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. 2020 Dec 8:12:1337-1346.
doi: 10.2147/CLEP.S271763. eCollection 2020.

Survival of Hospitalized COVID-19 Patients in Northern Italy: A Population-Based Cohort Study by the ITA-COVID-19 Network

Eliana Ferroni  1 , Paolo Giorgi Rossi  2 , Stefania Spila Alegiani  3 , Gianluca Trifirò  4 , Gisella Pitter  1 , Olivia Leoni  5 , Danilo Cereda  5 , Massimiliano Marino  2 , Michele Pellizzari  1 , Massimo Fabiani  6 , Flavia Riccardo  6 , Janet Sultana  4 , Marco Massari  3 ; ITA-COVID Working Group
Affiliations

Survival of Hospitalized COVID-19 Patients in Northern Italy: A Population-Based Cohort Study by the ITA-COVID-19 Network

Eliana Ferroni et al. Clin Epidemiol. .

Abstract

Introduction: COVID-19 case fatality rate in hospitalized patients varies across countries and studies. Reliable estimates, specific for age, sex, and comorbidities, are needed to monitor the epidemic, to compare the outcome in different settings, and to correctly design trials for COVID-19 interventions. The aim of this study was to provide population-based survival curves of hospitalized COVID-19 patients.

Materials and methods: A cohort study was conducted in three areas of Northern Italy, heavily affected by SARS-CoV-2 infection (Lombardy and Veneto Regions, and Reggio Emilia province), using a loco-regional COVID-19 surveillance system, linked to hospital discharge databases. We included all patients testing positive for SARS-CoV-2 RNA by RT-PCR on nasopharyngeal/throat swab samples who were hospitalized from 21 February to 21 April 2020. Kaplan-Meier survival estimates were calculated at 14 and 30 days for death in any setting, stratifying by age, sex, and the Charlson Index.

Results: Overall, 42,926 hospitalized COVID-19 patients were identified. Patients' median age was 69 years (IQR: 57-79), 62.6% were males, and 6.0% had a Charlson Index ≥3. Survival curves showed that 22.0% (95% CI 21.6-22.4) of patients died within 14 days and 27.6% (95% CI 27.2-28.1) within 30 days from hospitalization. Survival was higher in younger patients and in females. The negative impact of comorbidities on survival was more pronounced in younger age groups.

Conclusion: The high fatality rate observed in the study (28% at 30 days) suggests that studies should focus on death as primary endpoint during a follow-up of at least one month.

Keywords: COVID-19; Italy; cohort study; hospitalized patients; survival.

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Conflict of interest statement

Eliana Ferroni, Paolo Giorgi Rossi, Stefania Spila Alegiani, Gisella Pitter, Olivia Leoni, Danilo Cereda, Massimo Fabiani, Flavia Riccardo, Massimiliano Marino, Michele Pellizzari, and Marco Massari declare no competing interests. Gianluca Trifirò reports grants from Novartis, from the Italian Drug Agency, during the conduction of the study. He has participated in advisory boards within the last five years on topics not related to this manuscript and organized by Sandoz, Hospira, Sanofi, Biogen, Ipsen, Shire and is a consultant for Otsuka. He is the principal investigator of observational studies of the University of Messina funded by several pharmaceutical companies (eg, Amgen, AstraZeneca, Daiichi Sankyo, IBSA) as well as scientific coordinator of the Master’s program “Pharmacovigilance, pharmacoepidemiology and pharmacoeconomics: real-world data evaluations” at the University of Messina, which receives unconditional funding from several pharmaceutical companies. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Kaplan–Meier survival curves for hospitalized COVID-19 patients in Northern Italy, 21 February–21 April 2020. (A): overall; (B): stratified by age groups; (C): stratified by sex at birth; (D): stratified by the Charlson Index.
Figure 2
Figure 2
Kaplan–Meier survival curves for hospitalized COVID-19 patients in Northern Italy stratified by age and the Charlson Index, 21 February–21 April 2020. (A): age 18–49 years; (B): age 50–59 years; (C): age 60–69 years; (D): age 70–79 years; (E): age 80–89 years; (F): age 90+ years.
See this image and copyright information in PMC

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