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In Nutrition, metabolism, and cardiovascular diseases : NMCD

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.

Di Castelnuovo Augusto, Bonaccio Marialaura, Costanzo Simona, Gialluisi Alessandro, Antinori Andrea, Berselli Nausicaa, Blandi Lorenzo, Bruno Raffaele, Cauda Roberto, Guaraldi Giovanni, My Ilaria, Menicanti Lorenzo, Parruti Giustino, Patti Giuseppe, Perlini Stefano, Santilli Francesca, Signorelli Carlo, Stefanini Giulio G, Vergori Alessandra, Abdeddaim Amina, Ageno Walter, Agodi Antonella, Agostoni Piergiuseppe, Aiello Luca, Al Moghazi Samir, Aucella Filippo, Barbieri Greta, Bartoloni Alessandro, Bologna Carolina, Bonfanti Paolo, Brancati Serena, Cacciatore Francesco, Caiano Lucia, Cannata Francesco, Carrozzi Laura, Cascio Antonio, Cingolani Antonella, Cipollone Francesco, Colomba Claudia, Crisetti Annalisa, Crosta Francesca, Danzi Gian B, D’Ardes Damiano, de Gaetano Donati Katleen, Di Gennaro Francesco, Di Palma Gisella, Di Tano Giuseppe, Fantoni Massimo, Filippini Tommaso, Fioretto Paola, Fusco Francesco M, Gentile Ivan, Grisafi Leonardo, Guarnieri Gabriella, Landi Francesco, Larizza Giovanni, Leone Armando, Maccagni Gloria, Maccarella Sandro, Mapelli Massimo, Maragna Riccardo, Marcucci Rossella, Maresca Giulio, Marotta Claudia, Marra Lorenzo, Mastroianni Franco, Mengozzi Alessandro, Menichetti Francesco, Milic Jovana, Murri Rita, Montineri Arturo, Mussinelli Roberta, Mussini Cristina, Musso Maria, Odone Anna, Olivieri Marco, Pasi Emanuela, Petri Francesco, Pinchera Biagio, Pivato Carlo A, Pizzi Roberto, Poletti Venerino, Raffaelli Francesca, Ravaglia Claudia, Righetti Giulia, Rognoni Andrea, Rossato Marco, Rossi Marianna, Sabena Anna, Salinaro Francesco, Sangiovanni Vincenzo, Sanrocco Carlo, Scarafino Antonio, Scorzolini Laura, Sgariglia Raffaella, Simeone Paola G, Spinoni Enrico, Torti Carlo, Trecarichi Enrico M, Vezzani Francesca, Veronesi Giovanni, Vettor Roberto, Vianello Andrea, Vinceti Marco, De Caterina Raffaele, Iacoviello Licia

2020-Jul-31

COVID-19, Epidemiology, In-hospital mortality, Risk factors