Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 May 20;9(5):1548.
doi: 10.3390/jcm9051548.

Early Predictors of Clinical Deterioration in a Cohort of 239 Patients Hospitalized for Covid-19 Infection in Lombardy, Italy

Maurizio Cecconi  1   2 , Daniele Piovani  1   2 , Enrico Brunetta  1   2 , Alessio Aghemo  1   2 , Massimiliano Greco  1   2 , Michele Ciccarelli  1   2 , Claudio Angelini  1   2 , Antonio Voza  1   2 , Paolo Omodei  1   2 , Edoardo Vespa  1   2 , Nicola Pugliese  1   2 , Tommaso Lorenzo Parigi  1   2 , Marco Folci  1   2 , Silvio Danese  1   2 , Stefanos Bonovas  1   2
Affiliations

Early Predictors of Clinical Deterioration in a Cohort of 239 Patients Hospitalized for Covid-19 Infection in Lombardy, Italy

Maurizio Cecconi et al. J Clin Med. .

Abstract

We described features of hospitalized Covid-19 patients and identified predictors of clinical deterioration. We included patients consecutively admitted at Humanitas Research Hospital (Rozzano, Milan, Italy); retrospectively extracted demographic; clinical; laboratory and imaging findings at admission; used survival methods to identify factors associated with clinical deterioration (defined as intensive care unit (ICU) transfer or death), and developed a prognostic index. Overall; we analyzed 239 patients (29.3% females) with a mean age of 63.9 (standard deviation [SD]; 14.0) years. Clinical deterioration occurred in 70 patients (29.3%), including 41 (17.2%) ICU transfers and 36 (15.1%) deaths. The most common symptoms and signs at admission were cough (77.8%) and elevated respiratory rate (34.1%), while 66.5% of patients had at least one coexisting medical condition. Imaging frequently revealed ground-glass opacity (68.9%) and consolidation (23.8%). Age; increased respiratory rate; abnormal blood gas parameters and imaging findings; coexisting coronary heart disease; leukocytosis; lymphocytopenia; and several laboratory parameters (elevated procalcitonin; interleukin-6; serum ferritin; C-reactive protein; aspartate aminotransferase; lactate dehydrogenase; creatinine; fibrinogen; troponin-I; and D-dimer) were significant predictors of clinical deterioration. We suggested a prognostic index to assist risk-stratification (C-statistic; 0.845; 95% CI; 0.802‒0.887). These results could aid early identification and management of patients at risk, who should therefore receive additional monitoring and aggressive supportive care.

Keywords: 2019 novel coronavirus; 2019-nCoV; COVID-19; SARS-CoV-2; severe acute respiratory syndrome coronavirus 2.

PubMed Disclaimer

Conflict of interest statement

All other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier curve in patients with confirmed COVID-19 admitted to Humanitas Research Hospital, between 22 February to 22 March 2020. The composite endpoint was ICU transfer or death. The overall 20-day event-free survival was 0.66 (95% CI, 0.59–0.72). CI: confidence interval; ICU: intensive care unit.
Figure 2
Figure 2
Kaplan–Meier curves by risk-category. The composite endpoint was ICU transfer or death. The 20-day event-free survival was 0.97 (95% CI, 0.87–0.99) for the “low risk” group (upper curve), 0.67 (95% CI, 0.51–0.79) for the “intermediate risk” (intermediate), and 0.24 (95% CI, 0.10–0.40) for the “high risk” group (lower curve). CI: confidence interval; ICU: intensive care unit.
See this image and copyright information in PMC

References

    1. Zhu N., Zhang D., Wang W., Li X., Yang B., Song J., Zhao X., Huang B., Shi W., Lu R., et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N. Engl. J. Med. 2020;382:727–733. doi: 10.1056/NEJMoa2001017. - DOI - PMC - PubMed
    1. Phelan A.L., Katz R., Gostin L.O. The Novel Coronavirus Originating in Wuhan, China. JAMA. 2020;323:709. doi: 10.1001/jama.2020.1097. - DOI - PubMed
    1. Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. Gorbalenya A.E. The species Severe acute respiratory syndrome-related coronavirus: Classifying 2019-nCoV and naming it SARS-CoV-2. Nat. Microbiol. 2020;5:536–544. doi: 10.1038/s41564-020-0695-z. - DOI - PMC - PubMed
    1. World Health Organization Rolling Updates on Coronavirus Disease (COVID-19) [(accessed on 24 April 2020)]; Available online: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-a....
    1. Huang C., Wang Y., Li X., Ren L., Zhao J., Hu Y., Zhang L., Fan G., Xu J., Gu X., et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506. doi: 10.1016/S0140-6736(20)30183-5. - DOI - PMC - PubMed