Competing-risk analysis of coronavirus disease 2019 in-hospital mortality in a Northern Italian centre from SMAtteo COvid19 REgistry (SMACORE)

An accurate prediction of the clinical outcomes of European patients requiring hospitalisation for Coronavirus Disease 2019 (COVID-19) is lacking. The aim of the study is to identify predictors of in-hospital mortality and discharge in a cohort of Lombardy patients with COVID-19. All consecutive hos...

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Published inScientific reports Vol. 11; no. 1; pp. 1137 - 10
Main Authors Zuccaro, Valentina, Celsa, Ciro, Sambo, Margherita, Battaglia, Salvatore, Sacchi, Paolo, Biscarini, Simona, Valsecchi, Pietro, Pieri, Teresa Chiara, Gallazzi, Ilaria, Colaneri, Marta, Sachs, Michele, Roda, Silvia, Asperges, Erika, Lupi, Matteo, Di Filippo, Alessandro, Seminari, Elena, Di Matteo, Angela, Novati, Stefano, Maiocchi, Laura, Enea, Marco, Attanasio, Massimo, Cammà, Calogero, Bruno, Raffaele
Format Journal Article
LanguageEnglish
Published London Nature Publishing Group UK 13.01.2021
Nature Publishing Group
Nature Portfolio
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Online AccessGet full text
ISSN2045-2322
2045-2322
DOI10.1038/s41598-020-80679-2

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Abstract An accurate prediction of the clinical outcomes of European patients requiring hospitalisation for Coronavirus Disease 2019 (COVID-19) is lacking. The aim of the study is to identify predictors of in-hospital mortality and discharge in a cohort of Lombardy patients with COVID-19. All consecutive hospitalised patients from February 21st to March 30th, 2020, with confirmed COVID-19 from the IRCCS Policlinico San Matteo, Pavia, Lombardy, Italy, were included. In-hospital mortality and discharge were evaluated by competing risk analysis. The Fine and Gray model was fitted in order to estimate the effect of covariates on the cumulative incidence functions (CIFs) for in-hospital mortality and discharge. 426 adult patients [median age 68 (IQR 56 to 77 years)] were admitted with confirmed COVID-19 over a 5-week period; 292 (69%) were male. By 21 April 2020, 141 (33%) of these patients had died, 239 (56%) patients had been discharged and 46 (11%) were still hospitalised. Among these 46 patients, updated as of 30 May, 2020, 5 (10.9%) had died, 8 (17.4%) were still in ICU, 12 (26.1%) were transferred to lower intensity care units and 21 (45.7%) were discharged. Regression on the CIFs for in-hospital mortality showed that older age, male sex, number of comorbidities and hospital admission after March 4th were independent risk factors associated with in-hospital mortality. Older age, male sex and number of comorbidities definitively predicted in-hospital mortality in hospitalised patients with COVID-19.
AbstractList An accurate prediction of the clinical outcomes of European patients requiring hospitalisation for Coronavirus Disease 2019 (COVID-19) is lacking. The aim of the study is to identify predictors of in-hospital mortality and discharge in a cohort of Lombardy patients with COVID-19. All consecutive hospitalised patients from February 21st to March 30th, 2020, with confirmed COVID-19 from the IRCCS Policlinico San Matteo, Pavia, Lombardy, Italy, were included. In-hospital mortality and discharge were evaluated by competing risk analysis. The Fine and Gray model was fitted in order to estimate the effect of covariates on the cumulative incidence functions (CIFs) for in-hospital mortality and discharge. 426 adult patients [median age 68 (IQR 56 to 77 years)] were admitted with confirmed COVID-19 over a 5-week period; 292 (69%) were male. By 21 April 2020, 141 (33%) of these patients had died, 239 (56%) patients had been discharged and 46 (11%) were still hospitalised. Among these 46 patients, updated as of 30 May, 2020, 5 (10.9%) had died, 8 (17.4%) were still in ICU, 12 (26.1%) were transferred to lower intensity care units and 21 (45.7%) were discharged. Regression on the CIFs for in-hospital mortality showed that older age, male sex, number of comorbidities and hospital admission after March 4th were independent risk factors associated with in-hospital mortality. Older age, male sex and number of comorbidities definitively predicted in-hospital mortality in hospitalised patients with COVID-19.
An accurate prediction of the clinical outcomes of European patients requiring hospitalisation for Coronavirus Disease 2019 (COVID-19) is lacking. The aim of the study is to identify predictors of in-hospital mortality and discharge in a cohort of Lombardy patients with COVID-19. All consecutive hospitalised patients from February 21st to March 30th, 2020, with confirmed COVID-19 from the IRCCS Policlinico San Matteo, Pavia, Lombardy, Italy, were included. In-hospital mortality and discharge were evaluated by competing risk analysis. The Fine and Gray model was fitted in order to estimate the effect of covariates on the cumulative incidence functions (CIFs) for in-hospital mortality and discharge. 426 adult patients [median age 68 (IQR 56 to 77 years)] were admitted with confirmed COVID-19 over a 5-week period; 292 (69%) were male. By 21 April 2020, 141 (33%) of these patients had died, 239 (56%) patients had been discharged and 46 (11%) were still hospitalised. Among these 46 patients, updated as of 30 May, 2020, 5 (10.9%) had died, 8 (17.4%) were still in ICU, 12 (26.1%) were transferred to lower intensity care units and 21 (45.7%) were discharged. Regression on the CIFs for in-hospital mortality showed that older age, male sex, number of comorbidities and hospital admission after March 4th were independent risk factors associated with in-hospital mortality. Older age, male sex and number of comorbidities definitively predicted in-hospital mortality in hospitalised patients with COVID-19.An accurate prediction of the clinical outcomes of European patients requiring hospitalisation for Coronavirus Disease 2019 (COVID-19) is lacking. The aim of the study is to identify predictors of in-hospital mortality and discharge in a cohort of Lombardy patients with COVID-19. All consecutive hospitalised patients from February 21st to March 30th, 2020, with confirmed COVID-19 from the IRCCS Policlinico San Matteo, Pavia, Lombardy, Italy, were included. In-hospital mortality and discharge were evaluated by competing risk analysis. The Fine and Gray model was fitted in order to estimate the effect of covariates on the cumulative incidence functions (CIFs) for in-hospital mortality and discharge. 426 adult patients [median age 68 (IQR 56 to 77 years)] were admitted with confirmed COVID-19 over a 5-week period; 292 (69%) were male. By 21 April 2020, 141 (33%) of these patients had died, 239 (56%) patients had been discharged and 46 (11%) were still hospitalised. Among these 46 patients, updated as of 30 May, 2020, 5 (10.9%) had died, 8 (17.4%) were still in ICU, 12 (26.1%) were transferred to lower intensity care units and 21 (45.7%) were discharged. Regression on the CIFs for in-hospital mortality showed that older age, male sex, number of comorbidities and hospital admission after March 4th were independent risk factors associated with in-hospital mortality. Older age, male sex and number of comorbidities definitively predicted in-hospital mortality in hospitalised patients with COVID-19.
An accurate prediction of the clinical outcomes of European patients requiring hospitalisation for Coronavirus Disease 2019 (COVID-19) is lacking. The aim of the study is to identify predictors of in-hospital mortality and discharge in a cohort of Lombardy patients with COVID-19. All consecutive hospitalised patients from February 21st to March 30th, 2020, with confirmed COVID-19 from the IRCCS Policlinico San Matteo, Pavia, Lombardy, Italy, were included. In-hospital mortality and discharge were evaluated by competing risk analysis. The Fine and Gray model was fitted in order to estimate the effect of covariates on the cumulative incidence functions (CIFs) for in-hospital mortality and discharge. 426 adult patients [median age 68 (IQR 56 to 77 years)] were admitted with confirmed COVID-19 over a 5-week period; 292 (69%) were male. By 21 April 2020, 141 (33%) of these patients had died, 239 (56%) patients had been discharged and 46 (11%) were still hospitalised. Among these 46 patients, updated as of 30 May, 2020, 5 (10.9%) had died, 8 (17.4%) were still in ICU, 12 (26.1%) were transferred to lower intensity care units and 21 (45.7%) were discharged. Regression on the CIFs for in-hospital mortality showed that older age, male sex, number of comorbidities and hospital admission after March 4th were independent risk factors associated with in-hospital mortality. Older age, male sex and number of comorbidities definitively predicted in-hospital mortality in hospitalised patients with COVID-19.
Abstract An accurate prediction of the clinical outcomes of European patients requiring hospitalisation for Coronavirus Disease 2019 (COVID-19) is lacking. The aim of the study is to identify predictors of in-hospital mortality and discharge in a cohort of Lombardy patients with COVID-19. All consecutive hospitalised patients from February 21st to March 30th, 2020, with confirmed COVID-19 from the IRCCS Policlinico San Matteo, Pavia, Lombardy, Italy, were included. In-hospital mortality and discharge were evaluated by competing risk analysis. The Fine and Gray model was fitted in order to estimate the effect of covariates on the cumulative incidence functions (CIFs) for in-hospital mortality and discharge. 426 adult patients [median age 68 (IQR 56 to 77 years)] were admitted with confirmed COVID-19 over a 5-week period; 292 (69%) were male. By 21 April 2020, 141 (33%) of these patients had died, 239 (56%) patients had been discharged and 46 (11%) were still hospitalised. Among these 46 patients, updated as of 30 May, 2020, 5 (10.9%) had died, 8 (17.4%) were still in ICU, 12 (26.1%) were transferred to lower intensity care units and 21 (45.7%) were discharged. Regression on the CIFs for in-hospital mortality showed that older age, male sex, number of comorbidities and hospital admission after March 4th were independent risk factors associated with in-hospital mortality. Older age, male sex and number of comorbidities definitively predicted in-hospital mortality in hospitalised patients with COVID-19.
ArticleNumber 1137
Author Celsa, Ciro
Biscarini, Simona
Roda, Silvia
Seminari, Elena
Attanasio, Massimo
Cammà, Calogero
Pieri, Teresa Chiara
Di Matteo, Angela
Sambo, Margherita
Sachs, Michele
Battaglia, Salvatore
Enea, Marco
Asperges, Erika
Di Filippo, Alessandro
Colaneri, Marta
Novati, Stefano
Sacchi, Paolo
Valsecchi, Pietro
Lupi, Matteo
Maiocchi, Laura
Gallazzi, Ilaria
Zuccaro, Valentina
Bruno, Raffaele
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/33441892$$D View this record in MEDLINE/PubMed
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FabbianFA modified Elixhauser score for predicting in-hospital mortality in internal medicine admissionsEur. J. Intern. Med.201740374210.1016/j.ejim.2017.02.002
Richardson, S., et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area (published online ahead of print, 2020 Apr 22). JAMA. e206775, https://doi.org/10.1001/jama.2020.6775 (2020)
SingerMThe third international consensus definitions for sepsis and septic shock (Sepsis-3)JAMA20163158018101:CAS:528:DC%2BC28XhtlGrt7fE10.1001/jama.2016.0287
PutterHFioccoMGeskusRBTutorial in biostatistics: Competing risks and multi-state modelsStat. Med.200726112389243023684221:STN:280:DC%2BD2s3hs1agsA%3D%3D10.1002/sim.2712
JaillonSBerthenetKGarlandaCSexual dimorphism in innate immunityClin. Rev. Allergy Immunol.20195633083211:CAS:528:DC%2BC2sXhs1SktL%2FF10.1007/s12016-017-8648-x
SuissaSAzoulayLMetformin and the risk of cancer: Time-related biases in observational studiesDiab. Care201235266526731:CAS:528:DC%2BC38XhvFShsrnN10.2337/dc12-0788
ZhengZRisk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysisJ Infect.2020812e16e251:CAS:528:DC%2BB3cXhsVKkt7%2FO10.1016/j.jinf.2020.04.021
GlesbyMJHooverDRSurvivor treatment selection bias in observational studies: Examples from the AIDS literatureAnn. Intern. Med.199612499910051:STN:280:DyaK283ht1egtA%3D%3D10.7326/0003-4819-124-11-199606010-00008
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OpalSMGirardTDElyEWThe immunopathogenesis of sepsis in elderly patientsClin. Infect. Dis.202541suppl 7S504S512
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CormanVMDetection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCREuro Surveill.2020253200004510.2807/1560-7917.ES.2020.25.3.2000045
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De Giorgi, A., et al. OUTcome and COMorbidity Evaluation of INTernal MEDicine COVID19 (OUTCOME-INTMED-COV19) Study Collaborators. Prediction of in-hospital mortality of patients with SARS-CoV-2 infection by comorbidity indexes: an Italian internal medicine single center study. Eur. Rev. Med. Pharmacol. Sci.24(19), 10258–10266 (2020)
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FangXEpidemiological, comorbidity factors with severity and prognosis of COVID-19: A systematic review and meta-analysisAging (Albany NY).2020121312493125031:CAS:528:DC%2BB3cXisFCmurrJ10.18632/aging.103579
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GaoCAssociation between cardiac injury and mortality in hospitalized patients infected with Avian Influenza A (H7N9) virusCrit. Care Med.20204844514581:CAS:528:DC%2BB3cXltlKntL4%3D10.1097/CCM.0000000000004207
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References_xml – reference: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020
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– reference: GlesbyMJHooverDRSurvivor treatment selection bias in observational studies: Examples from the AIDS literatureAnn. Intern. Med.199612499910051:STN:280:DyaK283ht1egtA%3D%3D10.7326/0003-4819-124-11-199606010-00008
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– reference: Asperges, E., et al. Rapid response to COVID-19 outbreak in Northern Italy: How to convert a classic infectious disease ward into a COVID-19 response centre. J. Hosp. Infect.105(3), 477–479, https://doi.org/10.1016/j.jhin.2020.03.020 (2020)
– reference: OpalSMGirardTDElyEWThe immunopathogenesis of sepsis in elderly patientsClin. Infect. Dis.202541suppl 7S504S512
– reference: JaillonSBerthenetKGarlandaCSexual dimorphism in innate immunityClin. Rev. Allergy Immunol.20195633083211:CAS:528:DC%2BC2sXhs1SktL%2FF10.1007/s12016-017-8648-x
– reference: Cai, H. Sex difference and smoking predisposition in patients with COVID-19 (published correction appears in Lancet Respir. Med.8(4)) (2020)
– reference: YangJPrevalence of comorbidities and its effects in patients infected with SARS-CoV-2: A systematic review and meta-analysisInt. J. Infect. Dis.20209491951:CAS:528:DC%2BB3cXnslOgsrY%3D10.1016/j.ijid.2020.03.017
– reference: ZhouFClinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort studyLancet202039510229105410621:CAS:528:DC%2BB3cXkvVGktL8%3D10.1016/S0140-6736(20)30566-3
– reference: SingerMThe third international consensus definitions for sepsis and septic shock (Sepsis-3)JAMA20163158018101:CAS:528:DC%2BC28XhtlGrt7fE10.1001/jama.2016.0287
– reference: RemuzziARemuzziGCOVID-19 and Italy: What next?Lancet202039510231122512281:CAS:528:DC%2BB3cXltFeqsLw%3D10.1016/S0140-6736(20)30627-9
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– reference: Iosa, M., Paolucci, S., & Morone, G. Covid-19: A dynamic analysis of fatality risk in Italy. Front. Med. (Lausanne). 7, 185, https://doi.org/10.3389/fmed.2020.00185 (2020)
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– reference: De Giorgi, A., et al. OUTcome and COMorbidity Evaluation of INTernal MEDicine COVID19 (OUTCOME-INTMED-COV19) Study Collaborators. Prediction of in-hospital mortality of patients with SARS-CoV-2 infection by comorbidity indexes: an Italian internal medicine single center study. Eur. Rev. Med. Pharmacol. Sci.24(19), 10258–10266 (2020)
– reference: Putter, H., Schumacher, M., & van Houwelingen, H.C. On the relation between the cause-specific hazard and the subdistribution rate for competing risks data: The Fine-Gray model revisited. Biom. J. 62(3), 790–807, https://doi.org/10.1002/bimj.201800274 (2020)
– reference: PutterHFioccoMGeskusRBTutorial in biostatistics: Competing risks and multi-state modelsStat. Med.200726112389243023684221:STN:280:DC%2BD2s3hs1agsA%3D%3D10.1002/sim.2712
– reference: Wang, D., et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China (published online ahead of print, 2020 Feb 7). JAMA. 323(11), 1061–1069, https://doi.org/10.1001/jama.2020.1585 (2020)
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– reference: Coronavirus Disease (COVID-19) Technical Guidance: Laboratory Testing for 2019-nCoV in Humans. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/laboratory-guidance.
– reference: CharlsonMEPompeiPAlesKLMacKenzieCRA new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJ. Chronic Dis.19874053733831:STN:280:DyaL2s7ms1GnsQ%3D%3D10.1016/0021-9681(87)90171-8
– reference: ZhengZRisk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysisJ Infect.2020812e16e251:CAS:528:DC%2BB3cXhsVKkt7%2FO10.1016/j.jinf.2020.04.021
– reference: FangXEpidemiological, comorbidity factors with severity and prognosis of COVID-19: A systematic review and meta-analysisAging (Albany NY).2020121312493125031:CAS:528:DC%2BB3cXisFCmurrJ10.18632/aging.103579
– reference: GaoCAssociation between cardiac injury and mortality in hospitalized patients infected with Avian Influenza A (H7N9) virusCrit. Care Med.20204844514581:CAS:528:DC%2BB3cXltlKntL4%3D10.1097/CCM.0000000000004207
– reference: FabbianFA modified Elixhauser score for predicting in-hospital mortality in internal medicine admissionsEur. J. Intern. Med.201740374210.1016/j.ejim.2017.02.002
– reference: ShiHRadiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: A descriptive studyLancet Infect. Dis.20202044254341:CAS:528:DC%2BB3cXjvFWhtbs%3D10.1016/S1473-3099(20)30086-4
– reference: CormanVMDetection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCREuro Surveill.2020253200004510.2807/1560-7917.ES.2020.25.3.2000045
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Snippet An accurate prediction of the clinical outcomes of European patients requiring hospitalisation for Coronavirus Disease 2019 (COVID-19) is lacking. The aim of...
Abstract An accurate prediction of the clinical outcomes of European patients requiring hospitalisation for Coronavirus Disease 2019 (COVID-19) is lacking. The...
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Aged
Aged, 80 and over
Coronaviruses
COVID-19
COVID-19 - epidemiology
COVID-19 - mortality
Female
Hospital Mortality
Humanities and Social Sciences
Humans
Italy - epidemiology
Male
Middle Aged
Mortality
multidisciplinary
Patients
Registries - statistics & numerical data
Risk analysis
Risk Assessment
Risk factors
Science
Science (multidisciplinary)
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Title Competing-risk analysis of coronavirus disease 2019 in-hospital mortality in a Northern Italian centre from SMAtteo COvid19 REgistry (SMACORE)
URI https://link.springer.com/article/10.1038/s41598-020-80679-2
https://www.ncbi.nlm.nih.gov/pubmed/33441892
https://www.proquest.com/docview/2477382521
https://www.proquest.com/docview/2478038936
https://pubmed.ncbi.nlm.nih.gov/PMC7806993
https://doaj.org/article/9a0f24734a7545488ea94e28c19a055f
Volume 11
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