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Observational Study
. 2021 Mar:178:106323.
doi: 10.1016/j.rmed.2021.106323. Epub 2021 Jan 30.

Characteristics and outcomes in hospitalized COVID-19 patients during the first 28 days of the spring and autumn pandemic waves in Milan: An observational prospective study

Dejan Radovanovic  1 , Stefano Pini  2 , Elisa Franceschi  3 , Marica Pecis  4 , Andrea Airoldi  5 , Maurizio Rizzi  6 , Pierachille Santus  7
Affiliations
Observational Study

Characteristics and outcomes in hospitalized COVID-19 patients during the first 28 days of the spring and autumn pandemic waves in Milan: An observational prospective study

Dejan Radovanovic et al. Respir Med. 2021 Mar.

Abstract

Background: The therapeutic approach to COVID-19 and healthcare system preparedness improved during 2020. We compared characteristics and outcomes of hospitalized COVID-19 patients during the first 28 days of the March and October pandemic waves in Milan, Italy.

Material and methods: A prospective, observational study enrolling adult patients hospitalized with COVID-19 pneumonia during March 7-April 4 (1st period) and October 15-November 12 (2nd period). During the 1st period hydroxychloroquine, lopinavir/ritonavir and therapeutic enoxaparin when thrombosis was confirmed were administered; systemic corticosteroids were given in case of severe pneumonia. During the 2nd period dexamethasone, methylprednisolone, remdesivir, thromboprophylaxis or anticoagulation were administered according to international recommendations. Patients with respiratory distress on oxygen masks initiated CPAP. Outcomes were: length of hospital stay, all-cause in-hospital mortality and need for intubation.

Results: We included 70 patients (75% males) during the 1st and 76 patients (51% males, p = 0.522) during the 2nd period. Prevalence of severe respiratory failure (30% vs. 12%, p = 0.006), and D-dimer >3000 FEU (34% vs. 15%, P = 0.012) were reduced during the 2nd period, while anticoagulation and corticosteroids were more frequently administered (both p < 0.01). Mortality and time to referral were also reduced (39.4% vs. 22.4%, p = 0.019 and 6 vs. 5 days, p = 0.014), while need for intubation didn't change. Hospitalization length was comparable, but the proportion of patients discharged home was higher during the 2nd period (28.2% vs. 55.4%, p = 0.001).

Conclusions: Changing treatment paradigms and early referral might have reduced mortality in COVID-19 patients. The effects of specific therapeutic regimens needs further confirmation in future clinical studies.

Keywords: COVID-19; CPAP; Mortality; Pneumonia; Respiratory failure; Treatment.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Mortality during the 1st and 2nd pandemic wave. Survival curves in patients admitted to the HDRU during the March– April (blue line) and October– November 2020 (red dotted line) pandemic periods in the whole cohort (left panel) and in patients treated with CPAP (right panel). HDRU: high dependency respiratory unit; CPAP: continuous positive airway pressure. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
See this image and copyright information in PMC

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