SARS-COV-2 comorbidity network and outcome in hospitalized patients in Crema, Italy

• Published in: PloS one Vol. 16; no. 3; p. e0248498
• Main Authors: Gili, Tommaso, Benelli, Giampaolo, Buscarini, Elisabetta, Canetta, Ciro, La Piana, Giuseppe, Merli, Guido, Scartabellati, Alessandro, Viganò, Giovanni, Sfogliarini, Roberto, Melilli, Giovanni, Assandri, Roberto, Cazzato, Daniele, Rossi, Davide Sebastiano, Usai, Susanna, Caldarelli, Guido, Tramacere, Irene, Pellegata, Germano, Lauria, Giuseppe
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 25-03-2021; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Angiotensin II; Angiotensin-converting enzyme inhibitors; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Arthritis; Asthma; Biology and life sciences; Body temperature; C-Reactive Protein - analysis; Cardiovascular diseases; Child; Child, Preschool; Chronic obstructive pulmonary disease; Comorbidity; Computed tomography; Computer and Information Sciences; Coronaviruses; COVID-19; COVID-19 - mortality; COVID-19 - pathology; COVID-19 - virology; COVID-19 Drug Treatment; Diabetes; Diabetes mellitus; Disease; Drug therapy; Dyslipidemia; Editing; Emergency medical care; Enzyme inhibitors; Fatalities; Female; Fibrillation; Hematology; Hospitalization; Hospitalization - statistics & numerical data; Hospitals; Humans; Hypertension; Intensive care; Italy; Laboratories; Lung diseases; Male; Medical imaging; Medicine and health sciences; Middle Aged; Network analysis; Neurosciences; Obstructive lung disease; Oximetry; Patients; People and Places; Peptidyl-dipeptidase A; Pneumonia; Public health; Pulmonology; Renal insufficiency; Research and Analysis Methods; Respiratory diseases; Risk Factors; SARS-CoV-2 - isolation & purification; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Signs and symptoms; Sleep; Sulfur dioxide; Technology; Treatment Outcome; Ventilators; Viral diseases; Young Adult; Italy
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0248498

We report onset, course, correlations with comorbidities, and diagnostic accuracy of nasopharyngeal swab in 539 individuals suspected to carry SARS-COV-2 admitted to the hospital of Crema, Italy. All individuals underwent clinical and laboratory exams, SARS-COV-2 reverse transcriptase-polymerase chain reaction on nasopharyngeal swab, and chest X-ray and/or computed tomography (CT). Data on onset, course, comorbidities, number of drugs including angiotensin converting enzyme (ACE) inhibitors and angiotensin-II-receptor antagonists (sartans), follow-up swab, pharmacological treatments, non-invasive respiratory support, ICU admission, and deaths were recorded. Among 411 SARS-COV-2 patients (67.7% males) median age was 70.8 years (range 5-99). Chest CT was performed in 317 (77.2%) and showed interstitial pneumonia in 304 (96%). Fatality rate was 17.5% (74% males), with 6.6% in 60-69 years old, 21.1% in 70-79 years old, 38.8% in 80-89 years old, and 83.3% above 90 years. No death occurred below 60 years. Non-invasive respiratory support rate was 27.2% and ICU admission 6.8%. Charlson comorbidity index and high C-reactive protein at admission were significantly associated with death. Use of ACE inhibitors or sartans was not associated with outcomes. Among 128 swab negative patients at admission (63.3% males) median age was 67.7 years (range 1-98). Chest CT was performed in 87 (68%) and showed interstitial pneumonia in 76 (87.3%). Follow-up swab turned positive in 13 of 32 patients. Using chest CT at admission as gold standard on the entire study population of 539 patients, nasopharyngeal swab had 80% accuracy. Comorbidity network analysis revealed a more homogenous distribution 60-40 aged SARS-COV-2 patients across diseases and a crucial different interplay of diseases in the networks of deceased and survived patients. SARS-CoV-2 caused high mortality among patients older than 60 years and correlated with pre-existing multiorgan impairment.