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Open Access 09-07-2022 | SARS-CoV-2 | IM - ORIGINAL

Comparison of the characteristics, morbidity and mortality of COVID-19 between first and second/third wave in a hospital setting in Lombardy: a retrospective cohort study

Authors: Francesca Leidi, Gianluca Edoardo Mario Boari, Ottavio Scarano, Benedetta Mangili, Giulia Gorla, Andrea Corbani, Beatrice Accordini, Federico Napoli, Chiara Ghidelli, Giulia Archenti, Daniele Turini, Michele Saottini, Vittoria Guarinoni, Giulia Ferrari-Toninelli, Francesca Manzoni, Silvia Bonetti, Giulia Chiarini, Paolo Malerba, Federico Braglia-Orlandini, Gianluca Bianco, Cristina Faustini, Claudia Agabiti-Rosei, Carolina De Ciuceis, Damiano Rizzoni

Published in: Internal and Emergency Medicine | Issue 7/2022

Abstract

Coronavirus disease 2019 (COVID-19) represents a major health problem in terms of deaths and long-term sequelae. We conducted a retrospective cohort study at Montichiari Hospital (Brescia, Italy) to better understand the determinants of outcome in two different COVID-19 outbreaks. A total of 634 unvaccinated patients admitted from local emergency room to the Internal Medicine ward with a confirmed diagnosis of SARS-CoV-2 infection and a moderate-to-severe COVID-19 were included in the study. A group of 260 consecutive patients during SARS-CoV-2 first wave (from February to May 2020) and 374 consecutive patients during SARS-CoV-2 2nd/3rd wave (from October 2020 to May 2021) were considered. Demographic data were not significantly different between waves, except a lower prevalence of female sex during first wave. Mortality was significantly higher during the 1^st wave than in the following periods (24.2% vs. 11%; p < 0.001). Time from symptoms onset to hospital admission was longer during first wave (8 ± 6 vs. 6 ± 4 days; p < 0.001), while in-hospital staying was significantly shorter (10 ± 14 vs. 15 ± 11 days; p < 0.001). Other significant differences were a larger use of corticosteroids and low-molecular weight heparin as well less antibiotic prescription during the second wave. Respiratory, bio-humoral and X-ray scores were significantly poorer at the time of admission in first-wave patients. After a multivariate regression analysis, C-reactive protein and procalcitonin values, % fraction of inspired oxygen on admission to the Internal Medicine ward and length of hospital stay and duration of symptoms were the strongest predictors of outcome. Concomitant anti-hypertensive treatment (including ACE-inhibitors and angiotensin-receptor blockers) did not affect the outcome. In conclusion, our data suggest that earlier diagnosis, timely hospital admission and rational use of the therapeutic options reduced the systemic inflammatory response and were associated to a better outcome during the 2nd/3rd wave.

WHO (2020) Clinical Care Severe Acute Respiratory Infection. Toolkit. WHO Technical Report Series, p 196. https://www.who.int/publications-detail/clinical-care-of-severe-acute-respiratory-infections-tool-kit

Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, Cereda D, Coluccello A, Foti G, Fumagalli R, Iotti G, Latronico N, Lorini L, Merler S, Natalini G, Piatti A, Ranieri MV, Scandroglio AM, Storti E, Cecconi M, Pesenti A, COVID-19 Lombardy ICU Network (2020) Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy. JAMA 323(16):1574–1581. https://doi.org/10.1001/jama.2020.5394CrossRefPubMedPubMedCentral

Characteristics of COVID-19 patients dying in Italy. Report based on available data on October 5th, 2021. Istituto Superiore di Sanità. https://www.epicentro.iss.it/coronavirus/

Vinceti M, Filippini T, Rothman KJ, di Federico S, Orsini N (2021) SARS-CoV-2 infection incidence during the first and second COVID-19 waves in Italy. Environ Res 197(March):111097. https://doi.org/10.1016/j.envres.2021.111097CrossRefPubMedPubMedCentral

Malerba P, Boari GEM, Nardin M, Tomasi C, Chiarini G, Bonetti S, Bianco G, Faustini C, Braglia-Orlandini F, De Ciuceis C, Rizzoni D (2022) Positive, mildly positive, and uncertain nasopharyngeal swab and outcome in COVID-19 patients. Infect Dis Clin Pract 30(1):e1089CrossRef

Borghesi A, Maroldi R (2020) COVID-19 outbreak in Italy: experimental chest X-ray scoring system for quantifying and monitoring disease progression. Radiol Med 125(5):509–513. https://doi.org/10.1007/s11547-020-01200-3CrossRefPubMedPubMedCentral

Borghesi A, Zigliani A, Golemi S, Carapella N, Maculotti P, Farina D, Maroldi R (2020) Chest X-ray severity index as a predictor of in-hospital mortality in coronavirus disease 2019: a study of 302 patients from Italy. Int J Infect Dis 96:291–293. https://doi.org/10.1016/j.ijid.2020.05.021CrossRefPubMedPubMedCentral

Maroldi R, Rondi P, Agazzi GM, Ravanelli M, Borghesi A, Farina D (2021) Which role for chest x-ray score in predicting the outcome in COVID-19 pneumonia? Eur Radiol 31(6):4016–4022. https://doi.org/10.1007/s00330-020-07504-2CrossRefPubMed

Boari GEM, Bonetti S, Braglia-Orlandini F, Chiarini G, Faustini C, Bianco G, Santagiuliana M, Guarinoni V, Saottini M, Viola S, Ferrari-Toninelli G, Pasini G, Bonzi B, Desenzani P, Tusi C, Malerba P, Zanotti E, Turini D, Rizzoni D (2021) Short-term consequences of SARS-CoV-2-related pneumonia: a follow up study. High Blood Press Cardiovasc Prev 28(4):373–381. https://doi.org/10.1007/s40292-021-00454-wCrossRefPubMedPubMedCentral

10.

Boari GEM, Chiarini G, Bonetti S, Malerba P, Bianco G, Faustini C, Braglia-Orlandini F, Turini D, Guarinoni V, Saottini M, Viola S, Ferrari-Toninelli G, Pasini G, Mascadri C, Bonzi B, Desenzani P, Tusi C, Zanotti E, Nardin M, Rizzoni D (2020) Prognostic factors and predictors of outcome in patients with COVID-19 and related pneumonia: a retrospective cohort study. Biosci Rep 40(12):BSR20203455. https://doi.org/10.1042/BSR20203455CrossRefPubMedPubMedCentral

11.

World Health Organization (2020) Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance 28 January 2020. (January):10

12.

Lighter J, Phillips M, Hochman S, Sterling S, Johnson D, Francois F, Stachel A (2020) Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission. Clin Infect Dis 71(15):896–897. https://doi.org/10.1093/cid/ciaa415CrossRefPubMed

13.

Rodriguez-Gonzalez CG, Chamorro-de-Vega E, Valerio M, Amor-Garcia MA, Tejerina F, Sancho-Gonzalez M, Narrillos-Moraza A, Gimenez-Manzorro A, Manrique-Rodriguez S, Machado M, Olmedo M, Escudero-Vilaplana V, Villanueva-Bueno C, Torroba-Sanz B, Melgarejo-Ortuño A, Vicente-Valor J, Herranz A, Bouza E, Muñoz P, Sanjurjo M (2021) COVID-19 in hospitalised patients in Spain: a cohort study in Madrid. Int J Antimicrob Agents 57(2):106249. https://doi.org/10.1016/j.ijantimicag.2020.106249CrossRefPubMed

14.

Giacomelli A, Ridolfo AL, Milazzo L, Oreni L, Bernacchia D, Siano M, Bonazzetti C, Covizzi A, Schiuma M, Passerini M, Piscaglia M, Coen M, Gubertini G, Rizzardini G, Cogliati C, Brambilla AM, Colombo R, Castelli A, Rech R, Riva A, Torre A, Meroni L, Rusconi S, Antinori S, Galli M (2020) 30-day mortality in patients hospitalized with COVID-19 during the first wave of the Italian epidemic: a prospective cohort study. Pharmacol Res 158:104931. https://doi.org/10.1016/j.phrs.2020.104931CrossRefPubMedPubMedCentral

15.

Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, Norman L, Holden KA, Read JM, Dondelinger F, Carson G, Merson L, Lee J, Plotkin D, Sigfrid L, Halpin S, Jackson C, Gamble C, Horby PW, Nguyen-Van-Tam JS, Ho A, Russell CD, Dunning J, Openshaw PJ, Baillie JK, Semple MG, ISARIC4C Investigators (2020) Features of 20,133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ 369:m1985. https://doi.org/10.1136/bmj.m1985CrossRefPubMedPubMedCentral

16.

Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, The Northwell COVID-19 Research Consortium, Barnaby DP, Becker LB, Chelico JD, Cohen SL, Cookingham J, Coppa K, Diefenbach MA, Dominello AJ, Duer-Hefele J, Falzon L, Gitlin J, Hajizadeh N, Harvin TG, Hirschwerk DA, Kim EJ, Kozel ZM, Marrast LM, Mogavero JN, Osorio GA, Qiu M, Zanos TP (2020) Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA 323(20):2052–2059. https://doi.org/10.1001/jama.2020.6775CrossRefPubMedPubMedCentral

17.

Wu P, Hao X, Lau EHY, Wong JY, Leung KSM, Wu JT, Cowling BJ, Leung GM (2020) Real-time tentative assessment of the epidemiological characteristics of novel coronavirus infections in Wuhan, China, as at 22 January 2020. Euro Surveill 25(3):2000044. https://doi.org/10.2807/1560-7917.ES.2020.25.3.2000044CrossRefPubMedCentral

18.

James N, Menzies M, Radchenko P (2021) COVID-19 second wave mortality in Europe and the United States This paper was selected as Featured COVID-19 second wave mortality in Europe and the United States. 031105. https://doi.org/10.1063/5.0041569

19.

Borghesi A, Golemi S, Carapella N, Zigliani A, Farina D, Maroldi R (2021) Lombardy, Northern Italy: COVID-19 second wave less severe and deadly than the first? A preliminary investigation. Infect Dis (Lond) 53(5):370–375. https://doi.org/10.1080/23744235.2021.1884745CrossRef

20.

Zhao H, Lu L, Peng Z et al (2022) SARS-CoV-2 Omicron variant shows less efficient replication and fusion activity when compared with Delta variant in TMPRSS2-expressed cells. Emerg Microbes Infect 11(1):277–283. https://doi.org/10.1080/22221751.2021.2023329CrossRefPubMedPubMedCentral

21.

Luo X, Zhou W, Yan X, Guo T, Wang B, Xia H, Ye L, Xiong J, Jiang Z, Liu Y, Zhang B, Yang W (2020) Prognostic value of C-reactive protein in patients with COVID-19. Clin Infect Dis 71(16):2174–2179. https://doi.org/10.1093/cid/ciaa641CrossRefPubMed

22.

Marnell L, Mold C, du Clos TW (2005) C-reactive protein: ligands, receptors and role in inflammation. Clin Immunol 117(2):104–111. https://doi.org/10.1016/j.clim.2005.08.004CrossRefPubMed

23.

Liu F, Li L, Xu MD, Wu J, Luo D, Zhu YS, Song XY, Zhou X (2020) Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. J Clin Virol 127:104370. https://doi.org/10.1016/j.jcv.2020.104370CrossRefPubMedPubMedCentral

24.

Corradini E, Ventura P, Ageno W, Cogliati CB, Muiesan ML, Girelli D, Pirisi M, Gasbarrini A, Angeli P, Querini PR, Bosi E, Tresoldi M, Vettor R, Cattaneo M, Piscaglia F, Brucato AL, Perlini S, Martelletti P, Pontremoli R, Porta M, Minuz P, Olivieri O, Sesti G, Biolo G, Rizzoni D, Serviddio G, Cipollone F, Grassi D, Manfredini R, Moreo GL, Pietrangelo A, SIMI-COVID-19 Collaborators (2021) Clinical factors associated with death in 3044 COVID-19 patients managed in internal medicine wards in Italy: results from the SIMI-COVID-19 study of the Italian Society of Internal Medicine (SIMI). Int Emerg Med 16(4):1005–1015. https://doi.org/10.1007/s11739-021-02742-8CrossRef

25.

Mancusi C, Grassi G, Borghi C, Carugo S, Fallo F, Ferri C, Giannattasio C, Grassi D, Letizia C, Minuz P, Muiesan ML, Perlini S, Pucci G, Rizzoni D, Salvetti M, Sarzani R, Sechi L, Veglio F, Volpe M, Iaccarino G, SARS-RAS Investigators (2021) Determinants of healing among patients with coronavirus disease 2019: the results of the SARS-RAS study of the Italian Society of Hypertension. J Hypertens 39(2):376–380. https://doi.org/10.1097/HJH.0000000000002666CrossRefPubMed

26.

Iaccarino G, Grassi G, Borghi C, Ferri C, Salvetti M, Volpe M, SARS-RAS Investigators (2020) Age and multimorbidity predict death among COVID-19 patients: results of the SARS-RAS study of the Italian Society of Hypertension. Hypertension 76(2):366–372. https://doi.org/10.1161/HYPERTENSIONAHA.120.15324CrossRefPubMed

27.

Iaccarino G, Grassi G, Borghi C, Carugo S, Fallo F, Ferri C, Giannattasio C, Grassi D, Letizia C, Mancusi C, Minuz P, Perlini S, Pucci G, Rizzoni D, Salvetti M, Sarzani R, Sechi L, Veglio F, Volpe M, Muiesan ML, SARS-RAS Investigators (2020) Gender differences in predictors of intensive care units admission among COVID-19 patients: the results of the SARS-RAS study of the Italian Society of Hypertension. PLoS ONE 15(10):e0237297. https://doi.org/10.1371/journal.pone.0237297 (eCollection 2020)CrossRefPubMedPubMedCentral

Title: Comparison of the characteristics, morbidity and mortality of COVID-19 between first and second/third wave in a hospital setting in Lombardy: a retrospective cohort study
Authors: Francesca Leidi
Gianluca Edoardo Mario Boari
Ottavio Scarano
Benedetta Mangili
Giulia Gorla
Andrea Corbani
Beatrice Accordini
Federico Napoli
Chiara Ghidelli
Giulia Archenti
Daniele Turini
Michele Saottini
Vittoria Guarinoni
Giulia Ferrari-Toninelli
Francesca Manzoni
Silvia Bonetti
Giulia Chiarini
Paolo Malerba
Federico Braglia-Orlandini
Gianluca Bianco
Cristina Faustini
Claudia Agabiti-Rosei
Carolina De Ciuceis
Damiano Rizzoni
Publication date: 09-07-2022
Publisher: Springer International Publishing
Keywords: SARS-CoV-2
COVID-19
Published in: Internal and Emergency Medicine / Issue 7/2022
Print ISSN: 1828-0447
Electronic ISSN: 1970-9366
DOI: https://doi.org/10.1007/s11739-022-03034-5

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