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Grippo F, Grande E, Maraschini A, Navarra S, Pappagallo M, Marchetti S, Crialesi R, Frova L, Orsi C, Simeoni S, Carinci A, Loreto G, Donfrancesco C, Lo Noce C, Palmieri L, Andrianou X, Urdiales AM, Onder G, Minelli G. Evolution of Pathology Patterns in Persons Who Died From COVID-19 in Italy: A National Study Based on Death Certificates. Front Med (Lausanne) 2021; 8:645543. [PMID: 33829025 PMCID: PMC8019728 DOI: 10.3389/fmed.2021.645543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/24/2021] [Indexed: 12/20/2022] Open
Abstract
Background: In Italy, during the first epidemic wave of 2020, the peak of coronavirus disease 2019 (COVID-19) mortality was reached at the end of March. Afterward, a progressive reduction was observed until much lower figures were reached during the summer, resulting from the contained circulation of SARS-CoV-2. This study aimed to determine if and how the pathological patterns of the individuals deceased from COVID-19 changed during the phases of epidemic waves in terms of: (i) main cause of death, (ii) comorbidities, and (iii) complications related to death. Methods: Death certificates of persons who died and tested positive for SARS-CoV-2, provided by the National Surveillance system, were coded according to ICD rev10. Deaths due to COVID-19 were defined as those in which COVID-19 was the underlying cause of death. Results: The percentage of COVID-19 deaths varied over time. It decreased in the downward phase of the epidemic curve (76.6 vs. 88.7%). In February-April 2020, hypertensive heart disease was mentioned as a comorbidity in 18.5% of death certificates, followed by diabetes (15.9% of cases), ischemic heart disease (13.1%), and neoplasms (12.1%). In May-September, the most frequent comorbidity was neoplasms (17.3% of cases), followed by hypertensive heart disease (14.9%), diabetes (14.8%), and dementia/Alzheimer's disease (11.9%). The most mentioned complications in both periods were pneumonia and respiratory failure with a frequency far higher than any other condition (78.4% in February-April 2020 and 63.7% in May-September 2020). Discussion: The age of patients dying from COVID-19 and their disease burden increased in the May-September 2020 period. A more serious disease burden was observed in this period, with a significantly higher frequency of chronic pathologies. Our study suggests better control of the virus' lethality in the second phase of the epidemic, when the health system was less burdened. Moreover, COVID-19 care protocols had been created in hospitals, and knowledge about the diagnosis and treatment of COVID-19 had improved, potentially leading to more accurate diagnosis and better treatment. All these factors may have improved survival in patients with COVID-19 and led to a shift in mortality to older, more vulnerable, and complex patients.
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Affiliation(s)
- Francesco Grippo
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | - Enrico Grande
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | | | - Simone Navarra
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | - Marilena Pappagallo
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | - Stefano Marchetti
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | - Roberta Crialesi
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | - Luisa Frova
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | - Chiara Orsi
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | - Silvia Simeoni
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, Rome, Italy
| | | | - Giuseppe Loreto
- Statistical Service, Istituto Superiore di Sanità, Rome, Italy
| | - Chiara Donfrancesco
- Department of Cardiovascular, Endocrine-metabolic Diseases and Ageing, Istituto Superiore di Sanità, Rome, Italy
| | - Cinzia Lo Noce
- Department of Cardiovascular, Endocrine-metabolic Diseases and Ageing, Istituto Superiore di Sanità, Rome, Italy
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-metabolic Diseases and Ageing, Istituto Superiore di Sanità, Rome, Italy
| | - Xanthi Andrianou
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | - Graziano Onder
- Department of Cardiovascular, Endocrine-metabolic Diseases and Ageing, Istituto Superiore di Sanità, Rome, Italy
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, Rome, Italy
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Grippo F, Navarra S, Orsi C, Manno V, Grande E, Crialesi R, Frova L, Marchetti S, Pappagallo M, Simeoni S, Di Pasquale L, Carinci A, Donfrancesco C, Lo Noce C, Palmieri L, Onder G, Minelli G. The Role of COVID-19 in the Death of SARS-CoV-2-Positive Patients: A Study Based on Death Certificates. J Clin Med 2020; 9:E3459. [PMID: 33121176 PMCID: PMC7692219 DOI: 10.3390/jcm9113459] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/13/2020] [Accepted: 10/22/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Death certificates are considered the most reliable source of information to compare cause-specific mortality across countries. The aim of the present study was to examine death certificates of persons who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to (a) quantify the number of deaths directly caused by coronavirus 2019 (COVID-19); (b) estimate the most common complications leading to death; and (c) identify the most common comorbidities. Methods: Death certificates of persons who tested positive for SARS-CoV-2 provided to the National Surveillance system were coded according to the 10th edition of the International Classification of Diseases. Deaths due to COVID-19 were defined as those in which COVID-19 was the underlying cause of death. Complications were defined as those conditions reported as originating from COVID-19, and comorbidities were conditions independent of COVID-19. Results: A total of 5311 death certificates of persons dying in March through May 2020 were analysed (16.7% of total deaths). COVID-19 was the underlying cause of death in 88% of cases. Pneumonia and respiratory failure were the most common complications, being identified in 78% and 54% of certificates, respectively. Other complications, including shock, respiratory distress and pulmonary oedema, and heart complications demonstrated a low prevalence, but they were more commonly observed in the 30-59 years age group. Comorbidities were reported in 72% of certificates, with little variation by age and gender. The most common comorbidities were hypertensive heart disease, diabetes, ischaemic heart disease, and neoplasms. Neoplasms and obesity were the main comorbidities among younger people. Discussion: In most persons dying after testing positive for SARS-CoV-2, COVID-19 was the cause directly leading to death. In a large proportion of death certificates, no comorbidities were reported, suggesting that this condition can be fatal in healthy persons. Respiratory complications were common, but non-respiratory complications were also observed.
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Affiliation(s)
- Francesco Grippo
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00184 Rome, Italy; (F.G.); (S.N.); (C.O.); (E.G.); (R.C.); (L.F.); (S.M.); (M.P.); (S.S.)
| | - Simone Navarra
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00184 Rome, Italy; (F.G.); (S.N.); (C.O.); (E.G.); (R.C.); (L.F.); (S.M.); (M.P.); (S.S.)
| | - Chiara Orsi
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00184 Rome, Italy; (F.G.); (S.N.); (C.O.); (E.G.); (R.C.); (L.F.); (S.M.); (M.P.); (S.S.)
| | - Valerio Manno
- Statistical Service, Istituto Superiore di Sanità, 00161 Rome, Italy; (V.M.); (L.D.P.); (A.C.)
| | - Enrico Grande
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00184 Rome, Italy; (F.G.); (S.N.); (C.O.); (E.G.); (R.C.); (L.F.); (S.M.); (M.P.); (S.S.)
| | - Roberta Crialesi
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00184 Rome, Italy; (F.G.); (S.N.); (C.O.); (E.G.); (R.C.); (L.F.); (S.M.); (M.P.); (S.S.)
| | - Luisa Frova
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00184 Rome, Italy; (F.G.); (S.N.); (C.O.); (E.G.); (R.C.); (L.F.); (S.M.); (M.P.); (S.S.)
| | - Stefano Marchetti
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00184 Rome, Italy; (F.G.); (S.N.); (C.O.); (E.G.); (R.C.); (L.F.); (S.M.); (M.P.); (S.S.)
| | - Marilena Pappagallo
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00184 Rome, Italy; (F.G.); (S.N.); (C.O.); (E.G.); (R.C.); (L.F.); (S.M.); (M.P.); (S.S.)
| | - Silvia Simeoni
- Division of Integrated Systems for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00184 Rome, Italy; (F.G.); (S.N.); (C.O.); (E.G.); (R.C.); (L.F.); (S.M.); (M.P.); (S.S.)
| | - Lucilla Di Pasquale
- Statistical Service, Istituto Superiore di Sanità, 00161 Rome, Italy; (V.M.); (L.D.P.); (A.C.)
| | - Annamaria Carinci
- Statistical Service, Istituto Superiore di Sanità, 00161 Rome, Italy; (V.M.); (L.D.P.); (A.C.)
| | - Chiara Donfrancesco
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Ageing, Istituto Superiore di Sanità, 00161 Rome, Italy; (C.D.); (C.L.N.); (L.P.)
| | - Cinzia Lo Noce
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Ageing, Istituto Superiore di Sanità, 00161 Rome, Italy; (C.D.); (C.L.N.); (L.P.)
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Ageing, Istituto Superiore di Sanità, 00161 Rome, Italy; (C.D.); (C.L.N.); (L.P.)
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Ageing, Istituto Superiore di Sanità, 00161 Rome, Italy; (C.D.); (C.L.N.); (L.P.)
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, 00161 Rome, Italy; (V.M.); (L.D.P.); (A.C.)
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Kodra Y, Minelli G, Rocchetti A, Manno V, Carinci A, Conti S, Taruscio D. The Italian National Rare Diseases Registry: a model of comparison and integration with Hospital Discharge Data. J Public Health (Oxf) 2019; 41:46-54. [PMID: 29294017 DOI: 10.1093/pubmed/fdx176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 11/14/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Italy has been the first country at European level to implement a population-based public health registry dedicated to rare diseases. This study describes the current situation of the Italian National Rare Diseases Registry (NRDR) and compares its data with those from the National Hospital Discharge Database (HDD). METHODS Three rare diseases were analysed: Huntington disease (HD), Hereditary Haemorragic Telangiectasia (HHT) and Prader-Willi Syndrome (PWS), selected for their different characteristics. The two sources (NRDR and HDD) were linked: incidence rate ratio (IRR), sensitivity and predictive positive value (PPV) were calculated. RESULTS Incidence rates from NRDR and from HDD were compared by age groups, and IRR calculated: 1.08 for HD, 1.41 for HHT, 1.21 for PSW. For HD, sensitivity was 0.52 and PPV 0.48; for HHT sensitivity was 0.71 and PPV 0.52; for PWS the sensitivity was 0.71 and PPV 0.58. We found a strong regional variability in the results. CONCLUSIONS The integrated use of the two sources helps tracking those cases that are not captured by the Registry; further, it is a precious tool to accurately describe clinical histories of rare disease affected individuals, in terms of concomitant pathologies and medical procedures performed during hospitalization.
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Affiliation(s)
- Yllka Kodra
- National Centre for Rare Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Giada Minelli
- Service of Statistics, Istituto Superiore di Sanità, Rome, Italy
| | - Adele Rocchetti
- National Centre for Rare Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Valerio Manno
- Service of Statistics, Istituto Superiore di Sanità, Rome, Italy
| | | | - Susanna Conti
- Service of Statistics, Istituto Superiore di Sanità, Rome, Italy
| | - Domenica Taruscio
- National Centre for Rare Diseases, Istituto Superiore di Sanità, Rome, Italy
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Antonelli C, Franchi F, Della Marta ME, Carinci A, Sbrana G, Tanasi P, De Fina L, Brauzzi M. Guiding principles in choosing a therapeutic table for DCI hyperbaric therapy. Minerva Anestesiol 2009; 75:151-161. [PMID: 19221544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Hyperbaric therapy is the basis of treatment for pervasive development disorders. For this reason, the choice of the right therapeutic table for each case is critical. Above all, the delay in recompression time with respect to the first symptoms and to the severity of the case must be considered. In our experience, the use of low-pressure oxygen tables resolves almost all cases if recompression takes place within a short time. When recompression is possible almost immediately, the mechanical effect of reduction on bubble volume due to pressure is of remarkable importance. In these cases, high-pressure tables can be considered. These tables can also be used in severe spinal-cord decompression sickness. The preferred breathing mixture is still disputed. Heliox seems to be favored because it causes fewer problems during the recompression of divers, and above all, because nitrox can cause narcosis and contributes nitrogen. Saturation treatment should be avoided or at least used only in special cases. In cases of arterial gas embolism cerebral injury, it is recommended to start with an initial 6 ATA recompression only if the time between symptom onset and the beginning of recompression is less than a few hours.
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Affiliation(s)
- C Antonelli
- Unit of Diving and Hyperbaric Medicine, Misericordia Hospital, Via Senese, Grosseto, Italy.
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Sartini M, Cremonesi P, Tamagno R, Cristina ML, Orlando P, Vandelli A, Carinci A, Caruso A, Grotti A, Iacovella A, La Brocca A, Mangioncalda A, Longanesi AM, Susi B, Barletta C, Braglia D, Coen D, Tazza D, Gottardi E, Palego E, Urbano E, Bar F, Bussani F, De Giorgi F, Esposito F, Fabi F, Lotti F, Miglio F, Moscariello F, Pertoldi F, Sardella F, Tosato F, Abregal G, Baldi G, Carbone G, Cerqua G, Giagnorio G, Pia G, Piazza G, Tedesco G, Sallustio GF, Morana I, Beringheli L, Jannotti L, Spinsi L, Zulli L, Cavazza M, De Simone M, Galletti M, Gioffrè Florio M, Greco M, Longoni M, Luppi M, Magnani M, Mazzone M, Pastorello M, Pazzaglia M, Ravaglia M, Zammataro M, Zanna M, Bressan MA, Saggese MP, Gentiloni Silveri N, Scopetta N, De Mitri O, Fantin O, Boscolo P, Cancemi P, De Angelis P, Di Pietro P, Mosca P, Pacelli P, Torboli P, Copetti R, Fazio R, Losordo R, Melandri R, Papitto R, Chiaravalle S, Orlando S, Sturlese U, Di Grande A, Narbone G, Zimmermann H, Martinelli L, Clanchini V, Paternosto D, Fiorilli M, Del Prato C, Becheri M, Lanigra M, Guerra G, Sinno C, Soragna A, Ferranio MP, Bua V, Capra R, Lualdi E. Quality in emergency departments: a study on 3,285,440 admissions. J Prev Med Hyg 2007; 48:17-23. [PMID: 17506233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
INTRODUCTION A multi-centre study has been conducted, during 2005, by means of a questionnaire posted on the Italian Society of Emergency Medicine (SIMEU) web page. Our intention was to carry out an organisational and functional analysis of Italian Emergency Departments (ED) in order to pick out some macro-indicators of the activities performed. Participation was good, in that 69 ED (3,285,440 admissions to emergency services) responded to the questionnaire. METHODS The study was based on 18 questions: 3 regarding the personnel of the ED, 2 regarding organisational and functional aspects, 5 on the activity of the ED, 7 on triage and 1 on the assessment of the quality perceived by the users of the ED. RESULTS AND CONCLUSION The replies revealed that 91.30% of the ED were equipped with data-processing software, which, in 96.83% of cases, tracked the entire itinerary of the patient. About 48,000 patients/year used the ED: 76.72% were discharged and 18.31% were hospitalised. Observation Units were active in 81.16% of the ED examined. Triage programmes were in place in 92.75% of ED: in 75.81% of these, triage was performed throughout the entire itinerary of the patient; in 16.13% it was performed only symptom-based, and in 8.06% only on-call. Of the patients arriving at the ED, 24.19% were assigned a non-urgent triage code, 60.01% a urgent code, 14.30% a emergent code and 1.49% a life-threatening code. Waiting times were: 52.39 min for non-urgent patients, 40.26 min for urgent, 12.08 for emergent, and 1.19 for life-threatening patients.
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Affiliation(s)
- M Sartini
- Dept. Health Sciences, University of Genoa, Italy.
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Pastor SD, Carinci A, Khoury N, Rahni DN. The synthesis and conformation of sterically congested seven-membered rings containing tetracoordinate germanium(IV): determination of the DeltaG* for ring inversion. Inorg Chem 2001; 40:3830-2. [PMID: 11442386 DOI: 10.1021/ic010180t] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S D Pastor
- Pace University, Department of Chemistry, Pleasantville, New York 10570, USA
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