized patients with coronavirus disease 2019 (COVID-19). This study aimed to focus on the impact of relevant clinical and laboratory factors on the protective effect of glucocorticoids on mortality. Methods A sub-analysis was performed of the multicenter Cardio-COVID-Italy registry, enrolling consecutive patients with COVID-19 admitted to 13 Italian cardiology units between 01 March 2020 and 09 April 2020. The primary endpoint was in-hospital mortality. Results A total of 706 COVID-19 patients were included (349 treated with glucocorticoids, 357 not treated with glucocorticoids). After adjustment for relevant covariates, use of glucocorticoids was associated with a lower risk of in-hospital mortality (adjusted HR 0.44; 95% CI 0.26–0.72; p = 0.001). A significant interaction was observed between the protective effect of glucocorticoids on mortality and PaO2/FiO2 ratio on admission (p = 0.042), oxygen saturation on admission (p = 0.017), and peak CRP (0.023). Such protective effects of glucocorticoids were mainly observed in patients with lower PaO2/FiO2 ratio (<300), lower oxygen saturation (<90%), and higher CRP (>100 mg/L). Conclusions The protective effects of glucocorticoids on mortality in COVID-19 were more evident among patients with worse respiratory parameters and higher systemic inflammation.
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Affiliation(s)
- Matteo Pagnesi
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Riccardo M Inciardi
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Carlo M Lombardi
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Pietro Ameri
- IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Genova, Italy
| | - Lucia Barbieri
- Division of Cardiology, Ospedale San Paolo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Antonio Bellasi
- Innovation and Brand Reputation Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Rita Camporotondo
- Intensive Cardiac Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Claudia Canale
- IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Genova, Italy
| | - Valentina Carubelli
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Carugo
- Division of Cardiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Milan, Italy
| | - Francesco Catagnano
- Intensive Cardiac Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy; Cardiology Department, Policlinico di Monza, Monza, Italy
| | - Laura A Dalla Vecchia
- Cardiology Department, IRCCS Istituti Clinici Scientifici Maugeri, Istituto Scientifico di Milano, Milan, Italy
| | | | - Mattia Di Pasquale
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Margherita Gaudenzi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Stefano Giovinazzo
- IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Genova, Italy
| | - Massimiliano Gnecchi
- Intensive Cardiac Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Marco Guazzi
- Heart Failure Unit, Cardiology Department, University of Milan, Milan, Italy; IRCCS San Donato Hospital, Milan, Italy
| | - Annamaria Iorio
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Maria Teresa La Rovere
- Cardiology Department, IRCCS Istituti Clinici Scientifici Maugeri, Istituto Scientifico di Pavia, Pavia, Italy
| | - Sergio Leonardi
- Intensive Cardiac Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Gloria Maccagni
- Division of Cardiology, Ospedale Maggiore di Cremona, Cremona, Italy
| | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Davide Margonato
- Intensive Cardiac Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy; Cardiology Department, Policlinico di Monza, Monza, Italy
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Luca Monzo
- Istituto Clinico Casalpalocco and Policlinico Casilino, Rome, Italy
| | - Andrea Mortara
- Cardiology Department, Policlinico di Monza, Monza, Italy
| | - Vincenzo Nuzzi
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Massimo Piepoli
- Heart Failure Unit, Guglielmo da Saliceto Hospital, AUSL Piacenza, Piacenza, Italy; Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Italo Porto
- IRCCS Ospedale Policlinico San Martino and Department of Internal Medicine, University of Genova, Genova, Italy
| | - Andrea Pozzi
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Filippo Sarullo
- Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Chiara Tedino
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Daniela Tomasoni
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | - Gregorio Zaccone
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Michele Senni
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
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13
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Di Castelnuovo A, Costanzo S, Antinori A, Berselli N, Blandi L, Bonaccio M, Cauda R, Guaraldi G, Menicanti L, Mennuni M, Parruti G, Patti G, Santilli F, Signorelli C, Vergori A, Abete P, Ageno W, Agodi A, Agostoni P, Aiello L, Al Moghazi S, Arboretti R, Astuto M, Aucella F, Barbieri G, Bartoloni A, Bonfanti P, Cacciatore F, Caiano L, Carrozzi L, Cascio A, Ciccullo A, Cingolani A, Cipollone F, Colomba C, Colombo C, Crosta F, Danzi GB, D'Ardes D, de Gaetano Donati K, Di Gennaro F, Di Tano G, D'Offizi G, Fantoni M, Fusco FM, Gentile I, Gianfagna F, Grandone E, Graziani E, Grisafi L, Guarnieri G, Larizza G, Leone A, Maccagni G, Madaro F, Maitan S, Mancarella S, Mapelli M, Maragna R, Marcucci R, Maresca G, Marongiu S, Marotta C, Marra L, Mastroianni F, Mazzitelli M, Mengozzi A, Menichetti F, Meschiari M, Milic J, Minutolo F, Molena B, Montineri A, Mussini C, Musso M, Niola D, Odone A, Olivieri M, Palimodde A, Parisi R, Pasi E, Pesavento R, Petri F, Pinchera B, Poletti V, Ravaglia C, Rognoni A, Rossato M, Rossi M, Sangiovanni V, Sanrocco C, Scorzolini L, Sgariglia R, Simeone PG, Taddei E, Torti C, Vettor R, Vianello A, Vinceti M, Virano A, Vocciante L, De Caterina R, Iacoviello L. Heparin in COVID-19 Patients Is Associated with Reduced In-Hospital Mortality: The Multicenter Italian CORIST Study. Thromb Haemost 2021; 121:1054-1065. [PMID: 33412596 DOI: 10.1055/a-1347-6070] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION A hypercoagulable condition was described in patients with coronavirus disease 2019 (COVID-19) and proposed as a possible pathogenic mechanism contributing to disease progression and lethality. AIM We evaluated if in-hospital administration of heparin improved survival in a large cohort of Italian COVID-19 patients. METHODS In a retrospective observational study, 2,574 unselected patients hospitalized in 30 clinical centers in Italy from February 19, 2020 to June 5, 2020 with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 infection were analyzed. The primary endpoint in a time-to event analysis was in-hospital death, comparing patients who received heparin (low-molecular-weight heparin [LMWH] or unfractionated heparin [UFH]) with patients who did not. We used multivariable Cox proportional-hazards regression models with inverse probability for treatment weighting by propensity scores. RESULTS Out of 2,574 COVID-19 patients, 70.1% received heparin. LMWH was largely the most used formulation (99.5%). Death rates for patients receiving heparin or not were 7.4 and 14.0 per 1,000 person-days, respectively. After adjustment for propensity scores, we found a 40% lower risk of death in patients receiving heparin (hazard ratio = 0.60; 95% confidence interval: 0.49-0.74; E-value = 2.04). This association was particularly evident in patients with a higher severity of disease or strong coagulation activation. CONCLUSION In-hospital heparin treatment was associated with a lower mortality, particularly in severely ill COVID-19 patients and in those with strong coagulation activation. The results from randomized clinical trials are eagerly awaited to provide clear-cut recommendations.
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Affiliation(s)
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Isernia, 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
| | | | - Marialaura Bonaccio
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Roberto Cauda
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy.,Dipartimento di Sicurezza e Bioetica Sede di Roma, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Guaraldi
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Marco Mennuni
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, 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
| | - 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, Milan, Italy
| | - Alessandra Vergori
- Department of HIV/AIDS, National Institute for Infectious Diseases "Lazzaro Spallanzani"-IRCCS, Rome, Italy
| | - Pasquale Abete
- Dipartimento di Scienze Mediche Traslazionali, Università degli studi di Napoli "Federico II," Napoli, 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, Milan, Italy.,Section of Cardiovascular, Department of Clinical Sciences and Community Health, University of Milano, Milan, 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
| | - Rosa Arboretti
- Department of Civil Environmental and Architectural Engineering, University of Padova, Padova, Italy
| | - Marinella Astuto
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, U.O. Anestesia, Rianimazione 1. P.O. "G. Rodolico," AOU Policlinico "G. Rodolico - San Marco," Catania, Italy
| | - Filippo Aucella
- Fondazione I.R.C.C.S "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Foggia, Italy
| | - Greta Barbieri
- Department of Surgical, Medical and Molecular Medicine and Critical Care, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Paolo Bonfanti
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Francesco Cacciatore
- Dipartimento di Scienze Mediche Traslazionali, Università degli studi di Napoli "Federico II," Napoli, Italy
| | - Lucia Caiano
- Department of Medicine and Surgery, University of Insubria, Varese, 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
| | - Arturo Ciccullo
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy
| | - Antonella Cingolani
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy.,Dipartimento di Sicurezza e Bioetica Sede di Roma, Università Cattolica del Sacro Cuore, Rome, 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
| | - Crizia Colombo
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Francesca Crosta
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | | | - Damiano D'Ardes
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | | | | | | | - Gianpiero D'Offizi
- UOC Malattie Infettive-Epatologia, National Institute for Infectious Diseases L, Spallanzani, IRCCS, Roma, Italy
| | - Massimo Fantoni
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy.,Dipartimento di Sicurezza e Bioetica Sede di Roma, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Maria 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
| | - Francesco Gianfagna
- Mediterranea Cardiocentro, Napoli, Italy.,Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Elvira Grandone
- Fondazione I.R.C.C.S "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Foggia, Italy
| | - Emauele Graziani
- Medicina Interna, Ospedale di Ravenna, AUSL della Romagna, Ravenna, Italy
| | - Leonardo Grisafi
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Gabriella Guarnieri
- Division of Respiratory Pathophysiology, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Giovanni Larizza
- COVID-19 Unit, EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Armando Leone
- UOC di Pneumologia, P.O. San Giuseppe Moscati, Taranto, Italy
| | - Gloria Maccagni
- Department of Cardiology, Ospedale di Cremona, Cremona, Italy
| | - Ferruccio Madaro
- COVID-19 Unit, EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Stefano Maitan
- UOC, Anestesia e Rianimazione, Dipartimento di Chirurgia Generale Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Sandro Mancarella
- ASST Milano Nord, Ospedale Edoardo Bassini Cinisello Balsamo, Milan, Italy
| | - Massimo Mapelli
- Centro Cardiologico Monzino IRCCS, Milan, Italy.,Section of Cardiovascular, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Riccardo Maragna
- Centro Cardiologico Monzino IRCCS, Milan, Italy.,Section of Cardiovascular, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Giulio Maresca
- UOC di Medicina - Presidio Ospedaliero 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, Bari, Italy
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences "Magna Graecia" University, Catanzaro, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Francesco Menichetti
- Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Marianna Meschiari
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Jovana Milic
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Beatrice Molena
- Division of Respiratory Pathophysiology, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, 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
| | - Daniela Niola
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | | | - Marco Olivieri
- Computer Service, University of Molise, Campobasso, Italy
| | | | - Roberta Parisi
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Emanuela Pasi
- Medicina Interna, Ospedale di Ravenna, AUSL della Romagna, Ravenna, Italy
| | - Raffaele Pesavento
- Clinica Medica 3, Department of Medicine - DIMED, University hospital of Padova, Padova, 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
| | - Venerino Poletti
- UOC Pneumologia, Dipartimento di Malattie Apparato Respiratorio e Torace, Ospedale Morgagni-Pierantoni, Forlì, Italy.,Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Claudia Ravaglia
- UOC Pneumologia, Dipartimento di Malattie Apparato Respiratorio e Torace, Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Andrea Rognoni
- University of Eastern Piedmont, Maggiore della Carità Hospital, 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
| | - 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
| | - Laura Scorzolini
- UOC Malattie Infettive ad Alta Intensità di Cura, National Institute for Infectious Diseases "L. Spallanzani," IRCCS, Rome, Italy
| | | | - Paola Giustina Simeone
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Eleonora Taddei
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy
| | - Carlo Torti
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences "Magna Graecia" University, Catanzaro, Italy
| | - Roberto Vettor
- Clinica Medica 3, Department of Medicine - DIMED, University hospital of Padova, Padova, Italy
| | - Andrea Vianello
- Division of Respiratory Pathophysiology, 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, Massachusetts, United States
| | - Alexandra Virano
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Laura Vocciante
- UOC di Medicina - Presidio Ospedaliero S. Maria di Loreto Nuovo. ASL Napoli 1 Centro. Napoli. Italy
| | - 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, Isernia, Italy.,Department of Medicine and Surgery, University of Insubria, Varese, Italy
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14
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Lombardi CM, Carubelli V, Iorio A, Inciardi RM, Bellasi A, Canale C, Camporotondo R, Catagnano F, Dalla Vecchia LA, Giovinazzo S, Maccagni G, Mapelli M, Margonato D, Monzo L, Nuzzi V, Oriecuia C, Peveri G, Pozzi A, Provenzale G, Sarullo F, Tomasoni D, Ameri P, Gnecchi M, Leonardi S, Merlo M, Agostoni P, Carugo S, Danzi GB, Guazzi M, La Rovere MT, Mortara A, Piepoli M, Porto I, Sinagra G, Volterrani M, Specchia C, Metra M, Senni M. Association of Troponin Levels With Mortality in Italian Patients Hospitalized With Coronavirus Disease 2019: Results of a Multicenter Study. JAMA Cardiol 2020; 5:1274-1280. [PMID: 32845276 DOI: 10.1001/jamacardio.2020.3538] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance Myocardial injury, detected by elevated plasma troponin levels, has been associated with mortality in patients hospitalized with coronavirus disease 2019 (COVID-19). However, the initial data were reported from single-center or 2-center studies in Chinese populations. Compared with these patients, European and US patients are older, with more comorbidities and higher mortality rates. Objective To evaluate the prevalence and prognostic value of myocardial injury, detected by elevated plasma troponin levels, in a large population of White Italian patients with COVID-19. Design, Setting, and Participants This is a multicenter, cross-sectional study enrolling consecutive patients with laboratory-confirmed COVID-19 who were hospitalized in 13 Italian cardiology units from March 1 to April 9, 2020. Patients admitted for acute coronary syndrome were excluded. Elevated troponin levels were defined as values greater than the 99th percentile of normal values. Main Outcomes and Measures Clinical characteristics and outcomes stratified as elevated or normal cardiac troponin levels at admission, defined as troponin T or troponin I at a level greater than the 99th percentile of normal values. Results A total of 614 patients with COVID-19 were included in this study (mean age [SD], 67 [13] years; 70.8% male), of whom 148 patients (24.1%) died during the hospitalization. Elevated troponin levels were found in 278 patients (45.3%). These patients were older (mean [SD] age, 64.0 [13.6] years vs 71.3 [12.0] years; P < .001) and had higher prevalence of hypertension (168 patients [50.5%] vs 182 patients [65.9%]; P < .001), heart failure (24 [7.2%]; 63 [22.8%]; P < .001), coronary artery disease (50 [15.0%] vs 87 [31.5%]; P < .001), and atrial fibrillation (33 [9.9%] vs 67 [24.3%]; P < .001). Elevated troponin levels were associated with an increased in-hospital mortality (37% vs 13%; HR, 1.71 [95% CI, 1.13-2.59]; P = .01 via multivariable Cox regression analysis), and this was independent from concomitant cardiac disease. Elevated troponin levels were also associated with a higher risk of in-hospital complications: heart failure (44 patients [19.2%] vs 7 patients [2.9%]; P < .001), sepsis (31 [11.7%] vs 21 [6.4%]; P = .03), acute kidney failure (41 [20.8%] vs 13 [6.2%]; P < .001), multiorgan failure (21 [10.9%] vs 6 [2.9%]; P = .003), pulmonary embolism (27 [9.9%] vs 17 [5.2%]; P = .04), delirium (13 [6.8%] vs 3 [1.5%]; P = .02), and major bleeding (16 [7.0%] vs 4 [1.6%]; P = .008). Conclusions and Relevance In this multicenter, cross-sectional study of Italian patients with COVID-19, elevated troponin was an independent variable associated with in-hospital mortality and a greater risk of cardiovascular and noncardiovascular complications during a hospitalization for COVID-19.
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Affiliation(s)
- Carlo Mario Lombardi
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Valentina Carubelli
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Annamaria Iorio
- Cardiology Unit, Cardiovascular Department, Papa Giovanni XXIII Hospital-Bergamo, Bergamo, Italy
| | - Riccardo M Inciardi
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Antonio Bellasi
- Innovation and Brand Reputation Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Claudia Canale
- IRCCS Ospedale Policlinico San Martino-IRCCS Italian Cardiovascular Network, Department of Internal Medicine, University of Genova, Genova, Italy
| | - Rita Camporotondo
- Intensive Cardiac Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | | | - Laura A Dalla Vecchia
- Istituti Clinici Scientifici Maugeri, IRCCS, Dipartimento di Cardiologia, Istituto Scientifico di Milano, Milan, Italy
| | - Stefano Giovinazzo
- IRCCS Ospedale Policlinico San Martino-IRCCS Italian Cardiovascular Network, Department of Internal Medicine, University of Genova, Genova, Italy
| | - Gloria Maccagni
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Division of Cardiology, Ospedale di Cremona, Cremona, Italy
| | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Davide Margonato
- Cardiology Department, Policlinico di Monza, Monza, Italy.,Department of Cardiology, University of Pavia, Pavia, Italy
| | - Luca Monzo
- Istituto Clinico Casal Palocco, Rome, Italy.,Policlinico Casilino, Rome, Italy
| | - Vincenzo Nuzzi
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), and Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Chiara Oriecuia
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Giulia Peveri
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Andrea Pozzi
- Cardiology Unit, Cardiovascular Department, Papa Giovanni XXIII Hospital-Bergamo, Bergamo, Italy
| | - Giovanni Provenzale
- Division of Cardiology, Ospedale San Paolo, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Filippo Sarullo
- Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Pietro Ameri
- IRCCS Ospedale Policlinico San Martino-IRCCS Italian Cardiovascular Network, Department of Internal Medicine, University of Genova, Genova, Italy
| | - Massimiliano Gnecchi
- Intensive Cardiac Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.,Department of Molecular Medicine, Cardiology Unit, University of Pavia, Pavia, Italy
| | - Sergio Leonardi
- Intensive Cardiac Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.,Department of Molecular Medicine, Cardiology Unit, University of Pavia, Pavia, Italy
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), and Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Stefano Carugo
- Division of Cardiology, Ospedale San Paolo, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | | | - Marco Guazzi
- Heart Failure Unit, Cardiology Department, University of Milan, Milan, Italy.,IRCCS Policlinico San Donato, Milan, Italy
| | - Maria Teresa La Rovere
- Istituti Clinici Scientifici Maugeri, IRCCS, Dipartimento di Cardiologia, Istituto Scientifico di Montescano, Pavia, Italy
| | - Andrea Mortara
- Cardiology Department, Policlinico di Monza, Monza, Italy
| | - Massimo Piepoli
- Heart Failure Unit, Guglielmo da Saliceto Hospital, AUSL Piacenza, Piacenza, Italy.,Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Italo Porto
- IRCCS Ospedale Policlinico San Martino-IRCCS Italian Cardiovascular Network, Department of Internal Medicine, University of Genova, Genova, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), and Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Maurizio Volterrani
- Department of Cardiovascular and Respiratory Sciences, IRCCS, San Raffaele Pisana Rome, Rome, Italy
| | - Claudia Specchia
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Michele Senni
- Cardiology Unit, Cardiovascular Department, Papa Giovanni XXIII Hospital-Bergamo, Bergamo, Italy
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15
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Tomasoni D, Inciardi RM, Lombardi CM, Tedino C, Agostoni P, Ameri P, Barbieri L, Bellasi A, Camporotondo R, Canale C, Carubelli V, Carugo S, Catagnano F, Dalla Vecchia LA, Danzi GB, Di Pasquale M, Gaudenzi M, Giovinazzo S, Gnecchi M, Iorio A, La Rovere MT, Leonardi S, Maccagni G, Mapelli M, Margonato D, Merlo M, Monzo L, Mortara A, Nuzzi V, Piepoli M, Porto I, Pozzi A, Sarullo F, Sinagra G, Volterrani M, Zaccone G, Guazzi M, Senni M, Metra M. Impact of heart failure on the clinical course and outcomes of patients hospitalized for COVID-19. Results of the Cardio-COVID-Italy multicentre study. Eur J Heart Fail 2020; 22:2238-2247. [PMID: 33179839 DOI: 10.1002/ejhf.2052] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/11/2020] [Accepted: 09/11/2020] [Indexed: 12/14/2022] Open
Abstract
AIMS To assess the prognostic value of a history of heart failure (HF) in patients with coronavirus disease 2019 (COVID-19). METHODS AND RESULTS We enrolled 692 consecutive patients admitted for COVID-19 in 13 Italian cardiology centres between 1 March and 9 April 2020. Mean age was 67.4 ± 13.2 years, 69.5% of patients were males, 90 (13.0%) had a history of HF, median hospitalization length was 14 days (interquartile range 9-24). In-hospital death occurred in 37 of 90 patients (41.1%) with HF history vs. 126 of those with no HF history (20.9%). The increased risk of death associated with HF history remained significant after adjustment for clinical variables related to COVID-19 and HF severity, including comorbidities, oxygen saturation, lymphocyte count and plasma troponin [adjusted hazard ratio (HR) for death: 2.25; 95% confidence interval (CI) 1.26-4.02; P = 0.006 at multivariable Cox regression model including 404 patients]. Patients with a history of HF also had more in-hospital complications including acute HF (33.3% vs. 5.1%, P < 0.001), acute renal failure (28.1% vs. 12.9%, P < 0.001), multiorgan failure (15.9% vs. 5.8%, P = 0.004) and sepsis (18.4% vs. 8.9%, P = 0.006). Other independent predictors of outcome were age, sex, oxygen saturation and oxygen partial pressure at arterial gas analysis/fraction of inspired oxygen ratio (PaO2 /FiO2 ). In-hospital treatment with corticosteroids and heparin had beneficial effects (adjusted HR for death: 0.46; 95% CI 0.29-0.74; P = 0.001; n = 404 for corticosteroids, and adjusted HR 0.41; 95% CI 0.25-0.67; P < 0.001; n = 364 for heparin). CONCLUSIONS Hospitalized patients with COVID-19 and a history of HF have an extremely poor outcome with higher mortality and in-hospital complications. HF history is an independent predictor of increased in-hospital mortality.
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Affiliation(s)
- Daniela Tomasoni
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Riccardo M Inciardi
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Carlo M Lombardi
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Chiara Tedino
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Piergiuseppe Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Pietro Ameri
- IRCCS Ospedale Policlinico San Martino - IRCCS Italian Cardiovascular Network and Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Lucia Barbieri
- Division of Cardiology, Ospedale San Paolo, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Antonio Bellasi
- Research, Innovation and Brand Reputation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Rita Camporotondo
- Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia, Italy
| | - Claudia Canale
- IRCCS Ospedale Policlinico San Martino - IRCCS Italian Cardiovascular Network and Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Valentina Carubelli
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Carugo
- Division of Cardiology, Ospedale San Paolo, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Francesco Catagnano
- Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia, Italy.,Department of Cardiology, Policlinico di Monza, Monza, Italy
| | - Laura A Dalla Vecchia
- Department of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Istituto Scientifico di Milano, Milan, Italy
| | | | - Mattia Di Pasquale
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Margherita Gaudenzi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Stefano Giovinazzo
- IRCCS Ospedale Policlinico San Martino - IRCCS Italian Cardiovascular Network and Department of Internal Medicine, University of Genova, Genoa, Italy
| | | | - Annamaria Iorio
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Maria Teresa La Rovere
- Department of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Istituto Scientifico di Montescano, Pavia, Italy
| | - Sergio Leonardi
- Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia, Italy
| | - Gloria Maccagni
- Division of Cardiology, Ospedale Maggiore di Cremona, Cremona, Italy
| | - Massimo Mapelli
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Davide Margonato
- Fondazione IRCCS Policlinico S. Matteo and University of Pavia, Pavia, Italy.,Department of Cardiology, Policlinico di Monza, Monza, Italy
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Luca Monzo
- Istituto Clinico Casal Palocco, Policlinico Casilino, Rome, Italy
| | - Andrea Mortara
- Department of Cardiology, Policlinico di Monza, Monza, Italy
| | - Vincenzo Nuzzi
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Massimo Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza, Piacenza, Italy.,Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Italo Porto
- IRCCS Ospedale Policlinico San Martino - IRCCS Italian Cardiovascular Network and Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Andrea Pozzi
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Filippo Sarullo
- Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | | | - Gregorio Zaccone
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Guazzi
- Heart Failure Unit, Cardiology Department, University of Milan, IRCCS San Donato Hospital, Milan, Italy
| | - Michele Senni
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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16
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Affiliation(s)
- Renzo D'Ortona
- Cardiology Unit and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia and University of Brescia, Brescia, Italy
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17
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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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18
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Abstract
: The coronavirus disease 2019 (COVID-19) has important implications for the cardiovascular care of patients. COVID-19 interacts with the cardiovascular system on multiple levels, increasing morbidity in patients with underlying cardiovascular conditions and favoring acute myocardial injury and dysfunction. COVID-19 infection may also have long-term implications for overall cardiovascular health. Many issues regarding the involvement of the cardiovascular system remain controversial. Despite angiotensin-converting enzyme 2 serving as the site of entry of the virus into the cells, the role of angiotensin-converting enzyme inhibitors or AT1 blockers requires further investigation. Therapies under investigation for COVID-19 may have cardiovascular side effects. Treatment of COVID-19, especially the use of antivirals, must be closely monitored. This article is a review of the most updated literature.
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Affiliation(s)
| | - Gloria Maccagni
- Cardiology, ASST Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Cardiothoracic Department, Civil Hospitals, Brescia, Italy
| | - Leonardo Italia
- Cardiology, ASST Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Cardiothoracic Department, Civil Hospitals, Brescia, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Cardiothoracic Department, Civil Hospitals, Brescia, Italy
| | - Gian B Danzi
- Division of Cardiology, Ospedale di Cremona, Cremona
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19
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Cagnoni F, Sganzerla P, Bontempelli E, Masserini AB, Cavalleri C, Negrini P, Maccagni G, Destro M. RDN in Hypertensives: Results from a Novel Anatomical Approach. J Am Soc Hypertens 2016; 10 Suppl 1:e5. [PMID: 27677139 DOI: 10.1016/j.jash.2016.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- F Cagnoni
- Medical Science, ASST Bergamo Ovest, Treviglio, Italy
| | - P Sganzerla
- Cardiology Ward and Cath Lab, ASST Bergamo Ovest, Treviglio, Italy
| | - E Bontempelli
- Medical Science, ASST Bergamo Ovest, Treviglio, Italy
| | | | - C Cavalleri
- Medical Science, ASST Bergamo Ovest, Treviglio, Italy
| | - P Negrini
- Cardiology Ward and Cath Lab, ASST Bergamo Ovest, Treviglio, Italy
| | - G Maccagni
- Sport Medicine, Minerva Medica Sport Medicine Center, Cassano D'Adda, Italy
| | - M Destro
- Medical Science, ASST Bergamo Ovest, Treviglio, Italy
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20
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Ghiringhelli P, Limbiati S, Maccagni G, Chelazzi G. [Adult-onset Still's disease. Report of 5 cases]. Minerva Med 1999; 90:133-42. [PMID: 10518958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
The authors report 5 cases of Still's disease in adults whose symptoms were mainly characterised by high fever, transient exanthema, polyarthralgia and/or polyarthritis, lymphoadenomegaly, splenomegaly and neutrophil leukocytosis. Assays for leukocytosis were positive, as were those for inflammatory markers and serum ferritin was also high in all 3 patients in which it assayed. On the contrary, serum ferritin latex test, Waaler-Rose reaction and all other tests commonly used to diagnose long-term fevers were all negative. All the subjects examined recovered after prolonged steroid therapy. Only one patient reported severe sequelae in the hip joints and subsequently underwent bilateral hip replacement surgery.
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21
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Madonini E, Briatico-Vangosa G, Pappacoda A, Maccagni G, Cardani A, Saporiti F. Seasonal increase of bronchial reactivity in allergic rhinitis. J Allergy Clin Immunol 1987; 79:358-63. [PMID: 3819219 DOI: 10.1016/0091-6749(87)90156-4] [Citation(s) in RCA: 86] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Twenty-seven patients with hay fever had a carbachol inhalation challenge both out of season and during the pollen season. Eight patients with allergic asthma were used as a control group. Only three patients (11.1%) demonstrated a value of a provocative dose causing a 20% fall in FEV1 in the asthmatic range out of pollen season, but during pollen exposure, the number of positive responses significantly increased to 13 (48.1%). We observed differences regarding mean age, age of onset of symptoms, sex, and family history between patients with positive responses and patients who failed to react to inhalation challenge. It appears reasonable that an aspecific bronchial provocation test, performed during the pollen season, can detect with greater sensitivity patients with hay fever at risk of developing asthma in the future, and it also appears reasonable that these patients should be treated differently from subjects with "pure" allergic rhinitis. We expect the ongoing follow-up to clarify the prognostic value to be attributed to these findings.
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