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Campagna D, Farsalinos K, Costantino G, Carpinteri G, Caponnetto P, Cucuzza F, Polosa R. Tobacco Smoking or Nicotine Phenotype and Severity of Clinical Presentation at the Emergency Department (SMOPHED): Protocol for a Noninterventional Observational Study. JMIR Res Protoc 2024; 13:e54041. [PMID: 38657239 DOI: 10.2196/54041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/24/2024] [Accepted: 02/19/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND In the last few years, several nicotine products have become available as alternatives to smoking tobacco. While laboratory and limited clinical studies suggest that these devices are less toxic compared to classic tobacco cigarettes, very little is known about their epidemiological impact. Visiting the emergency department (ED) often represents the first or even the only contact of patients with the health care system. Therefore, a study conducted at the ED to assess the impact of these products on health can be reliable and reflect a real-life setting. OBJECTIVE The aim of this noninterventional observational study (SMOPHED study) is to analyze the association between the severity of clinical presentation observed during ED visits among patients using various nicotine products and the subsequent outcomes, specifically hospitalization and mortality. METHODS Outcomes (hospitalization and mortality in the ED) will be examined in relation to various patterns of nicotine products use. We plan to enroll approximately 2000 participants during triage at the ED. These individuals will be characterized based on their patterns of tobacco and nicotine consumption, identified through a specific questionnaire. This categorization will allow for a detailed analysis of how different usage patterns of nicotine products correlate with the clinical diagnosis made during the ED visits and the consequent outcomes. RESULTS Enrollment into the study started in March 2024. We enrolled a total of 901 participants in 1 month (approximately 300 potential participants did not provide the informed consent to participate). The data will be analyzed by a statistician as soon as the database is completed. Full data will be published by December 2024. CONCLUSIONS There is substantial debate about the harm reduction potential of alternative nicotine products in terms of their smoking-cessation and risk-reduction potential. This study represents an opportunity to document epidemiological data on the link between the use of different types of nicotine products and disease diagnosis and severity during an ED visit, and thus evaluate the harm reduction potential claims for these products. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/54041.
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Affiliation(s)
- Davide Campagna
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Center of Excellence for the Acceleration of Harm Reduction, University of Catania, Catania, Italy
- Emergency Department, Policlinico Teaching Hospital, Catania, Italy
| | - Konstantinos Farsalinos
- Department of Public and Community Health, School of Public Health, University of West Attica, Athens, Greece
| | - Giorgio Costantino
- Scientific Institute for Research, Hospitalization and Healthcare Ca' Granda Ospedale Maggiore Policlinico, Unità Operativa Complessa Pronto Soccorso e Medicina d'Urgenza, University of Milan, Milan, Italy
| | | | - Pasquale Caponnetto
- Department of Educational Sciences, Section of Psychology, University of Catania, Catania, Italy
| | | | - Riccardo Polosa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Center of Excellence for the Acceleration of Harm Reduction, University of Catania, Catania, Italy
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Gianni F, Bonzi M, Jachetti A, Solbiati M, Dreon G, Colombo G, Colombo G, Russo A, Furlan L, Casazza G, Costantino G. How to recognize pulmonary embolism in syncope patients: A simple rule. Eur J Intern Med 2024; 121:121-126. [PMID: 37945410 DOI: 10.1016/j.ejim.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/18/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Syncope can be the presenting symptom of Pulmonary Embolism (PE). It is not known wether using a standardized algorithm to rule-out PE in all patients with syncope admitted to the Emergency Departments (ED) is of value or can lead to overdiagnosis and overtreatment. METHODS We tested if simple anamnestic and clinical parameters could be used as a rule to identify patients with syncope and PE in a multicenter observational study. The rule's sensitivity was tested on a cohort of patients that presented to the ED for syncopal episodes caused by PE. The clinical impact of the rule was assessed on a population of consecutive patients admitted for syncope in the ED. RESULTS Patients were considered rule-positive in the presence of any of the following: hypotension, tachycardia, peripheral oxygen saturation ≤ 93 % (SpO2), chest pain, dyspnea, recent history of prolonged bed rest, clinical signs of deep vein thrombosis, history of previous venous thrombo-embolism and active neoplastic disease. The sensitivity of the rule was 90.3 % (95 % CI: 74.3 % to 98.0 %). The application of the rule to a population of 217 patients with syncope would have led to a 70 % reduction in the number of subjects needing additional diagnostic tests to exclude PE. CONCLUSIONS Most patients with syncope due to PE present with anamnestic and clinical features indicative of PE diagnosis. A clinical decision rule can be used to identify patients who would benefit from further diagnostic tests to exclude PE, while reducing unnecessary exams that could lead to over-testing and over-diagnosis.
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Affiliation(s)
- Francesca Gianni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOC Pronto Soccorso, Milan, Italy; Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Mattia Bonzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOC Pronto Soccorso, Milan, Italy
| | - Alessandro Jachetti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOC Pronto Soccorso, Milan, Italy
| | - Monica Solbiati
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOC Pronto Soccorso, Milan, Italy; Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Giulia Dreon
- Scuola di Specializzazione in Medicina di Emergenza-Urgenza, Università degli Studi di Milano, Milan, Italy
| | - Giorgio Colombo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOC Pronto Soccorso, Milan, Italy
| | - Giulia Colombo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOC Pronto Soccorso, Milan, Italy
| | - Antonio Russo
- Epidemiology Unit, Agency for Health Protection of Milan, Italy
| | - Ludovico Furlan
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOC Pronto Soccorso, Milan, Italy; Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Costantino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOC Pronto Soccorso, Milan, Italy; Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy.
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Paganuzzi M, Nattino G, Ghilardi GI, Costantino G, Rossi C, Cortellaro F, Cosentini R, Paglia S, Migliori M, Mira A, Bertolini G. Assessing the heterogeneity of the impact of COVID-19 incidence on all-cause excess mortality among healthcare districts in Lombardy, Italy, to evaluate the local response to the pandemic: an ecological study. BMJ Open 2024; 14:e077476. [PMID: 38326265 PMCID: PMC10860029 DOI: 10.1136/bmjopen-2023-077476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVES The fragmentation of the response to the COVID-19 pandemic at national, regional and local levels is a possible source of variability in the impact of the pandemic on society. This study aims to assess how much of this variability affected the burden of COVID-19, measured in terms of all-cause 2020 excess mortality. DESIGN Ecological retrospective study. SETTING Lombardy region of Italy, 2015-2020. OUTCOME MEASURES We evaluated the relationship between the intensity of the epidemics and excess mortality, assessing the heterogeneity of this relationship across the 91 districts after adjusting for relevant confounders. RESULTS The epidemic intensity was quantified as the COVID-19 hospitalisations per 1000 inhabitants. Five confounders were identified through a directed acyclic graph: age distribution, population density, pro-capita gross domestic product, restriction policy and population mobility.Analyses were based on a negative binomial regression model with district-specific random effects. We found a strong, positive association between COVID-19 hospitalisations and 2020 excess mortality (p<0.001), estimating that an increase of one hospitalised COVID-19 patient per 1000 inhabitants resulted in a 15.5% increase in excess mortality. After adjusting for confounders, no district differed in terms of COVID-19-unrelated excess mortality from the average district. Minimal heterogeneity emerged in the district-specific relationships between COVID-19 hospitalisations and excess mortality (6 confidence intervals out of 91 did not cover the null value). CONCLUSIONS The homogeneous effect of the COVID-19 spread on the excess mortality in the Lombardy districts suggests that, despite the unprecedented conditions, the pandemic reactions did not result in health disparities in the region.
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Affiliation(s)
- Marco Paganuzzi
- University of Milan, Milan, Italy
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (BG), Italy
| | - Giovanni Nattino
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (BG), Italy
| | - Giulia Irene Ghilardi
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (BG), Italy
| | - Giorgio Costantino
- University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlotta Rossi
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (BG), Italy
| | | | | | | | | | - Antonietta Mira
- Università della Svizzera italiana, Lugano, Switzerland
- University of Insubria, Varese, Italy
| | - Guido Bertolini
- Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (BG), Italy
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Cattaneo C, Tambuzzi S, De Vecchi S, Maggioni L, Costantino G. Consequences of the lack of clinical forensic medicine in emergency departments. Int J Legal Med 2024; 138:139-150. [PMID: 36806756 PMCID: PMC10772006 DOI: 10.1007/s00414-023-02973-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 02/08/2023] [Indexed: 02/23/2023]
Abstract
Most victims of physical violence sooner or later will access a hospital or medical cabinet because of that violence, and in particular emergency departments (EDs). This paper aims to analyze the performance of emergency ward clinicians in the forensic management of such victims by examining the activities carried out and the data reported. A total of 991 medical records were extrapolated from the database of the ED of the Policlinico of Milan in an average pre-pandemic 1-year activity. For each medical record, 16 parameters were analyzed in-depth including epidemiological data, information on the type of violent actions, injuries, and time between the infliction of the lesion and access to the ED. In the vast majority of cases, all the actions with medicolegal implications had been neglected by health professionals causing loss of data not only for the justice system but especially for correctly interpreting what happened and taking appropriate measures to protect the patient/victim. Hence, given that clinicians in EDs are busy with non-forensic clinical tasks (and rightly so), it should be ensured that there be specific forensic clinical personnel. However, it is crucial that when unfortunately there can be no forensic staff, at least the clinicians who work in the ED are properly trained to correctly apply essential medicolegal measures. Overall, timely and informed medical and forensic intervention is possible and necessary for the improvement and maintenance of the mental and physical health of victims of violence.
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Affiliation(s)
- Cristina Cattaneo
- Istituto di Medicina Legale, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, via Luigi Mangiagalli, 37, 20133, Milan, Italy
| | - Stefano Tambuzzi
- Istituto di Medicina Legale, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, via Luigi Mangiagalli, 37, 20133, Milan, Italy.
| | - Stefano De Vecchi
- Istituto di Medicina Legale, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, via Luigi Mangiagalli, 37, 20133, Milan, Italy
| | - Lidia Maggioni
- Istituto di Medicina Legale, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, via Luigi Mangiagalli, 37, 20133, Milan, Italy
| | - Giorgio Costantino
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Ramponi G, Gianni F, Karlafti E, Piazza I, Albertoni F, Colombo G, Casazza G, Garegnani A, Casella R, Costantino G. The diagnostic accuracy of carbon monoxide pulse oximetry in adults with suspected acute carbon monoxide poisoning: a systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1250845. [PMID: 38223786 PMCID: PMC10786445 DOI: 10.3389/fmed.2023.1250845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/09/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction Acute carbon monoxide poisoning (COP) is one of the leading causes of intoxication among patients presenting to the emergency department (ED). COP symptoms are not always specific and may vary from mild to critical. In the last few years, COHb pulse oximeters have been developed and applied to the setting of suspected COP. The aim of this systematic review is to assess the diagnostic accuracy of CO pulse oximetry (SpCO) with carboxyhemoglobin (COHb) levels measured by blood gas analysis, used as a reference standard, in patients with suspected COP. Methods We developed our search strategy according to the PICOS framework, population, index/intervention, comparison, outcome, and study, considering the diagnostic accuracy of SpCO compared to COHb levels measured by blood gas analysis, used as a reference standard, in patients with suspected COP enrolled in cross-sectional studies in English. The search was performed on MEDLINE/PubMed and EMBASE in February 2022. Quality assessment was performed using the QUADAS-2 methodology. A COHb cutoff of 10% was chosen to test the sensitivity and specificity of the index test. A bivariate model was used to perform the meta-analysis. The protocol was registered on PROSPERO (CRD42022359144). Results A total of six studies (1734 patients) were included. The pooled sensitivity of the test was 0.65 (95% CI 0.44-0.81), and the pooled specificity was 0.93 (95% CI 0.83-0.98). The pooled LR+ was 9.4 (95% CI 4.4 to 20.1), and the pooled LR- was 0.38 (95% CI 0.24 to 0.62). Conclusion Our results show that SpCO cannot be used as a screening tool for COP in the ED due to its low sensitivity. Because of its high LR+, it would be interesting to evaluate, if SpCO could have a role in the prehospital setting as a tool to quickly identify COP patients and prioritize their transport to specialized hospitals on larger samples with a prospective design.
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Affiliation(s)
- Giacomo Ramponi
- Dipartimento di Scienze Cliniche e Comunità, Università degli Studi di Milano, Milan, Italy
| | - Francesca Gianni
- Dipartimento di Scienze Cliniche e Comunità, Università degli Studi di Milano, Milan, Italy
- Pronto Soccorso, Dipartimento di Emergenza Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eleni Karlafti
- Emergency Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Isabelle Piazza
- Dipartimento di Scienze Cliniche e Comunità, Università degli Studi di Milano, Milan, Italy
- Pronto Soccorso, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Giorgio Colombo
- Pronto Soccorso, Dipartimento di Emergenza Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Cliniche e Comunità, Università degli Studi di Milano, Milan, Italy
- Pronto Soccorso, Dipartimento di Emergenza Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Garegnani
- Pronto Soccorso, Dipartimento di Emergenza Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosa Casella
- Pronto Soccorso, Dipartimento di Emergenza Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Costantino
- Dipartimento di Scienze Cliniche e Comunità, Università degli Studi di Milano, Milan, Italy
- Pronto Soccorso, Dipartimento di Emergenza Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Dipaola F, Gatti M, Menè R, Shiffer D, Giaj Levra A, Solbiati M, Villa P, Costantino G, Furlan R. A Hybrid Model for 30-Day Syncope Prognosis Prediction in the Emergency Department. J Pers Med 2023; 14:4. [PMID: 38276219 PMCID: PMC10817569 DOI: 10.3390/jpm14010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 10/25/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
Syncope is a challenging problem in the emergency department (ED) as the available risk prediction tools have suboptimal predictive performances. Predictive models based on machine learning (ML) are promising tools whose application in the context of syncope remains underexplored. The aim of the present study was to develop and compare the performance of ML-based models in predicting the risk of clinically significant outcomes in patients presenting to the ED for syncope. We enrolled 266 consecutive patients (age 73, IQR 58-83; 52% males) admitted for syncope at three tertiary centers. We collected demographic and clinical information as well as the occurrence of clinically significant outcomes at a 30-day telephone follow-up. We implemented an XGBoost model based on the best-performing candidate predictors. Subsequently, we integrated the XGboost predictors with knowledge-based rules. The obtained hybrid model outperformed the XGboost model (AUC = 0.81 vs. 0.73, p < 0.001) with acceptable calibration. In conclusion, we developed an ML-based model characterized by a commendable capability to predict adverse events within 30 days post-syncope evaluation in the ED. This model relies solely on clinical data routinely collected during a patient's initial syncope evaluation, thus obviating the need for laboratory tests or syncope experienced clinical judgment.
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Affiliation(s)
- Franca Dipaola
- Internal Medicine, Syncope Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy;
| | | | - Roberto Menè
- Department of Medicine and Surgery, University of Milano-Bicocca, 20100 Milan, Italy;
| | - Dana Shiffer
- Emergency Department, IRCCS Humanitas Research Hospital, 20089 Milan, Italy;
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | | | - Monica Solbiati
- Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università Degli Studi Di Milano, 20100 Milan, Italy; (M.S.); (G.C.)
| | - Paolo Villa
- Emergency Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20100 Milan, Italy;
| | - Giorgio Costantino
- Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università Degli Studi Di Milano, 20100 Milan, Italy; (M.S.); (G.C.)
| | - Raffaello Furlan
- Internal Medicine, Syncope Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy;
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
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Nattino G, Paganuzzi MM, Ghilardi GI, Costantino G, Rossi C, Cortellaro F, Cosentini R, Paglia S, Migliori M, Bertolini G. Strategies to convert hospital beds for COVID-19 patients to minimize emergency department overcrowding. Health Serv Manage Res 2023:9514848231218648. [PMID: 38059353 DOI: 10.1177/09514848231218648] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 12/08/2023]
Abstract
Background: The shortage of hospital beds for COVID-19 patients has been one critical cause of Emergency Department (ED) overcrowding. Purpose: We aimed at elaborating a strategy of conversion of hospital beds, from non-COVID-19 to COVID-19 care, minimizing both ED overcrowding and the number of beds eventually converted. Research Design: Observational retrospective study. Study Sample: We considered the centralized database of all ED admissions in the Lombardy region of Italy during the second "COVID-19 wave" (October to December 2020). Data collection and Analysis: We analyzed all admissions to 82 EDs. We devised a family of Monte Carlo simulations to evaluate the performance of hospital beds' conversion strategies triggered by ED crowding of COVID-19 patients, determining a critical number of beds to be converted when passing an ED-specific crowding threshold. Results: Our results suggest that the maximum number of patients waiting for hospitalization could have been decreased by 70% with the proposed strategy. Such a reduction would have been achieved by converting 30% more hospital beds than the total number converted in the region. Conclusions: The disproportion between reduction in ED crowding and additionally converted beds suggests that a wide margin to improve the efficiency of the conversions exists. The proposed simulation apparatus can be easily generalized to study management policies synchronizing ED output and in-hospital bed availability.
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Affiliation(s)
- Giovanni Nattino
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (BG), Italy
| | | | | | - Giorgio Costantino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
- Università degli Studi di Milano, Milano, Italy
| | - Carlotta Rossi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (BG), Italy
| | | | | | | | | | - Guido Bertolini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica (BG), Italy
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8
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Canuti M, Monti MC, Bobbio C, Muscatello A, Muheberimana T, Baldi SL, Blasi F, Canetta C, Costantino G, Nobili A, Peyvandi F, Tettamanti M, Villa S, Aliberti S, Raviglione MC, Gori A, Bandera A. The role of immune suppression in COVID-19 hospitalization: clinical and epidemiological trends over three years of SARS-CoV-2 epidemic. Front Med (Lausanne) 2023; 10:1260950. [PMID: 37746083 PMCID: PMC10513414 DOI: 10.3389/fmed.2023.1260950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
Specific immune suppression types have been associated with a greater risk of severe COVID-19 disease and death. We analyzed data from patients >17 years that were hospitalized for COVID-19 at the "Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico" in Milan (Lombardy, Northern Italy). The study included 1727 SARS-CoV-2-positive patients (1,131 males, median age of 65 years) hospitalized between February 2020 and November 2022. Of these, 321 (18.6%, CI: 16.8-20.4%) had at least one condition defining immune suppression. Immune suppressed subjects were more likely to have other co-morbidities (80.4% vs. 69.8%, p < 0.001) and be vaccinated (37% vs. 12.7%, p < 0.001). We evaluated the contribution of immune suppression to hospitalization during the various stages of the epidemic and investigated whether immune suppression contributed to severe outcomes and death, also considering the vaccination status of the patients. The proportion of immune suppressed patients among all hospitalizations (initially stable at <20%) started to increase around December 2021, and remained high (30-50%). This change coincided with an increase in the proportions of older patients and patients with co-morbidities and with a decrease in the proportion of patients with severe outcomes. Vaccinated patients showed a lower proportion of severe outcomes; among non-vaccinated patients, severe outcomes were more common in immune suppressed individuals. Immune suppression was a significant predictor of severe outcomes, after adjusting for age, sex, co-morbidities, period of hospitalization, and vaccination status (OR: 1.64; 95% CI: 1.23-2.19), while vaccination was a protective factor (OR: 0.31; 95% IC: 0.20-0.47). However, after November 2021, differences in disease outcomes between vaccinated and non-vaccinated groups (for both immune suppressed and immune competent subjects) disappeared. Since December 2021, the spread of the less virulent Omicron variant and an overall higher level of induced and/or natural immunity likely contributed to the observed shift in hospitalized patient characteristics. Nonetheless, vaccination against SARS-CoV-2, likely in combination with naturally acquired immunity, effectively reduced severe outcomes in both immune competent (73.9% vs. 48.2%, p < 0.001) and immune suppressed (66.4% vs. 35.2%, p < 0.001) patients, confirming previous observations about the value of the vaccine in preventing serious disease.
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Affiliation(s)
- Marta Canuti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), Università degli Studi di Milano, Milan, Italy
- Coordinate Research Centre EpiSoMI (Epidemiology and Molecular Surveillance of Infections), Università degli Studi di Milano, Milan, Italy
| | - Maria Cristina Monti
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, Università degli Studi di Pavia, Pavia, Italy
| | - Chiara Bobbio
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Antonio Muscatello
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | | | - Sante Leandro Baldi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), Università degli Studi di Milano, Milan, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Ciro Canetta
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Giorgio Costantino
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Alessandro Nobili
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Mauro Tettamanti
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Simone Villa
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), Università degli Studi di Milano, Milan, Italy
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy
| | - Mario C. Raviglione
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), Università degli Studi di Milano, Milan, Italy
| | - Andrea Gori
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Alessandra Bandera
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
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9
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Dipaola F, Gatti M, Giaj Levra A, Menè R, Shiffer D, Faccincani R, Raouf Z, Secchi A, Rovere Querini P, Voza A, Badalamenti S, Solbiati M, Costantino G, Savevski V, Furlan R. Multimodal deep learning for COVID-19 prognosis prediction in the emergency department: a bi-centric study. Sci Rep 2023; 13:10868. [PMID: 37407595 DOI: 10.1038/s41598-023-37512-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 06/22/2023] [Indexed: 07/07/2023] Open
Abstract
Predicting clinical deterioration in COVID-19 patients remains a challenging task in the Emergency Department (ED). To address this aim, we developed an artificial neural network using textual (e.g. patient history) and tabular (e.g. laboratory values) data from ED electronic medical reports. The predicted outcomes were 30-day mortality and ICU admission. We included consecutive patients from Humanitas Research Hospital and San Raffaele Hospital in the Milan area between February 20 and May 5, 2020. We included 1296 COVID-19 patients. Textual predictors consisted of patient history, physical exam, and radiological reports. Tabular predictors included age, creatinine, C-reactive protein, hemoglobin, and platelet count. TensorFlow tabular-textual model performance indices were compared to those of models implementing only tabular data. For 30-day mortality, the combined model yielded slightly better performances than the tabular fastai and XGBoost models, with AUC 0.87 ± 0.02, F1 score 0.62 ± 0.10 and an MCC 0.52 ± 0.04 (p < 0.32). As for ICU admission, the combined model MCC was superior (p < 0.024) to the tabular models. Our results suggest that a combined textual and tabular model can effectively predict COVID-19 prognosis which may assist ED physicians in their decision-making process.
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Affiliation(s)
- Franca Dipaola
- Internal Medicine, Humanitas Clinical and Research Center, IRCCS, Humanitas Research Hospital, Humanitas University, Via A. Manzoni, 56, 20089, Rozzano, Milan, Italy
| | | | - Alessandro Giaj Levra
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Rozzano, Milan, Italy
| | - Roberto Menè
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
| | - Dana Shiffer
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Italy
| | - Roberto Faccincani
- Emergency Department, Humanitas Mater Domini, Castellanza, Varese, Italy
| | - Zainab Raouf
- IRCCS-Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy
| | - Antonio Secchi
- IRCCS-Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy
| | | | - Antonio Voza
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Italy
- Emergency Department, IRCCS - Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, Italy
| | - Salvatore Badalamenti
- Internal Medicine, Humanitas Clinical and Research Center, IRCCS, Humanitas Research Hospital, Humanitas University, Via A. Manzoni, 56, 20089, Rozzano, Milan, Italy
| | - Monica Solbiati
- Emergency Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore, Milan, Italy
| | - Giorgio Costantino
- Emergency Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore, Milan, Italy
| | - Victor Savevski
- AI Center, IRCCS - Humanitas Research Hospital, Via Manzoni 56, Rozzano, Italy
| | - Raffaello Furlan
- Internal Medicine, Humanitas Clinical and Research Center, IRCCS, Humanitas Research Hospital, Humanitas University, Via A. Manzoni, 56, 20089, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Italy.
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10
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Porzio M, Maggio CD, Costantino G. Can lung ultrasound replace CT scan in a 6-month follow-up of severe COVID-19 pneumonia? A brief commentary. Intern Emerg Med 2023; 18:977-978. [PMID: 37004666 PMCID: PMC10066992 DOI: 10.1007/s11739-023-03210-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/18/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Marianna Porzio
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Giorgio Costantino
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
- Dipartimento Di Scienze Cliniche E Di Comunità, Università Degli Studi Di Milano, Via San Barnaba 8, 20122, Milan, Italy.
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11
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Furlan L, Di Francesco P, Tobaldini E, Solbiati M, Colombo G, Casazza G, Costantino G, Montano N. The environmental cost of unwarranted variation in the use of magnetic resonance imaging and computed tomography scans. Eur J Intern Med 2023; 111:47-53. [PMID: 36759306 DOI: 10.1016/j.ejim.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Pollution is a major threat to global health, and there is growing interest on strategies to reduce emissions caused by health care systems. Unwarranted clinical variation, i.e. variation in the utilization of health services unexplained by differences in patient illness or preferences, may be an avoidable source of CO2 when related to overuse. Our objective was to evaluate the CO2 emissions attributable to unwarranted variation in the use of MRI and CT scans among countries of the G20-area. METHODS We selected seven countries of the G20-area with available data on the use of CT and MRI scans from the organization for Economic Co-operation and Development repository. Each nation's annual electric energy expenditure per 1000 inhabitants for such exams (T-Enex-1000) was calculated and compared with the median and lowest value. Based on such differences we estimated the national energy and corresponding tons of CO2 that could be potentially avoided each year. RESULTS With available data we found a significant variation in T-Enex-1000 (median value 1782 kWh, range 1200-3079 kWh) and estimated a significant amount of potentially avoidable emissions each year (range 2046-175120 tons of CO2). In practical terms such emissions would need, in the case of Germany, 71900 and 104210 acres of forest to be cleared from the atmosphere, which is 1.2 and 1.7 times the size of the largest German forest (Bavarian National Forest). CONCLUSION Among countries with a similar rate of development, unwarranted clinical variation in the use of MRI and CT scan causes significant emissions of CO2.
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Affiliation(s)
- Ludovico Furlan
- Department of Internal Medicine, General Medicine Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Pietro Di Francesco
- Department of Internal Medicine, General Medicine Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Eleonora Tobaldini
- Department of Internal Medicine, General Medicine Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Monica Solbiati
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Department of Anaesthesia and Intensive Care Unit, Emergency Department and Emergency Medicine Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Colombo
- Department of Anaesthesia and Intensive Care Unit, Emergency Department and Emergency Medicine Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Casazza
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giorgio Costantino
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Department of Anaesthesia and Intensive Care Unit, Emergency Department and Emergency Medicine Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Montano
- Department of Internal Medicine, General Medicine Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
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12
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Minozzi S, Gonzalez-Lorenzo M, Cinquini M, Berardinelli D, Cagnazzo C, Ciardullo S, De Nardi P, Gammone M, Iovino P, Lando A, Rissone M, Simeone G, Stracuzzi M, Venezia G, Moja L, Costantino G. Adherence of systematic reviews to Cochrane RoB2 guidance was frequently poor: a meta epidemiological study. J Clin Epidemiol 2022; 152:47-55. [PMID: 36156301 DOI: 10.1016/j.jclinepi.2022.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 03/22/2022] [Revised: 08/23/2022] [Accepted: 09/06/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To assess whether the use of the revised Cochrane risk of bias tool for randomized trials (RoB2) in systematic reviews (SRs) adheres to RoB2 guidance. METHODS We searched MEDLINE, Embase, Cochrane Library from 2019 to May 2021 to identify SRs using RoB2. We analyzed methods and results sections to see whether risk of bias was assessed at outcome measure level and applied to primary outcomes of the SR as per RoB2 guidance. The relation between SR characteristics and adequacy of RoB2 use was examined by logistic regression analysis. RESULTS Two hundred-eight SRs were included. We could assess adherence in 137 SRs as 12 declared using RoB2 but actually used RoB1 and 59 did not report the number of primary outcomes. The tool usage was adherent in 69.3% SRs. Considering SRs with multiple primary outcomes, adherence dropped to 28.8%. We found a positive association between RoB2 guidance adherence and the methodological quality of the reviews assessed by AMSTAR2 (p-for-trend 0.007). Multivariable regression analysis suggested journal impact factor [first quartile vs. other quartiles] was associated with RoB2 adherence (OR 0.34; 95% CI: 0.16-0.72). CONCLUSIONS Many SRs did not adhere to RoB2 guidance as they applied the tool at the study level rather than at the outcome measure level. Lack of adherence was more likely among low and very low quality reviews.
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Affiliation(s)
- Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Marien Gonzalez-Lorenzo
- Laboratorio di Metodologia delle revisioni sistematiche e produzione di Linee Guida, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - Michela Cinquini
- Laboratorio di Metodologia delle revisioni sistematiche e produzione di Linee Guida, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Daniela Berardinelli
- Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Turin, Italy
| | - Celeste Cagnazzo
- Department of Sciences of Public Health and Pediatrics, University of Turin, Turin, Italy; Division of Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Stefano Ciardullo
- Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy; Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Paola De Nardi
- Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Paolo Iovino
- Department of Biomedicine and Prevention University of Rome Tor Vergata, Rome, Italy; School of Nursing, Midwifery and Paramedicine Faculty of Health Science, Australian Catholic University, Melbourne, Australia
| | - Alex Lando
- Laboratory of Rehabilitation Technologies, IRCCS San Camillo Hospital, Venice, Italy
| | - Marco Rissone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Giovanni Simeone
- Local Health Unit of Brindisi, Pediatric Department, Brindisi, Italy
| | - Marta Stracuzzi
- Pediatric Infectious Disease Unit, Department of Pediatrics, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | | | - Lorenzo Moja
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Giorgio Costantino
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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13
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Callisto E, Costantino G, Tabner A, Kerslake D, Reed MJ. The clinical effectiveness of the STUMBL score for the management of ED patients with blunt chest trauma compared to clinical evaluation alone. Intern Emerg Med 2022; 17:1785-1793. [PMID: 35739456 PMCID: PMC9463325 DOI: 10.1007/s11739-022-03001-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/06/2022] [Indexed: 11/25/2022]
Abstract
The STUMBL (STUdy of the Management of BLunt chest wall trauma) score is a new prognostic score to assist ED (Emergency Department) decision making in the management of blunt chest trauma. This is a retrospective cohort chart review study conducted in a UK University Hospital ED seeing 120,000 patients a year, comparing its performance characteristics to ED clinician judgement. All blunt chest trauma patients that presented to our ED over a 6-month period were included. Patients were excluded if age < 18, if they had immediate life-threatening injury, required critical care admission for other injuries or in case of missing identification data. Primary endpoint was complication defined as any of lower respiratory tract infection, pulmonary consolidation, empyema, pneumothorax, haemothorax, splenic or hepatic injury and 30-day mortality. Clinician judgement (clinician decision to admit) and STUMBL score were compared using the receiver-operating curve (ROC) and sensitivity analysis. Three hundred and sixty-nine patients were included. ED clinicians admitted 95 of 369 patients. ED clinician decision to admit had a sensitivity of 83.9% and specificity of 86.0% for predicting complications. STUMBL score ≥ 11 had a sensitivity of 79.0% and specificity of 77.9% for the same and would have led to 117 of 369 patients being admitted. Area under the curve (AUC) of STUMBL score and ED clinician decision to admit was 0.84 (95% CI 0.78-0.90) and 0.85 (95% CI 0.79-0.91), respectively. Our findings show that a STUMBL score ≥ 11 performs no better than ED clinician judgement and leads to more patients being admitted to hospital.
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Affiliation(s)
- Elena Callisto
- Emergency Medicine Research Group, Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.
- Pronto Soccorso, ASST Lodi, Largo Donatori del Sangue 1, 26900, Lodi, Italy.
| | - Giorgio Costantino
- Pronto Soccorso e Medicina D'Urgenza, Fondazione IRRCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Via Francesco Sforza, 28, 20122, Milan, Italy
- Università degli Studi di Milano, Facoltà di Medicina e Chirurgia, Via Festa del Perdono, 7, 20122, Milan, Italy
| | - Andrew Tabner
- REMEDY (Research Emergency Medicine Derby), University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Dean Kerslake
- Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
| | - Matthew J Reed
- Emergency Medicine Research Group, Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
- Department of Emergency Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK
- Acute Care Edinburgh (ACE), Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Nine Edinburgh BioQuarter, 9 Little France Road, Edinburgh, EH16 4UX, UK
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14
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Degenhardt F, Ellinghaus D, Juzenas S, Lerga-Jaso J, Wendorff M, Maya-Miles D, Uellendahl-Werth F, ElAbd H, Rühlemann MC, Arora J, Özer O, Lenning OB, Myhre R, Vadla MS, Wacker EM, Wienbrandt L, Blandino Ortiz A, de Salazar A, Garrido Chercoles A, Palom A, Ruiz A, Garcia-Fernandez AE, Blanco-Grau A, Mantovani A, Zanella A, Holten AR, Mayer A, Bandera A, Cherubini A, Protti A, Aghemo A, Gerussi A, Ramirez A, Braun A, Nebel A, Barreira A, Lleo A, Teles A, Kildal AB, Biondi A, Caballero-Garralda A, Ganna A, Gori A, Glück A, Lind A, Tanck A, Hinney A, Carreras Nolla A, Fracanzani AL, Peschuck A, Cavallero A, Dyrhol-Riise AM, Ruello A, Julià A, Muscatello A, Pesenti A, Voza A, Rando-Segura A, Solier A, Schmidt A, Cortes B, Mateos B, Nafria-Jimenez B, Schaefer B, Jensen B, Bellinghausen C, Maj C, Ferrando C, de la Horra C, Quereda C, Skurk C, Thibeault C, Scollo C, Herr C, Spinner CD, Gassner C, Lange C, Hu C, Paccapelo C, Lehmann C, Angelini C, Cappadona C, Azuure C, Bianco C, Cea C, Sancho C, Hoff DAL, Galimberti D, Prati D, Haschka D, Jiménez D, Pestaña D, Toapanta D, Muñiz-Diaz E, Azzolini E, Sandoval E, Binatti E, Scarpini E, Helbig ET, Casalone E, Urrechaga E, Paraboschi EM, Pontali E, Reverter E, Calderón EJ, Navas E, Solligård E, Contro E, Arana-Arri E, Aziz F, Garcia F, García Sánchez F, Ceriotti F, Martinelli-Boneschi F, Peyvandi F, Kurth F, Blasi F, Malvestiti F, Medrano FJ, Mesonero F, Rodriguez-Frias F, Hanses F, Müller F, Hemmrich-Stanisak G, Bellani G, Grasselli G, Pezzoli G, Costantino G, Albano G, Cardamone G, Bellelli G, Citerio G, Foti G, Lamorte G, Matullo G, Baselli G, Kurihara H, Neb H, My I, Kurth I, Hernández I, Pink I, de Rojas I, Galván-Femenia I, Holter JC, Afset JE, Heyckendorf J, Kässens J, Damås JK, Rybniker J, Altmüller J, Ampuero J, Martín J, Erdmann J, Banales JM, Badia JR, Dopazo J, Schneider J, Bergan J, Barretina J, Walter J, Hernández Quero J, Goikoetxea J, Delgado J, Guerrero JM, Fazaal J, Kraft J, Schröder J, Risnes K, Banasik K, Müller KE, Gaede KI, Garcia-Etxebarria K, Tonby K, Heggelund L, Izquierdo-Sanchez L, Bettini LR, Sumoy L, Sander LE, Lippert LJ, Terranova L, Nkambule L, Knopp L, Gustad LT, Garbarino L, Santoro L, Téllez L, Roade L, Ostadreza M, Intxausti M, Kogevinas M, Riveiro-Barciela M, Berger MM, Schaefer M, Niemi MEK, Gutiérrez-Stampa MA, Carrabba M, Figuera Basso ME, Valsecchi MG, Hernandez-Tejero M, Vehreschild MJGT, Manunta M, Acosta-Herrera M, D'Angiò M, Baldini M, Cazzaniga M, Grimsrud MM, Cornberg M, Nöthen MM, Marquié M, Castoldi M, Cordioli M, Cecconi M, D'Amato M, Augustin M, Tomasi M, Boada M, Dreher M, Seilmaier MJ, Joannidis M, Wittig M, Mazzocco M, Ciccarelli M, Rodríguez-Gandía M, Bocciolone M, Miozzo M, Imaz Ayo N, Blay N, Chueca N, Montano N, Braun N, Ludwig N, Marx N, Martínez N, Cornely OA, Witzke O, Palmieri O, Faverio P, Preatoni P, Bonfanti P, Omodei P, Tentorio P, Castro P, Rodrigues PM, España PP, Hoffmann P, Rosenstiel P, Schommers P, Suwalski P, de Pablo R, Ferrer R, Bals R, Gualtierotti R, Gallego-Durán R, Nieto R, Carpani R, Morilla R, Badalamenti S, Haider S, Ciesek S, May S, Bombace S, Marsal S, Pigazzini S, Klein S, Pelusi S, Wilfling S, Bosari S, Volland S, Brunak S, Raychaudhuri S, Schreiber S, Heilmann-Heimbach S, Aliberti S, Ripke S, Dudman S, Wesse T, Zheng T, Bahmer T, Eggermann T, Illig T, Brenner T, Pumarola T, Feldt T, Folseraas T, Gonzalez Cejudo T, Landmesser U, Protzer U, Hehr U, Rimoldi V, Monzani V, Skogen V, Keitel V, Kopfnagel V, Friaza V, Andrade V, Moreno V, Albrecht W, Peter W, Poller W, Farre X, Yi X, Wang X, Khodamoradi Y, Karadeniz Z, Latiano A, Goerg S, Bacher P, Koehler P, Tran F, Zoller H, Schulte EC, Heidecker B, Ludwig KU, Fernández J, Romero-Gómez M, Albillos A, Invernizzi P, Buti M, Duga S, Bujanda L, Hov JR, Lenz TL, Asselta R, de Cid R, Valenti L, Karlsen TH, Cáceres M, Franke A. Detailed stratified GWAS analysis for severe COVID-19 in four European populations. Hum Mol Genet 2022; 31:3945-3966. [PMID: 35848942 PMCID: PMC9703941 DOI: 10.1093/hmg/ddac158] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/11/2022] [Accepted: 07/26/2022] [Indexed: 12/11/2022] Open
Abstract
Given the highly variable clinical phenotype of Coronavirus disease 2019 (COVID-19), a deeper analysis of the host genetic contribution to severe COVID-19 is important to improve our understanding of underlying disease mechanisms. Here, we describe an extended genome-wide association meta-analysis of a well-characterized cohort of 3255 COVID-19 patients with respiratory failure and 12 488 population controls from Italy, Spain, Norway and Germany/Austria, including stratified analyses based on age, sex and disease severity, as well as targeted analyses of chromosome Y haplotypes, the human leukocyte antigen region and the SARS-CoV-2 peptidome. By inversion imputation, we traced a reported association at 17q21.31 to a ~0.9-Mb inversion polymorphism that creates two highly differentiated haplotypes and characterized the potential effects of the inversion in detail. Our data, together with the 5th release of summary statistics from the COVID-19 Host Genetics Initiative including non-Caucasian individuals, also identified a new locus at 19q13.33, including NAPSA, a gene which is expressed primarily in alveolar cells responsible for gas exchange in the lung.
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Affiliation(s)
- Frauke Degenhardt
- To whom correspondence should be addressed. (Frauke Degenhardt) and (Andre Franke)
| | | | | | | | | | | | | | - Hesham ElAbd
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Malte C Rühlemann
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany,Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Jatin Arora
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA,Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA,Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA,Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA,Center for Data Sciences, Brigham and Women’s Hospital, Boston, MA, USA
| | - Onur Özer
- Research Group for Evolutionary Immunogenomics, Max Planck Institute for Evolutionary Biology, Plön, Germany,Research Unit for Evolutionary Immunogenomics, Department of Biology, University of Hamburg, Hamburg, Germany
| | - Ole Bernt Lenning
- Research Department, Stavanger University Hospital, Stavanger, Norway,Randaberg Municipality, Stavanger, Norway
| | - Ronny Myhre
- Division of Health Data and Digitalization, Department of Genetics and Bioinformatics (HDGB), Norwegian Institute of Public Health, Oslo, Norway
| | - May Sissel Vadla
- Randaberg Municipality, Stavanger, Norway,Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Eike M Wacker
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Lars Wienbrandt
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Aaron Blandino Ortiz
- Department of Intensive Care, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - Adolfo de Salazar
- Ibs.Granada Instituto de Investigación Biosanitaria, Granada, Spain,Microbiology Unit. Hospital Universitario Clinico San Cecilio, Granada, Spain
| | - Adolfo Garrido Chercoles
- Clinical Biochemistry Department, Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, San Sebastian, Spain
| | - Adriana Palom
- Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Barcelona, Spain,Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Agustín Ruiz
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain,CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III, Madrid, Spain
| | | | - Albert Blanco-Grau
- Department of Biochemistry, University Hospital Vall d’Hebron, Barcelona, Spain
| | - Alberto Mantovani
- IRCCS Humanitas Research Hospital, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alberto Zanella
- University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Aleksander Rygh Holten
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Alena Mayer
- Charite Universitätsmedizin Berlin, Berlin, Germany
| | - Alessandra Bandera
- University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Alessandro Protti
- IRCCS Humanitas Research Hospital, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alessio Aghemo
- IRCCS Humanitas Research Hospital, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alessio Gerussi
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy,Division of Gastroenterology, School of Medicine and Surgery, Center for Autoimmune Liver Diseases, University of Milano-Bicocca, Milan, Italy
| | - Alfredo Ramirez
- Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Medical Faculty, Bonn, Germany,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany,Department of Psychiatry, Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, San Antonio, TX, USA
| | - Alice Braun
- Charite Universitätsmedizin Berlin, Berlin, Germany
| | - Almut Nebel
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Ana Barreira
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ana Lleo
- IRCCS Humanitas Research Hospital, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Ana Teles
- Research Group for Evolutionary Immunogenomics, Max Planck Institute for Evolutionary Biology, Plön, Germany,Research Unit for Evolutionary Immunogenomics, Department of Biology, University of Hamburg, Hamburg, Germany
| | - Anders Benjamin Kildal
- Department of Anesthesiology and Intensive Care, University Hospital of North Norway, Tromsø, Norway
| | - Andrea Biondi
- Pediatric Departement, Centro Tettamanti-European Reference Network (ERN) PaedCan, EuroBloodNet, MetabERN-University of Milano-Bicocca-Fondazione MBBM/Ospedale, San Gerardo, Italy
| | | | - Andrea Ganna
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Andrea Gori
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy,Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
| | - Andreas Glück
- Klinik für Innere Medizin I, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Andreas Lind
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - Anja Tanck
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Anke Hinney
- Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anna Carreras Nolla
- Genomes for Life-GCAT Lab, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Anna Ludovica Fracanzani
- University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Peschuck
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | | | - Anne Ma Dyrhol-Riise
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Infectious diseases, Oslo University Hospital, Oslo, Norway
| | | | - Antonio Julià
- Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Barcelona, Spain
| | | | - Antonio Pesenti
- University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Voza
- IRCCS Humanitas Research Hospital, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Ariadna Rando-Segura
- Microbiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain,Universitat Autònoma de Barcelona, Bellatera, Spain
| | - Aurora Solier
- Department of Respiratory Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain,Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), University of Alcalá, Madrid, Spain
| | - Axel Schmidt
- Institute of Human Genetics, University of Bonn School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Beatriz Cortes
- Genomes for Life-GCAT Lab, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Beatriz Mateos
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - Beatriz Nafria-Jimenez
- Clinical Biochemistry Department, Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, San Sebastian, Spain
| | - Benedikt Schaefer
- Department of Medicine I, Gastroenterology, Hepatology and Endocrinology, Medical University of Innsbruck, Innsbruck, Austria,Christian Doppler Laboratory of Iron and Phosphate Biology at the Department of Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - Björn Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty Heinrich Heine University, Duesseldorf, Germany
| | - Carla Bellinghausen
- Department of Respiratory Medicine and Allergology, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Carlo Maj
- Institute of Genomic Statistics and Bioinformatics, University Hospital Bonn, Medical Faculty University of Bonn, Bonn, Germany
| | - Carlos Ferrando
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain,Hospital Clinic, University of Barcelona, and IDIBAPS, Barcelona, Spain
| | - Carmen de la Horra
- Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, Spain,Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain,University of Sevilla, Sevilla, Spain,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain,Consejo Superior de Investigaciones Científicas, Sevilla, Spain
| | - Carmen Quereda
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | | | | | - Chiara Scollo
- Department of Transfusion Medicine and Haematology Laboratory, San Gerardo Hospital, Monza, Italy
| | - Christian Herr
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital Saarland, Homburg, Germany
| | - Christoph D Spinner
- Department of Internal Medicine II, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christoph Gassner
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany,Institute of Translational Medicine, Private University in the Principality of Liechtenstein (UFL), Triesen, Liechtenstein
| | - Christoph Lange
- Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany,Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany,Clinical Tuberculosis Unit, German Center for Infection Research (DZIF), Borstel, Germany
| | - Cinzia Hu
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cinzia Paccapelo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Clara Lehmann
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany,German Center for Infection Research (DZIF), Cologne, Germany
| | | | - Claudio Cappadona
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Clinton Azuure
- Research Group for Evolutionary Immunogenomics, Max Planck Institute for Evolutionary Biology, Plön, Germany,Research Unit for Evolutionary Immunogenomics, Department of Biology, University of Hamburg, Hamburg, Germany
| | | | - Cristiana Bianco
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristina Cea
- Department of Biochemistry, University Hospital Vall d’Hebron, Barcelona, Spain
| | - Cristina Sancho
- Osakidetza Basque Health Service, Basurto University Hospital, Respiratory Service, Bilbao, Spain
| | - Dag Arne Lihaug Hoff
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway,Department of Medicine, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Daniela Galimberti
- University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Prati
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - David Haschka
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - David Jiménez
- Department of Respiratory Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain,Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), University of Alcalá, Madrid, Spain
| | - David Pestaña
- Department of Anesthesiology and Critical Care, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - David Toapanta
- Hospital Clinic, University of Barcelona, and IDIBAPS, Barcelona, Spain
| | - Eduardo Muñiz-Diaz
- Immunohematology Department, Banc de Sang i Teixits, Autonomous University of Barcelona, Barcelona, Spain
| | - Elena Azzolini
- IRCCS Humanitas Research Hospital, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Elena Sandoval
- Hospital Clinic, University of Barcelona, and IDIBAPS, Barcelona, Spain
| | - Eleonora Binatti
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy,Division of Gastroenterology, School of Medicine and Surgery, Center for Autoimmune Liver Diseases, University of Milano-Bicocca, Milan, Italy
| | - Elio Scarpini
- University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Elisabetta Casalone
- Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy
| | - Eloisa Urrechaga
- Osakidetza Basque Health Service, Galdakao Hospital, Respiratory Service, Galdakao, Spain,Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Elvezia Maria Paraboschi
- IRCCS Humanitas Research Hospital, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Emanuele Pontali
- Department of Infectious Diseases, E.O. Ospedali Galliera, Genova, Italy
| | - Enric Reverter
- Hospital Clinic, University of Barcelona, and IDIBAPS, Barcelona, Spain
| | - Enrique J Calderón
- Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, Spain,Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain,University of Sevilla, Sevilla, Spain,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain,Consejo Superior de Investigaciones Científicas, Sevilla, Spain
| | - Enrique Navas
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - Erik Solligård
- Geminicenter for Sepsis Research, Institute of Circulation and Medical Imaging (ISB), NTNU, Trondheim, Norway,Clinic of Anesthesia and Intensive Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ernesto Contro
- Accident and Emergency and Emergency Medicine Unit, San Gerardo Hospital, Monza, Italy
| | | | - Fátima Aziz
- Hospital Clinic, University of Barcelona, and IDIBAPS, Barcelona, Spain
| | - Federico Garcia
- Ibs.Granada Instituto de Investigación Biosanitaria, Granada, Spain,Microbiology Unit. Hospital Universitario Clinico San Cecilio, Granada, Spain,Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Félix García Sánchez
- Histocompatibilidad y Biologia Molecular, Centro de Transfusion de Madrid, Madrid, Spain
| | | | - Filippo Martinelli-Boneschi
- Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, Milan, Italy,Neurology Unit, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Florian Kurth
- Charite Universitätsmedizin Berlin, Berlin, Germany,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany,Department of Medicine I, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Francesco Blasi
- Respiratory Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | | | - Francisco J Medrano
- Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain,University of Sevilla, Sevilla, Spain,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain,Consejo Superior de Investigaciones Científicas, Sevilla, Spain,Internal Medicine Department, Virgen del Rocio University Hospital, Sevilla, Spain
| | - Francisco Mesonero
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - Francisco Rodriguez-Frias
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Barcelona, Spain,Department of Biochemistry, University Hospital Vall d’Hebron, Barcelona, Spain,Microbiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain,Universitat Autònoma de Barcelona, Bellatera, Spain,Biochemistry Department, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Frank Hanses
- Emergency Department, University Hospital Regensburg, Regensburg, Germany,Department for Infectious Diseases and Infection Control, University Hospital Regensburg, Regensburg, Germany
| | - Fredrik Müller
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | | | - Giacomo Bellani
- Department Emergency, Anesthesia and Intensive Care, San Gerardo Hospital, Monza, Italy,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giacomo Grasselli
- University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianni Pezzoli
- Fondazione Grigioni per il Morbo di Parkinson and Parkinson Institute, ASST Gaetano Pini-CTO, Milan, Italy
| | - Giorgio Costantino
- University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Giulia Cardamone
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Neurointensive Care Unit, San Gerardo Hospital, Monza, Italy
| | - Giuseppe Foti
- Department Emergency, Anesthesia and Intensive Care, San Gerardo Hospital, Monza, Italy,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giuseppe Lamorte
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Matullo
- Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy
| | - Guido Baselli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Holger Neb
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ilaria My
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Ingo Kurth
- Institute of Human Genetics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Isabel Hernández
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain,CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III, Madrid, Spain
| | - Isabell Pink
- Department of Pneumology, Hannover Medical School, Hannover, Germany
| | - Itziar de Rojas
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain,CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III, Madrid, Spain
| | - Iván Galván-Femenia
- Genomes for Life-GCAT Lab, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Jan Cato Holter
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - Jan Egil Afset
- Osakidetza Basque Health Service, Basurto University Hospital, Respiratory Service, Bilbao, Spain,Department of Medical Microbiology, Clinic of Laboratory Medicine, St. Olavs hospital, Trondheim, Norway
| | - Jan Heyckendorf
- Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany,Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany,Clinical Tuberculosis Unit, German Center for Infection Research (DZIF), Borstel, Germany
| | - Jan Kässens
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Jan Kristian Damås
- Department of Infectious Diseases, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway,Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway
| | - Jan Rybniker
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany,German Centre for Infection Research (DZIF), Cologne, Germany
| | - Janine Altmüller
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
| | - Javier Ampuero
- Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, Spain,Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain,University of Sevilla, Sevilla, Spain,Digestive Diseases Unit, Virgen del Rocio University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain
| | - Javier Martín
- Institute of Parasitology and Biomedicine Lopez-Neyra, CSIC, Granada, Spain
| | - Jeanette Erdmann
- Institute for Cardiogenetics, University of Lübeck, Lübeck, Germany,German Research Center for Cardiovascular Research, Lübeck, Germany,University Heart Center Lübeck, Lübeck, Germany
| | - Jesus M Banales
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute—Donostia University Hospital, University of the Basque Country (UPV/EHU), CIBERehd, Ikerbasque, San Sebastian, Spain,Ikerbasque, Basque Foundation for Science, Bilbao, Spain
| | - Joan Ramon Badia
- Respiratory ICU, Institut Clínic Respiratory, Hospital Clinic, University of Barcelona, and IDIBAPS, Barcelona, Spain
| | - Joaquin Dopazo
- Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain,Bioinformatics Area, Fundación Progreso y Salud, and Institute of Biomedicine of Sevilla (IBIS), Sevilla, Spain
| | - Jochen Schneider
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital Saarland, Homburg, Germany
| | - Jonas Bergan
- Department of Research, Ostfold Hospital Trust, Gralum, Norway
| | - Jordi Barretina
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Jörn Walter
- Department of Genetics & Epigenetics, Saarland University, Saarbrücken, Germany
| | - Jose Hernández Quero
- Ibs.Granada Instituto de Investigación Biosanitaria, Granada, Spain,Department of Infectious Diseases, Hospital Universitario Clinico San Cecilio, Granada, Spain
| | - Josune Goikoetxea
- Infectious Diseases Service, Osakidetza, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Juan Delgado
- Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, Spain,Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain,University of Sevilla, Sevilla, Spain,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain,Consejo Superior de Investigaciones Científicas, Sevilla, Spain
| | - Juan M Guerrero
- Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, Spain,Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain,University of Sevilla, Sevilla, Spain
| | - Julia Fazaal
- Institute of Human Genetics, University of Bonn School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Julia Kraft
- Charite Universitätsmedizin Berlin, Berlin, Germany
| | - Julia Schröder
- Institute of Human Genetics, University of Bonn School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Kari Risnes
- Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway,Department of Research, St. Olav Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Karina Banasik
- Novo Nordisk Foundation Center for Protein Research, Disease Systems Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Karl Erik Müller
- Medical Department, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Karoline I Gaede
- Research Center Borstel, BioMaterialBank Nord, Borstel, Germany,German Center for Lung Research (DZL), Airway Research Center North (ARCN), Borstel, Germany,Popgen 2.0 Network (P2N), Kiel, Germany
| | - Koldo Garcia-Etxebarria
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute—Donostia University Hospital, University of the Basque Country (UPV/EHU), CIBERehd, Ikerbasque, San Sebastian, Spain
| | - Kristian Tonby
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Infectious diseases, Oslo University Hospital, Oslo, Norway
| | - Lars Heggelund
- Medical Department, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Laura Izquierdo-Sanchez
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute—Donostia University Hospital, University of the Basque Country (UPV/EHU), CIBERehd, Ikerbasque, San Sebastian, Spain,Biodonostia Health Research Institute, Donostia University Hospital, San Sebastian, Spain
| | - Laura Rachele Bettini
- Pediatric Departement, Centro Tettamanti-European Reference Network (ERN) PaedCan, EuroBloodNet, MetabERN-University of Milano-Bicocca-Fondazione MBBM/Ospedale, San Gerardo, Italy
| | - Lauro Sumoy
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | | | | | | | - Lindokuhle Nkambule
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA,Stanley Center for Psychiatric Research & Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Lisa Knopp
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty Heinrich Heine University, Duesseldorf, Germany
| | - Lise Tuset Gustad
- Geminicenter for Sepsis Research, Institute of Circulation and Medical Imaging (ISB), NTNU, Trondheim, Norway,Clinic of Medicine and Rehabilitation, Levanger Hospital, Nord-Trondelag Hospital Trust, Levanger, Norway
| | | | - Luigi Santoro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luis Téllez
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - Luisa Roade
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain,Department of Respiratory Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | | | - Maider Intxausti
- Osakidetza Basque Health Service, Basurto University Hospital, Respiratory Service, Bilbao, Spain
| | - Manolis Kogevinas
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain,ISGlobal, Barcelona, Spain,Universitat Pompeu Fabra (UPF), Barcelona, Spain,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Mar Riveiro-Barciela
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain,Universitat Autònoma de Barcelona, Bellatera, Spain
| | - Marc M Berger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | | | - Mari E K Niemi
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - María A Gutiérrez-Stampa
- Osakidetza, OSI Donostialdea, Altza Primary Care, Biodonostia Health Research Institute, San Sebastián, Spain
| | - Maria Carrabba
- Internal Medicine Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria E Figuera Basso
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Maria Grazia Valsecchi
- Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | - Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt & Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Maria Manunta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Mariella D'Angiò
- Pediatric Departement, Centro Tettamanti-European Reference Network (ERN) PaedCan, EuroBloodNet, MetabERN-University of Milano-Bicocca-Fondazione MBBM/Ospedale, San Gerardo, Italy
| | - Marina Baldini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marina Cazzaniga
- Phase 1 Research Centre, ASST Monza, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Marit M Grimsrud
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Surgery, Inflammatory Diseases and Transplantation, Research Institute for Internal Medicine, Oslo University Hospital Rikshospitalet and University of Oslo, Oslo, Norway,Division of Surgery, Inflammatory Diseases and Transplantation, Department of Transplantation Medicine, Norwegian PSC Research Center, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Marta Marquié
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain,CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III, Madrid, Spain
| | | | - Mattia Cordioli
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Maurizio Cecconi
- IRCCS Humanitas Research Hospital, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Mauro D'Amato
- Ikerbasque, Basque Foundation for Science, Bilbao, Spain,Gastrointestinal Genetics Lab, CIC bioGUNE—BRTA, Derio, Spain,Department of Medicine and Surgery, LUM University, Casamassima, Italy
| | - Max Augustin
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany,German Center for Infection Research (DZIF), Cologne, Germany
| | - Melissa Tomasi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mercè Boada
- Research Center and Memory Clinic, Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain,CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III, Madrid, Spain
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
| | - Michael J Seilmaier
- Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Michael Wittig
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | | | | | - Miguel Rodríguez-Gandía
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | | | - Monica Miozzo
- University of Milan, Milan, Italy,Internal Medicine Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Natale Imaz Ayo
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Natalia Blay
- Genomes for Life-GCAT Lab, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Natalia Chueca
- Microbiology Unit. Hospital Universitario Clinico San Cecilio, Granada, Spain
| | - Nicola Montano
- University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicole Braun
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany,University Hospital Schleswig-Holstein, Kiel, Germany
| | - Nicole Ludwig
- Department of Human Genetics, Center of Human and Molecular Biology, University Hospital Saarland, Homburg/Saar, Germany
| | - Nikolaus Marx
- Department of Internal Medicine I, RWTH Aachen University Hospital, Aachen, Germany
| | - Nilda Martínez
- Department of Anesthesiology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | | | - Oliver A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,German Center for Infection Research (DZIF), Cologne, Germany,Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Orazio Palmieri
- Gastroenterology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Paola Faverio
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Pulmonary Unit, San Gerardo Hospital, Monza, Italy
| | | | - Paolo Bonfanti
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Infectious Diseases Unit, San Gerardo Hospital, Monza, Italy
| | - Paolo Omodei
- Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | | | - Pedro Castro
- Hospital Clinic, University of Barcelona, and IDIBAPS, Barcelona, Spain
| | - Pedro M Rodrigues
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute—Donostia University Hospital, University of the Basque Country (UPV/EHU), CIBERehd, Ikerbasque, San Sebastian, Spain,Ikerbasque, Basque Foundation for Science, Bilbao, Spain,Biodonostia Health Research Institute, Donostia University Hospital, San Sebastian, Spain
| | - Pedro Pablo España
- Osakidetza Basque Health Service, Galdakao Hospital, Respiratory Service, Galdakao, Spain
| | - Per Hoffmann
- Institute of Human Genetics, University of Bonn School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Philip Rosenstiel
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Philipp Schommers
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany,German Center for Infection Research (DZIF), Cologne, Germany
| | | | - Raúl de Pablo
- Department of Intensive Care, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - Ricard Ferrer
- Intensive Care Department, Vall d'Hebron University Hospital, SODIR-VHIR research group, Barcelona, Spain
| | - Robert Bals
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital Saarland, Homburg, Germany
| | - Roberta Gualtierotti
- University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rocío Gallego-Durán
- Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, Spain,Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain
| | - Rosa Nieto
- Department of Respiratory Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain,Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), University of Alcalá, Madrid, Spain
| | - Rossana Carpani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rubén Morilla
- Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, Spain,Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain,University of Sevilla, Sevilla, Spain,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain,Consejo Superior de Investigaciones Científicas, Sevilla, Spain
| | | | - Sammra Haider
- Department of Medicine, Møre & Romsdal Hospital Trust, Molde, Norway
| | - Sandra Ciesek
- Institute of Medical Virology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany,German Centre for Infection Research (DZIF), Frankfurt am Main, Germany
| | - Sandra May
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Sara Bombace
- IRCCS Humanitas Research Hospital, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Sara Marsal
- Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Barcelona, Spain
| | - Sara Pigazzini
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Sebastian Klein
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Serena Pelusi
- University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sibylle Wilfling
- Department for Infectious Diseases and Infection Control, University Hospital Regensburg, Regensburg, Germany,Zentrum für Humangenetik Regensburg, Regensburg, Germany,Department of Neurology, Bezirksklinikum Regensburg, University of Regensburg, Regensburg, Germany
| | - Silvano Bosari
- University of Milan, Milan, Italy,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sonja Volland
- Hannover Unified Biobank, Hannover Medical School, Hannover, Germany
| | - Søren Brunak
- Novo Nordisk Foundation Center for Protein Research, Disease Systems Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Soumya Raychaudhuri
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA,Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA,Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA,Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA,Center for Data Sciences, Brigham and Women’s Hospital, Boston, MA, USA,Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Stefan Schreiber
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany,Klinik für Innere Medizin I, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Stefanie Heilmann-Heimbach
- Institute of Human Genetics, University of Bonn School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Stefano Aliberti
- IRCCS Humanitas Research Hospital, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Susanne Dudman
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - Tanja Wesse
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Tenghao Zheng
- School of Biological Sciences, Monash University, Clayton, VIC, Australia
| | | | - Thomas Bahmer
- Klinik für Innere Medizin I, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Thomas Eggermann
- Institute of Human Genetics, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Thomas Illig
- Hannover Unified Biobank, Hannover Medical School, Hannover, Germany
| | - Thorsten Brenner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Tomas Pumarola
- Department of Microbiology, University Hospital Vall d’Hebron, Barcelona, Spain,Autonoma University of Barcelona, Barcelona, Spain
| | - Torsten Feldt
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty Heinrich Heine University, Duesseldorf, Germany
| | - Trine Folseraas
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Surgery, Inflammatory Diseases and Transplantation, Research Institute for Internal Medicine, Oslo University Hospital Rikshospitalet and University of Oslo, Oslo, Norway,Division of Surgery, Inflammatory Diseases and Transplantation, Department of Transplantation Medicine, Norwegian PSC Research Center, Oslo University Hospital Rikshospitalet, Oslo, Norway,Division for Cancer Medicine, Surgery and Transplantation, Section for Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | - Ulf Landmesser
- Berlin Institute of Health, Charite Universitätsmedizin Berlin, Berlin Germany
| | - Ulrike Protzer
- Institute of Virology, Technical University Munich/Helmholtz Zentrum München, Munich, Germany,German Center for Infection Research (DZIF), Munich, Germany
| | - Ute Hehr
- Zentrum für Humangenetik Regensburg, Regensburg, Germany
| | - Valeria Rimoldi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Valter Monzani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Vegard Skogen
- Department of Infectious Diseases, University Hospital of North Norway, Tromsø, Norway,Faculty of Health Sciences, UIT The Arctic University of Norway, Norway
| | - Verena Keitel
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty Heinrich Heine University, Duesseldorf, Germany
| | - Verena Kopfnagel
- Hannover Unified Biobank, Hannover Medical School, Hannover, Germany
| | - Vicente Friaza
- Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, Spain,Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain,University of Sevilla, Sevilla, Spain,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain,Consejo Superior de Investigaciones Científicas, Sevilla, Spain
| | - Victor Andrade
- Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Medical Faculty, Bonn, Germany
| | - Victor Moreno
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain,Catalan Institute of Oncology (ICO), Barcelona, Spain,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain,Universitat de Barcelona (UB), Barcelona, Spain
| | - Wolfgang Albrecht
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Wolfgang Peter
- Stefan-Morsch-Stiftung, Birkenfeld, Germany,Faculty of Medicine and University Hospital Cologne, Institute for Transfusion Medicine, University of Cologne, Cologne, Germany
| | | | - Xavier Farre
- Genomes for Life-GCAT Lab, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Xiaoli Yi
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany
| | - Xiaomin Wang
- Charite Universitätsmedizin Berlin, Berlin, Germany
| | - Yascha Khodamoradi
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt & Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - Anna Latiano
- Gastroenterology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Siegfried Goerg
- Institute of Transfusionsmedicine, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Petra Bacher
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany,Institute of Immunology, Christian-Albrechts-University of Kiel and UKSH Schleswig-Holstein, Kiel, Germany
| | - Philipp Koehler
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Florian Tran
- Institute of Clinical Molecular Biology, Christian-Albrechts-University, Kiel, Germany,Klinik für Innere Medizin I, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Heinz Zoller
- Department of Medicine I, Gastroenterology, Hepatology and Endocrinology, Medical University of Innsbruck, Innsbruck, Austria,Christian Doppler Laboratory of Iron and Phosphate Biology at the Department of Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - Eva C Schulte
- Institute of Virology, Technical University Munich/Helmholtz Zentrum München, Munich, Germany,Institute of Psychiatric Phenomics and Genomics, University Medical Center, University of Munich, Munich, Germany,Department of Psychiatry, University Medical Center, University of Munich, Munich, Germany
| | | | - Kerstin U Ludwig
- Institute of Human Genetics, University of Bonn School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Javier Fernández
- Hospital Clinic, University of Barcelona, and IDIBAPS, Barcelona, Spain,European Foundation for the Study of Chronic Liver Failure (EF-CLIF), Barcelona, Spain
| | - Manuel Romero-Gómez
- Hospital Universitario Virgen del Rocío de Sevilla, Sevilla, Spain,Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain,University of Sevilla, Sevilla, Spain,Digestive Diseases Unit, Virgen del Rocio University Hospital, Institute of Biomedicine of Seville, University of Seville, Seville, Spain
| | - Agustín Albillos
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - Pietro Invernizzi
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy,Division of Gastroenterology, School of Medicine and Surgery, Center for Autoimmune Liver Diseases, University of Milano-Bicocca, Milan, Italy
| | - Maria Buti
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain,Universitat Autònoma de Barcelona, Bellatera, Spain
| | - Stefano Duga
- IRCCS Humanitas Research Hospital, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Luis Bujanda
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III (ISCIII), Madrid, Spain,Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute—Donostia University Hospital, University of the Basque Country (UPV/EHU), CIBERehd, Ikerbasque, San Sebastian, Spain
| | | | | | | | | | | | | | | | - Andre Franke
- To whom correspondence should be addressed. (Frauke Degenhardt) and (Andre Franke)
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15
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Indirli R, Bandera A, Valenti L, Ceriotti F, Di Modugno A, Tettamanti M, Gualtierotti R, Peyvandi F, Montano N, Blasi F, Costantino G, Resi V, Orsi E, Arosio M, Mantovani G, Ferrante E. Prognostic value of copeptin and mid-regional proadrenomedullin in COVID-19-hospitalized patients. Eur J Clin Invest 2022; 52:e13753. [PMID: 35128648 PMCID: PMC9111431 DOI: 10.1111/eci.13753] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Biomarkers are used for diagnosis, risk stratification and medical decisions. Copeptin and mid-regional proadrenomedullin (MR-proADM) are markers of stress and endothelial function, respectively, which have been studied in pneumonia, sepsis and septic shock. This study aimed to assess whether copeptin and MR-proADM could predict coronavirus disease 2019 (COVID-19) in-hospital outcomes, that is multi-system complications, length of stay and mortality. METHODS Copeptin and MR-proADM were assessed at admission in 116 patients hospitalized with COVID-19. Data were retrospectively extracted from an online database. The primary endpoint was in-hospital mortality. The secondary endpoints were in-hospital complications, the composite outcome 'death, or admission to intensive care unit, or in-hospital complications', and length of stay. The predictive power was expressed as area under the receiver operator characteristic curve (AUROC). RESULTS Copeptin was increased in non-survivors (median 29.7 [interquartile range 13.0-106.2] pmol/L) compared to survivors (10.9 [5.9-25.3] pmol/L, p < 0.01). The AUROC for mortality was 0.71, with a hazard ratio of 3.67 (p < 0.01) for copeptin values > 25.3 pmol/L. MR-proADM differentiated survivors (0.8 [0.6-1.1] nmol/L) from non-survivors (1.5 [1.1-2.8] nmol/L, p < 0.001) and yielded a AUROC of 0.79 and a hazard ratio of 7.02 (p < 0.001) for MR-proADM values > 1.0 nmol/L. Copeptin and MR-proADM predicted sepsis (AUROC 0.95 and 0.96 respectively), acute kidney injury (0.87 and 0.90), the composite outcome (0.69 and 0.75) and length of stay (r = 0.42, p < 0.001, and r = 0.46, p < 0.001). CONCLUSIONS Admission MR-proADM and copeptin may be implemented for early risk stratification in COVID-19-hospitalized patients to help identify those eligible for closer monitoring and care intensification.
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Affiliation(s)
- Rita Indirli
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Valenti
- Transfusion Medicine (Biobank), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ferruccio Ceriotti
- Clinical Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Adriana Di Modugno
- Clinical Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mauro Tettamanti
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Roberta Gualtierotti
- Internal Medicine and Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Flora Peyvandi
- Internal Medicine and Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Montano
- Internal Medicine, Immunology and Allergology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Giorgio Costantino
- Emergency Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Veronica Resi
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuela Orsi
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maura Arosio
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giovanna Mantovani
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Emanuele Ferrante
- Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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16
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Affiliation(s)
- Ludovico Furlan
- Department of Internal Medicine, General Medicine Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Francesca Gianni
- Institute for Cancer Genetics, Columbia University, New York, NY, United States
| | - Giorgio Costantino
- Department of Anaesthesia-Intensive Care Unit, Emergency Department and Emergency Medicine Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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17
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Furlan L, Francesco PD, Costantino G, Montano N. Choosing Wisely in clinical practice: Embracing critical thinking, striving for safer care. J Intern Med 2022; 291:397-407. [PMID: 35307902 PMCID: PMC9314697 DOI: 10.1111/joim.13472] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In recent years, the Choosing Wisely and Less is More campaigns have gained growing attention in the medical scientific community. Several projects have been launched to facilitate confrontation among patients and physicians, to achieve better and harmless patient-centered care. Such initiatives have paved the way to a new "way of thinking." Embracing such a philosophy goes through a cognitive process that takes into account several issues. Medicine is a highly inaccurate science and physicians should deal with uncertainty. Evidence from the literature should not be accepted as it is but rather be translated into practice by medical practitioners who select treatment options for specific cases based on the best research, patient preferences, and individual patient characteristics. A wise choice requires active effort into minimizing the chance that potential biases may affect our clinical decisions. Potential harms and all consequences (both direct and indirect) of prescribing tests, procedures, or medications should be carefully evaluated, as well as patients' needs and preferences. Through such a cognitive process, a patient management shift is needed, moving from being centered on establishing a diagnosis towards finding the best management strategy for the right patient at the right time. Finally, while "thinking wisely," physicians should also "act wisely," being among the leading actors in facing upcoming healthcare challenges related to environmental issues and social discrepancies.
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Affiliation(s)
- Ludovico Furlan
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Internal Medicine, General Medicine Unit, IRCCS Ca' Granda Foundation, Ospedale Maggiore Policlinico, Milan, Italy
| | - Pietro Di Francesco
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Internal Medicine, General Medicine Unit, IRCCS Ca' Granda Foundation, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Costantino
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Anaesthesia-Intensive Care Unit, Emergency Department and Emergency Medicine Unit, IRCCS Ca' Granda Foundation Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Montano
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Internal Medicine, General Medicine Unit, IRCCS Ca' Granda Foundation, Ospedale Maggiore Policlinico, Milan, Italy
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18
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Costantino G, Solbiati M, Casazza G. In Reply: letter to the editor on 'Multicentre external validation of the Canadian Syncope Risk Score to predict adverse events and comparison with clinical judgement'. Emerg Med J 2022; 39:489. [PMID: 35264452 DOI: 10.1136/emermed-2022-212370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Giorgio Costantino
- UOC Pronto Soccorso e Medicina d'Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy .,Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milano, Italy
| | - Monica Solbiati
- UOC Pronto Soccorso e Medicina d'Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milano, Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milano, Italy
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19
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Gesu E, Bellone P, Bonzi M, Bertani GA, Brignolo Ottolini B, Bosco P, Conte G, Ferrari M, Fiorelli EM, Kurihara H, Solbiati M, Solimeno LP, Costantino G. Correction to: Management of patients with cervical spine trauma in the emergency department: a systematic critical appraisal of guidelines with a view to developing standardized strategies for clinical practice. Intern Emerg Med 2022; 17:627. [PMID: 34928465 PMCID: PMC9172771 DOI: 10.1007/s11739-021-02897-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Elisa Gesu
- Università degli Studi di Milano, Milan, Italy.
- Emergency Department and Emergency Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Pietro Bellone
- Università degli Studi di Milano, Milan, Italy
- Emergency Department and Emergency Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mattia Bonzi
- Emergency Department and Emergency Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulio Andrea Bertani
- Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Barbara Brignolo Ottolini
- Emergency Department and Emergency Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Bosco
- Health Professions Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Conte
- Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Ferrari
- Medical Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Maria Fiorelli
- Internal Medicine Allergology and Immunology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Hayato Kurihara
- Emergency Surgery and Trauma Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Monica Solbiati
- Università degli Studi di Milano, Milan, Italy
- Emergency Department and Emergency Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luigi Piero Solimeno
- Orthopedics and Traumatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Costantino
- Università degli Studi di Milano, Milan, Italy
- Emergency Department and Emergency Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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20
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Moja L, Banzi R, Cabitza F, Capobussi M, Castellini G, Cereda D, Cinquini M, Colombo C, Costantino G, D'Amico R, Gianola S, González-Lorenzo M, Lodi G, Lucenteforte E, Minozzi S, Moschetti I, Muti P, Petri D, Podda GM, Squizzato A, Tirani M, Virgili G, Berardinelli D. [10 years of stagnant clinical research in the Italian academic context.]. Recenti Prog Med 2022; 113:30-35. [PMID: 35044373 DOI: 10.1701/3733.37182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This article is about current challenges to evidence-based medicine (EMB) in Italy. The authors, who share a 20-year commitment to the field of clinical research, discuss what they define as a phase of "stagnation" in practicing and teaching methods and research tactics, both in clinical and academic settings. Early success of EBM cultural movement was not persistent. The authors reason about how the teaching of EBM has remained a niche, concerning few professionals compared to the needs of the country. The authors identify some reasons that might have led to inconsistent attention to research methodology and address ways to strengthen the contribution of academic medicine to clinical research.
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Affiliation(s)
- Lorenzo Moja
- Dipartimento di Scienze Biomediche per la Salute, Università di Milano
| | - Rita Banzi
- Centro di Politiche Regolatorie in Sanità Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano
| | - Federico Cabitza
- Dipartimento di Informatica, Sistemistica e Comunicazione, Università di Milano-Bicocca, Milano - IRCCS Istituto Ortopedico Galeazzi, Milano
| | - Matteo Capobussi
- Centro Interuniversitario in Ricerca Clinica, Università di Milano
| | | | - Danilo Cereda
- Direzione Generale Welfare, Regione Lombardia, Milano
| | | | - Cinzia Colombo
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano
| | | | - Roberto D'Amico
- Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, Università di Modena e Reggio Emilia, Modena
| | | | | | - Giovanni Lodi
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università di Milano
| | | | - Silvia Minozzi
- Dipartimento di Epidemiologia del SSR - Regione Lazio, Roma
| | - Ivan Moschetti
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano
| | - Paola Muti
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università di Milano
| | - Davide Petri
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa
| | | | - Alessandro Squizzato
- Dipartimento di Medicina e Chirurgia, Università dell'Insubria - ASST Lariana, Como
| | | | - Gianni Virgili
- Dipartimento di Neuroscienze, Area del Farmaco e Salute del Bambino, Università di Firenze
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21
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Salvato M, Solbiati M, Bosco P, Casazza G, Binda F, Iotti M, Calegari J, Laquintana D, Costantino G. Prospective comparison of AMB, GAP AND START scores and triage nurse clinical judgement for predicting admission from an ED: a single-centre prospective study. Emerg Med J 2021; 39:897-902. [PMID: 34969662 DOI: 10.1136/emermed-2020-210814] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 10/27/2020] [Accepted: 12/14/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND It is postulated that early determination of the need for admission can improve flow through EDs. There are several scoring systems which have been developed for predicting patient admission at triage, although they have not been directly compared. In addition, it is not known if these scoring systems perform better than clinical judgement. Therefore, the aim of this study was to validate existing tools in predicting hospital admission during triage and then compare them with the clinical judgement of triage nurses. METHODS To conduct this prospective, single-centre observational study, we enrolled consecutive adult patients who presented between 30 September 2019 and 25 October 2019 at the ED of a large teaching hospital in Milan, Italy. For each patient, triage nurses recorded all of the variables needed to perform Ambulatory (AMB), Glasgow Admission Prediction (GAP) and Sydney Triage to Admission Risk Tool (START) scoring. The probability of admission was estimated by the triage nurses using clinical judgement and expressed as a percentage from 0 to 100 with intervals of 5. Nurse estimates were dichotomised for analysis, with ≥50% likelihood being a prediction of admission. Receiver operating characteristic curves were generated for accuracy of the predictions. Area under the curve (AUC) with 95% CI for each of the scores and for the nursing judgements was also calculated. RESULTS A total of 1710 patients (844 men; median age, 54 years (IQR: 34-75)) and 35 nurses (15 men; median age, 37 years (IQR: 33-48)) were included in this study. Among these patients, 310 (18%) were admitted to hospital from the ED. AUC values for AMB, GAP and START scores were 0.77 (95% CI: 0.74 to 0.79), 0.72 (95% CI: 0.69 to 0.75) and 0.61 (95% CI: 0.58 to 0.64), respectively. The AUC for nurse clinical judgement was 0.86 (95% CI: 0.84 to 0.89). CONCLUSION AMB, GAP and START scores provided moderate accuracy in predicting patient admission. However, all of the scores were significantly worse than the clinical judgement of the triage nurses.
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Affiliation(s)
- Mauro Salvato
- UOC Pronto Soccorso e Medicina d'Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Monica Solbiati
- UOC Pronto Soccorso e Medicina d'Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Paola Bosco
- UOC Pronto Soccorso e Medicina d'Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,UOC Direzione delle Professioni Sanitarie, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Filippo Binda
- UOC Direzione delle Professioni Sanitarie, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Iotti
- UO Comparto Operatorio, Columbus Clinic Center, Milan, Italy
| | - Jessica Calegari
- UOC Pronto Soccorso e Medicina d'Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dario Laquintana
- UOC Direzione delle Professioni Sanitarie, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Costantino
- UOC Pronto Soccorso e Medicina d'Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
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22
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Solbiati M, Russo L, Beverina A, Groff P, Strada A, Furlan L, Montano N, Costantino G, Casazza G. Examination of the relationship between emergency department presentations and population mortality: a multicenter analysis of emergency department presentations during the COVID-19 pandemic. Eur J Intern Med 2021; 94:34-38. [PMID: 34511339 PMCID: PMC8364807 DOI: 10.1016/j.ejim.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/16/2021] [Accepted: 08/09/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND In the spring of 2020, Italy experienced a significant reduction in the number of emergency department (ED) presentations during the first wave of the COVID-19 pandemic. If ED access has an impact on patients' prognosis, such a reduction in ED presentations would be expected to correlate with a parallel increase in the mortality rate of the corresponding population. The aim of the present study was to evaluate the impact of reduced ED presentations on the all-cause mortality of the general population. METHODS Absolute and relative variation in ED accesses from March 1 to April 30 of both 2019 and 2020 in three hub hospitals in areas with different COVID-19 prevalence and age-standardized mortality data from January 1 to June 30 in 2019 and 2020 of the same areas were evaluated. RESULTS During March and April 2020, ED consults were decreased of approximately 50% in all three hospitals, as compared with the same months in 2019. There was a marked increase in cumulative mortality in Milan (high SARS-CoV2 infection spread zone) compared with the same period in 2019. In the other two municipalities (Ferrara and Perugia), which had intermediate and low levels of infection spread, the mortality in 2020 was not substantially changed from that of 2019. CONCLUSIONS Taking into account the increase in mortality due to SARS-CoV-2, reductions in ED access did not seem to affect death rates. If this finding will be confirmed, ED organization and access would need to be reconsidered.
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Affiliation(s)
- Monica Solbiati
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Lorenzo Russo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Paolo Groff
- Pronto Soccorso e Osservazione Breve, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Andrea Strada
- Medicina d'Emergenza Urgenza, Azienda Ospedaliero Universitaria S. Anna, Ferrara, Italy
| | - Ludovico Furlan
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Montano
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Giorgio Costantino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Università degli Studi di Milano, Milan, Italy.
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23
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Gesu E, Bellone P, Bonzi M, Bertani GA, Brignolo Ottolini B, Bosco P, Conte G, Ferrari M, Fiorelli EM, Kurihara H, Solbiati M, Solimeno LP, Costantino G. Management of patients with cervical spine trauma in the emergency department: a systematic critical appraisal of guidelines with a view to developing standardized strategies for clinical practice. Intern Emerg Med 2021; 16:2277-2296. [PMID: 34609677 PMCID: PMC8563599 DOI: 10.1007/s11739-021-02838-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 08/29/2021] [Indexed: 10/31/2022]
Abstract
Several guidelines on the evaluation of patients with suspected cervical spine trauma in the Emergency Department (ED) exist. High heterogeneity between different guidelines has been reported. Aim of this study was to find areas of agreement and disagreement between guidelines, to identify topics in which further research is needed and to provide an evidence-based cervical spine trauma algorithm for ED physicians. The three most relevant guidelines published on cervical spine trauma in the last 10 years were selected screening websites of the main scientific societies and through the comparison of a normalized Google Scholar and SCOPUS citation index. We compared the selected guidelines through seven a-priori defined questions. In case of disagreement between the guidelines or if the quality of evidence appeared low, evidence from published systematic reviews on the topic was added to build an evidence-based algorithm for approach to spinal trauma in the ED. The three selected guidelines were: NICE 2016, Eastern Association for the Surgery of Trauma 2009 and American Association of Neurological Surgeons and Congress of Neurological Surgeons 2013. We found complete agreement on one question, partial agreement for one questions, no agreement for two questions, while agreement was not assessable for 3 questions. The agreement between different guidelines and the evidence on which recommendations are based is low. An attempt to build an evidence-based algorithm has been made. More studies are needed on many topics.
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Affiliation(s)
- Elisa Gesu
- Università degli Studi di Milano, Milan, Italy.
- Emergency Department and Emergency Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Pietro Bellone
- Università degli Studi di Milano, Milan, Italy
- Emergency Department and Emergency Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mattia Bonzi
- Emergency Department and Emergency Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulio Andrea Bertani
- Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Barbara Brignolo Ottolini
- Emergency Department and Emergency Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Bosco
- Health Professions Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Conte
- Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Ferrari
- Medical Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Maria Fiorelli
- Internal Medicine Allergology and Immunology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Hayato Kurihara
- Emergency Surgery and Trauma Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Monica Solbiati
- Università degli Studi di Milano, Milan, Italy
- Emergency Department and Emergency Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luigi Piero Solimeno
- Orthopedics and Traumatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Costantino
- Università degli Studi di Milano, Milan, Italy
- Emergency Department and Emergency Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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24
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Costantino G, Furlan L, Bracco C, Cappellini MD, Casazza G, Nunziata V, Cogliati CB, Fracanzani A, Furlan R, Gambassi G, Manetti R, Manna R, Piccoli A, Pignone AM, Podda G, Salvatore T, Sella S, Squizzato A, Tresoldi M, Perticone F, Pietrangelo A, Corazza GR, Montano N. Impact of implementing a Choosing Wisely educational intervention into clinical practice: The CW-SIMI study (a multicenter-controlled study). Eur J Intern Med 2021; 93:71-77. [PMID: 34353705 DOI: 10.1016/j.ejim.2021.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/28/2021] [Accepted: 07/16/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the impact of an educational intervention based on the Italian Society of Internal Medicine Choosing Wisely (CW-SIMI) recommendations. DESIGN Multicenter, interventional, controlled study. SETTING Twenty-three acute-care hospital wards in Italy. PARTICIPANTS 303 Physicians working in internal medicine wards. INTERVENTION An online educational course. MAIN OUTCOMES The rate of proton pump inhibitor (PPI) prescriptions, the number of days of central venous catheter (CVC) usage, and the duration of intravenous (IV) antibiotic prescriptions evaluated at one month (T1) and at six months (T2) after course completion. Patients admitted and discharged during a 30-day period before the educational intervention (T0, one year before T2) were considered the comparison group. RESULTS A total of 232 physicians completed the course, while 71 did not attend the course. Data from 608, 662, and 555 patients were analyzed at T0, T1, and T2, respectively. The rate of PPI prescriptions declined at one month (RR: 0.67, 95% CI: 0.52-0.87, p = 0.0005) and at six months (RR: 0.62, 95% CI: 0.46-0.84, p = 0.003), and the number of days of CVC usage was reduced at six months (9.13 days at T0 vs. 5.52 days at T2, p = 0.007). The duration of IV antibiotic prescriptions displayed a decreasing trend (7.94 days at T0 vs. 7.42 days at T2, p = 0.081). CONCLUSIONS A simple online educational intervention based on the CW-SIMI recommendations was associated with a clinically relevant reduction in the usage of PPIs and CVCs. Further studies are needed to confirm these findings and a possible benefit on patients' outcomes.
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Affiliation(s)
- Giorgio Costantino
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy; Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milano, Italy
| | - Ludovico Furlan
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milano, Italy
| | - Vanessa Nunziata
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milano, Italy
| | - Chiara Beatrice Cogliati
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milano, Italy
| | - Anna Fracanzani
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy; Medicina Interna a indirizzo fisiopatologico, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Raffaello Furlan
- Humanitas Clinical and Research Center-IRCCS. Dept of Biomedical Sciences-Humanitas University, Rozzano, Italy
| | - Giovanni Gambassi
- Humanitas Clinical and Research Center-IRCCS. Dept of Biomedical Sciences-Humanitas University, Rozzano, Italy; Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Roberto Manetti
- Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali, Università degli Studi di Sassari, Sassari, Italy
| | - Raffaele Manna
- Institute of Internal Medicine, Periodic Fever and Rare Diseases Research Centre, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Alfonso Piccoli
- Medicina Interna, Istituto Clinico San Rocco di Istituti Ospedalieri Bresciani GSD, Italy
| | - Alberto Moggi Pignone
- Dipartimento Assistenziale Integrato di Emergenza ed Accettazione, Azienda Ospedaliera-Universitaria careggi, Firenze, Italy
| | - GianMarco Podda
- Medicina III, San Paolo, ASST Santi Paolo e Carlo, Dipartimento di Scienza della Salute, Università degli Studi di Milano, Milano, Italy
| | - Teresa Salvatore
- UOC di Medicina Interna, Azienda Ospedaliera dell'Università degli Studi Luigi Vanvitelli, Napoli, Italy
| | - Stefania Sella
- Dipartimento di Medicina, Clinica Medica 1, Università degli Studi di Padova, Padova, Italy
| | | | - Moreno Tresoldi
- Medicina Generale e delle Cure Avanzate IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Antonello Pietrangelo
- Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, Università degli Studi di Modena e Reggio Emilia, Italy
| | - Gino Roberto Corazza
- Dipartimento di Medicina Interna e Terapia Medica, Università degli Studi di Pavia, Pavia, Italy
| | - Nicola Montano
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy; Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milano, Italy.
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25
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Saccon E, Bandera A, Sciumè M, Mikaeloff F, Lashari AA, Aliberti S, Sachs MC, Billi F, Blasi F, Gabriel EE, Costantino G, De Roberto P, Krishnan S, Gori A, Peyvandi F, Scudeller L, Canetta C, Lorson CL, Valenti L, Singh K, Baldini L, Fracchiolla NS, Neogi U. Distinct Metabolic Profile Associated with a Fatal Outcome in COVID-19 Patients during the Early Epidemic in Italy. Microbiol Spectr 2021; 9:e0054921. [PMID: 34468185 PMCID: PMC8565516 DOI: 10.1128/spectrum.00549-21] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/30/2021] [Indexed: 01/10/2023] Open
Abstract
In one year of the coronavirus disease 2019 (COVID-19) pandemic, many studies have described the different metabolic changes occurring in COVID-19 patients, linking these alterations to the disease severity. However, a complete metabolic signature of the most severe cases, especially those with a fatal outcome, is still missing. Our study retrospectively analyzes the metabolome profiles of 75 COVID-19 patients with moderate and severe symptoms admitted to Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (Lombardy Region, Italy) following SARS-CoV-2 infection between March and April 2020. Italy was the first Western country to experience COVID-19, and the Lombardy Region was the epicenter of the Italian COVID-19 pandemic. This cohort shows a higher mortality rate compared to others; therefore, it represents a unique opportunity to investigate the underlying metabolic profiles of the first COVID-19 patients in Italy and to identify the potential biomarkers related to the disease prognosis and fatal outcome. IMPORTANCE Understanding the metabolic alterations occurring during an infection is a key element for identifying potential indicators of the disease prognosis, which are fundamental for developing efficient diagnostic tools and offering the best therapeutic treatment to the patient. Here, exploiting high-throughput metabolomics data, we identified the first metabolic profile associated with a fatal outcome, not correlated with preexisting clinical conditions or the oxygen demand at the moment of diagnosis. Overall, our results contribute to a better understanding of COVID-19-related metabolic disruption and may represent a useful starting point for the identification of independent prognostic factors to be employed in therapeutic practice.
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Affiliation(s)
- Elisa Saccon
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Alessandra Bandera
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
| | - Mariarita Sciumè
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Flora Mikaeloff
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Abid A. Lashari
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Stefano Aliberti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michael C. Sachs
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Filippo Billi
- Acute Medical Unit, Department of Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Erin E. Gabriel
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Giorgio Costantino
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Pasquale De Roberto
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Shuba Krishnan
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Andrea Gori
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luigia Scudeller
- Clinical Trials Team, Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ciro Canetta
- Acute Medical Unit, Department of Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Christian L. Lorson
- Bond Life Sciences Center, University of Missouri, Columbia, Missouri, USA
- Department of Veterinary Pathobiology, University of Missouri, Columbia, Missouri, USA
| | - Luca Valenti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Precision Medicine Unit, Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Kamal Singh
- Bond Life Sciences Center, University of Missouri, Columbia, Missouri, USA
- Department of Veterinary Pathobiology, University of Missouri, Columbia, Missouri, USA
| | - Luca Baldini
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | | | - on behalf of the COVID-19 Network Working Group,
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Acute Medical Unit, Department of Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Clinical Trials Team, Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Bond Life Sciences Center, University of Missouri, Columbia, Missouri, USA
- Department of Veterinary Pathobiology, University of Missouri, Columbia, Missouri, USA
- Precision Medicine Unit, Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Ujjwal Neogi
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
- Bond Life Sciences Center, University of Missouri, Columbia, Missouri, USA
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26
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Nazerian P, Sacco RM, Solbiati M, Targetti E, Marta C, Blasi F, Casazza G, Colao MG, Tomassetti S, Grifoni S, Rossolini GM, Costantino G. Laryngotracheal aspiration test reduce the false negative rate in patients with suspected SARS-COV-2 pneumonia despite a negative nasopharyngeal swab. Eur J Intern Med 2021; 91:59-62. [PMID: 34210553 PMCID: PMC8221977 DOI: 10.1016/j.ejim.2021.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/05/2021] [Accepted: 06/16/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND In the emergency department (ED) definitive diagnosis of SARS-COV-2 pneumonia is challenging as nasopharyngeal swab (NPS) can give false negative results. Strategies to reduce false negative rate of NPS have limitations. Serial NPSs (24-48 h from one another) are time-consuming, sputum can not be collected in the majority of patients, and bronchoalveolar lavage (BAL), the most sensitive test, requires specific expertise. Laryngotracheal aspiration (LTA) is easy to perform and showed a similar accuracy to BAL for diagnosis of other pulmonary diseases, however it was not studied to diagnose SARS-COV-2 pneumonia. OBJECTIVE An observational cross-sectional study was performed to evaluate the negative predictive value of LTA in patients with suspected SARS-COV-2 pneumonia despite a negative NPS. METHODS In the EDs of two university hospitals, consecutive patients with suspected SARS-COV-2 pneumonia despite a negative NPS underwent LTA performed with a nasotracheal tube connected to a vacuum system. Final diagnosis based on all respiratory specimen tests (NPS, LTA and BAL) and hospital data was established by two reviewers and in case of discordance by a third reviewer. RESULTS 117 patients were enrolled. LTA was feasible in all patients and no patients experienced adverse events. Fifteen (12.7%) patients were diagnosed with community-acquired SARS-COV-2 pneumonia: 13 LTA positive and only 2 (1.7%) LTA negative. The negative predictive value of NPS and LTA was 87.3% (79.9% - 92.7%) and 98.1% (93.3%99.8%) respectively. CONCLUSIONS LTA resulted feasible, safe and reduced false negative rate in patients with suspected SARS-COV-2 pneumonia despite a negative NPS.
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Affiliation(s)
- Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla, 3 Firenze, Italy.
| | - Roberto M Sacco
- Department of Emergency Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy
| | - Monica Solbiati
- Department of Emergency Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy
| | - Elena Targetti
- Department of Emergency Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy
| | - Chiara Marta
- Department of Emergency Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy
| | - Francesco Blasi
- Department of Internal Medicine Respiratory Unit and Adult Cystic Fibrosis Center Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - Maria Grazia Colao
- Clinical Microbiology and Virology, Department Experimental and Clinical Medicine, Careggi University Hospital, Firenze, Italy
| | - Sara Tomassetti
- Department of Clinical and Experimental Medicine, Interventional Pneumology Unit, Careggi University Hospital, Firenze, Italy
| | - Stefano Grifoni
- Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla, 3 Firenze, Italy
| | - Gian Maria Rossolini
- Clinical Microbiology and Virology, Department Experimental and Clinical Medicine, Careggi University Hospital, Firenze, Italy
| | - Giorgio Costantino
- Department of Emergency Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy
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27
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Norsa L, Bonaffini PA, Caldato M, Bonifacio C, Sonzogni A, Indriolo A, Valle C, Furfaro F, Bonanomi A, Franco PN, Gori M, Smania V, Scaramella L, Forzenigo L, Vecchi M, Solbiati M, Costantino G, Danese S, D'Antiga L, Sironi S, Elli L. Intestinal ischemic manifestations of SARS-CoV-2: Results from the ABDOCOVID multicentre study. World J Gastroenterol 2021; 27:5448-5459. [PMID: 34539144 PMCID: PMC8409161 DOI: 10.3748/wjg.v27.i32.5448] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/11/2021] [Accepted: 07/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intestinal ischemia has been described in case reports of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (coronavirus disease 19, COVID-19).
AIM To define the clinical and histological, characteristics, as well as the outcome of ischemic gastrointestinal manifestations of SARS-CoV-2 infection.
METHODS A structured retrospective collection was promoted among three tertiary referral centres during the first wave of the pandemic in northern Italy. Clinical, radiological, endoscopic and histological data of patients hospitalized for COVID-19 between March 1st and May 30th were reviewed. The diagnosis was established by consecutive analysis of all abdominal computed tomography (CT) scans performed.
RESULTS Among 2929 patients, 21 (0.7%) showed gastrointestinal ischemic manifestations either as presenting symptom or during hospitalization. Abdominal CT showed bowel distention in 6 patients while signs of colitis/enteritis in 12. Three patients presented thrombosis of main abdominal veins. Endoscopy, when feasible, confirmed the diagnosis (6 patients). Surgical resection was necessary in 4/21 patients. Histological tissue examination showed distinctive features of endothelial inflammation in the small bowel and colon. Median hospital stay was 9 d with a mortality rate of 39%.
CONCLUSION Gastrointestinal ischemia represents a rare manifestation of COVID-19. A high index of suspicion should lead to investigate this complication by CT scan, in the attempt to reduce its high mortality rate. Histology shows atypical feature of ischemia with important endotheliitis, probably linked to thrombotic microangiopathies.
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Affiliation(s)
- Lorenzo Norsa
- Department of Pediatric Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII, Bergamo 24127, Italy
| | - Pietro Andrea Bonaffini
- Department of Radiology Papa Giovanni XXIII Bergamo, University of Milano-Bicocca, Milan 20126, Italy
| | - Maja Caldato
- Fondazione IRCCS Ca’ Granda, Department of Emergency Medicine, Ospedale Maggiore Policlinico, Milano 20122, Italy
| | - Cristiana Bonifacio
- Department of Radiology, Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Italy
| | - Aurelio Sonzogni
- Department of Pathology, ASST Papa Giovanni XXIII, Bergamo 24127, Italy
| | - Amedeo Indriolo
- Department of Gastroenterology and Endoscopy, ASST Papa Giovanni XXIII, Bergamo 24127, Italy
| | - Clarissa Valle
- Department of Radiology Papa Giovanni XXIII Bergamo, University of Milano-Bicocca, Milan 20126, Italy
| | - Federica Furfaro
- IBD Center, Humanitas Clinical and Research Center IRCCS, Humanitas University, Rozzano 20089, Italy
| | - Alice Bonanomi
- Post-Graduate School of Diagnostic Radiology, University of Milano-Bicocca, Milano 20126, Italy
| | - Paolo Niccolò Franco
- Post-Graduate School of Diagnostic Radiology, University of Milano-Bicocca, Milano 20126, Italy
| | - Mauro Gori
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo 24127, Italy
| | - Veronica Smania
- Department of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20122, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milano 20122, Italy
| | - Lucia Scaramella
- Department of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20122, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milano 20122, Italy
| | - Laura Forzenigo
- Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20122, Italy
| | - Maurizio Vecchi
- Department of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20122, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milano 20122, Italy
| | - Monica Solbiati
- Fondazione IRCCS Ca’ Granda, Department of Emergency Medicine, Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milano 20122, Italy
| | - Giorgio Costantino
- Fondazione IRCCS Ca’ Granda, Department of Emergency Medicine, Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milano 20122, Italy
| | - Silvio Danese
- IBD Center, Humanitas Clinical and Research Center IRCCS, Humanitas University, Rozzano 20089, Italy
| | - Lorenzo D'Antiga
- Department of Pediatric Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII, Bergamo 24127, Italy
| | - Sandro Sironi
- Department of Radiology Papa Giovanni XXIII Bergamo, University of Milano-Bicocca, Milan 20126, Italy
- Post-Graduate School of Diagnostic Radiology, University of Milano-Bicocca, Milano 20126, Italy
| | - Luca Elli
- Department of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano 20122, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milano 20122, Italy
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28
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Borghetti P, Costantino G, Santoro V, Sepulcri M, Maddalo M, Greco D, Frassine F, Vitali P, Pastorello E, La Mattina S, Volpi G, Imbrescia J, Magrini S. PO-1194 A predictive model for OS in patients treated with Stereotactic Radiotherapy for early-stage NSCLC. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07645-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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29
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Milani GP, Casazza G, Corsello A, Marchisio P, Rocchi A, Colombo G, Agostoni C, Costantino G. Early evidence of SARS-CoV-2 in Milan, Jan-Feb 2020. Ital J Pediatr 2021; 47:145. [PMID: 34193222 PMCID: PMC8243623 DOI: 10.1186/s13052-021-01095-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A few studies have suggested that the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) was present in Northern Italy several weeks before its official detection on February 21, 2020. On the other hand, no clinical data have been provided so far to support such hypothesis. We investigated clinical-epidemiological evidence of SARS-CoV-2 infection among children and adults referring to emergency department (ED) in the main hospital of the center of Milan (Italy) before February 21, 2020. METHODS A retrospective analysis of medical records of ED visits at the Fondazione Ca' Granda Policlinico, Milan between January 11 and February 15 in 2017, 2018, 2019 and in 2020 was performed. The number of subjects referring with fever, cough or dyspnea was compared between the studied period of 2020 and the previous 3 years, by calculating a standardized referral ratio (SRR, number of observed cases in 2020 divided by the number of expected cases according to 2017-2019) and the corresponding 95% confidence interval (CI). RESULTS In the pediatric ED, 7709 (average 2570/year) and 2736 patients were visited during the period 2017-2019 and in the 2020, respectively. Among adults, 13,465 (average 4488/year) and 4787 were visited during the period 2017-2019 and in the 2020, respectively. The SRR was 1.16 (95% CI 1.10-1.23) in children and 1.25 (95% CI 1.16-1.35) in adults. The ratio for the two (children and adults) SRRs was 0.93 (0.84-1.02), suggesting a trend towards a higher frequency in adults compared to children. CONCLUSIONS This study suggests that SARS-CoV-2 might have spread in Milan before February 21, 2020 with a minor trend among children.
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Affiliation(s)
- Gregorio P Milani
- Pediatric Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - Antonio Corsello
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Paola Marchisio
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessia Rocchi
- Pediatric Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Colombo
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Carlo Agostoni
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy. .,Pediatric Intermediate Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 9, 20122, Milan, Italy.
| | - Giorgio Costantino
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy.,Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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30
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Jachetti A, Colombo G, Brignolo-Ottolini B, Franchi J, Solbiati M, Pecorino Meli M, Bosco P, Costantino G. Emergency department reorganisation to cope with COVID-19 outbreak in Milan university hospital: a time-sensitive challenge. BMC Emerg Med 2021; 21:74. [PMID: 34182927 PMCID: PMC8237540 DOI: 10.1186/s12873-021-00464-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/01/2020] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In March 2020 we faced a huge spread of the epidemic of SARS-CoV2 in northern Italy; the Emergency Departments (ED) and the Emergency Medical Services (EMS) were overwhelmed by patients requiring care. The hospitals were forced to reorganize their services, and the ED was the focal point of this challenge. As Emergency Department in a metropolitan area of the region most affected, we saw an increasing number of patients with COVID-19, and we made some structural and staff implementations according to the evolution of the epidemic. METHODS We analysed in a narrative way the weaknesses and the point of strength of our response to COVID-19 first outbreak, focusing point by point on main challenges and minor details involved in our ED response to the pandemics. RESULTS The main stems for our response to the pandemic were: use of clear and shared contingency plans, as long as preparedness to implement them; stockage of as much as useful material can be stocked; training of the personnel to be prepared for a fast response, trying to maintain divided pathway for COVID-19 and non-COVID-19 patients, well-done isolation is a key factor; preparedness to de-escalate as soon as needed. CONCLUSIONS We evaluated our experience and analysed the weakness and strength of our first response to share it with the rest of the scientific community and colleagues worldwide, hoping to facilitate others who will face the same challenge or similar challenges in the future. Shared experience is the best way to learn and to avoid making the same mistakes.
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Affiliation(s)
- A Jachetti
- UOC Pronto Soccorso e Medicina d'Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - G Colombo
- UOC Pronto Soccorso e Medicina d'Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - B Brignolo-Ottolini
- UOC Pronto Soccorso e Medicina d'Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - J Franchi
- UOC Pronto Soccorso e Medicina d'Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Solbiati
- UOC Pronto Soccorso e Medicina d'Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - M Pecorino Meli
- UOC Pronto Soccorso e Medicina d'Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - P Bosco
- UOC Pronto Soccorso e Medicina d'Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G Costantino
- UOC Pronto Soccorso e Medicina d'Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
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31
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Gambazza S, Galazzi A, Binda F, Passeri O, Bosco P, Costantino G, Laquintana D. Pattern of Visits in a Metropolitan Emergency Department in Lombardia (Italy): January 2019-December 2020. Healthcare (Basel) 2021; 9:791. [PMID: 34202591 PMCID: PMC8304284 DOI: 10.3390/healthcare9070791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/21/2021] [Revised: 06/11/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022] Open
Abstract
During the Coronavirus disease 2019 (COVID-19), a general decrease in the presentations to emergency departments (ED) was reported. However, we suspect that there was a lower number but an unchanged pattern of ED visits for urgent conditions in 2020 compared to 2019. This retrospective study assessed the change in the number of presentations in the ED of a tertiary level university hospital in Milano (Lombardia, Italy). Compared to 2019, a significant drop in ED presentations occurred (-46.4%), and we recorded a -15.7% difference in the proportion of patients admitted with white codes. The pattern of hourly presentations to the ED was unchanged, with overcrowding during the working daytime. COVID-19 changed ED flows, likely causing an overall reduction in the number of deferrable conditions. However, the pattern associated with urgent conditions did not change abruptly in 2020.
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Affiliation(s)
- Simone Gambazza
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy; (S.G.); (A.G.); (O.P.); (P.B.); (D.L.)
| | - Alessandro Galazzi
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy; (S.G.); (A.G.); (O.P.); (P.B.); (D.L.)
| | - Filippo Binda
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy; (S.G.); (A.G.); (O.P.); (P.B.); (D.L.)
| | - Onorina Passeri
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy; (S.G.); (A.G.); (O.P.); (P.B.); (D.L.)
| | - Paola Bosco
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy; (S.G.); (A.G.); (O.P.); (P.B.); (D.L.)
- Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy;
| | - Giorgio Costantino
- Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy;
- Department of Clinical Sciences and Community Health, University of Milan, Via Francesco Sforza 35, 20122 Milano, Italy
| | - Dario Laquintana
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy; (S.G.); (A.G.); (O.P.); (P.B.); (D.L.)
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32
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Solbiati M, Quinn JV, Dipaola F, Duca P, Furlan R, Montano N, Reed MJ, Sheldon RS, Sun BC, Ungar A, Casazza G, Costantino G. Correction: Personalized risk stratification through attribute matching for clinical decision making in clinical conditions with aspecific symptoms: The example of syncope. PLoS One 2021; 16:e0252967. [PMID: 34081756 PMCID: PMC8174697 DOI: 10.1371/journal.pone.0252967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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33
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Pecoraro V, Petri D, Costantino G, Squizzato A, Moja L, Virgili G, Lucenteforte E. The diagnostic accuracy of digital, infrared and mercury-in-glass thermometers in measuring body temperature: a systematic review and network meta-analysis. Intern Emerg Med 2021; 16:1071-1083. [PMID: 33237494 PMCID: PMC7686821 DOI: 10.1007/s11739-020-02556-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 10/28/2020] [Indexed: 12/11/2022]
Abstract
Not much is known about how accurate and reproducible different thermometers are at diagnosing patients with suspected fever. The study aims at evaluating which peripheral thermometers are more accurate and reproducible. We searched Medline, Embase, Scopus, WOS, CENTRAL, and Cinahl to perform: (1) diagnostic accuracy meta-analysis (MA) using rectal mercury-in-glass or digital thermometry as reference, and bivariate models for pooling; (2) network MA to estimate differences in mean temperature between devices; (3) Bland-Altman method to estimate 95% coefficient of reproducibility. PROSPERO registration: CRD42020174996. We included 46 studies enrolling more than 12,000 patients. Using 38 °C (100.4 ℉) as cut-off temperature, temporal infrared thermometry had a sensitivity of 0.76 (95% confidence interval, 0.65, 0.84; low certainty) and specificity of 0.96 (0.92, 0.98; moderate certainty); tympanic infrared thermometry had a sensitivity of 0.77 (0.60, 0.88; low certainty) and specificity of 0.98 (0.95, 0.99; moderate certainty). For all the other index devices, it was not possible to pool the estimates. Compared to the rectal mercury-in-glass thermometer, mean temperature differences were not statistically different from zero for temporal or tympanic infrared thermometry; the median coefficient of reproducibility ranged between 0.53 °C [0.95 ℉] for infrared temporal and 1.2 °C [2.16 ℉] for axillary digital thermometry. Several peripheral thermometers proved specific, but not sensitive for diagnosing fever with rectal thermometry as a reference standard, meaning that finding a temperature below 38 °C does not rule out fever. Fixed differences between temperatures together with random error means facing differences between measurements in the order of 2 °C [4.5 ℉]. This study informs practitioners of the limitations associated with different thermometers; peripheral ones are specific but not sensitive.
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Affiliation(s)
- Valentina Pecoraro
- Department of Laboratory Medicine and Pathology, Ospedale Civile Sant'Agostino Estense, AUSL Modena, Modena, Italy
| | - Davide Petri
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 10, 56126, Pisa, Italy
| | - Giorgio Costantino
- IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, UOC Pronto Soccorso e Medicina D'Urgenza, Università Degli Studi di Milano, Milan, Italy
| | | | - Lorenzo Moja
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), AOU Careggi, Florence, Italy
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 10, 56126, Pisa, Italy.
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Solbiati M, Talerico G, Villa P, Dipaola F, Furlan R, Furlan L, Fiorelli EM, Rabajoli F, Casagranda I, Cazzola K, Ramuscello S, Vicenzi A, Casazza G, Costantino G. Multicentre external validation of the Canadian Syncope Risk Score to predict adverse events and comparison with clinical judgement. Emerg Med J 2021; 38:701-706. [PMID: 34039646 DOI: 10.1136/emermed-2020-210579] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 08/27/2020] [Accepted: 05/17/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The Canadian Syncope Risk Score (CSRS) has been proposed for syncope risk stratification in the emergency department (ED). The aim of this study is to perform an external multicenter validation of the CSRS and to compare it with clinical judgement. METHODS Using patients previously included in the SyMoNE database, we enrolled subjects older than 18 years who presented reporting syncope at the ED. For each patient, we estimated the CSRS and recorded the physician judgement on the patients' risk of adverse events. We performed a 30-day follow-up. RESULTS From 1 September 2015 to 28 February 2017, we enrolled 345 patients; the median age was 71 years (IQR 51-81), 174 (50%) were men and 29% were hospitalised. Serious adverse events occurred in 43 (12%) of the patients within 30 days. The area under the curve of the CSRS and clinical judgement was 0.75 (95% CI 0.68 to 0.81) and 0.68 (95% CI 0.61 to 0.74), respectively. The risk of adverse events of patients at low risk according to the CSRS and clinical judgement was 6.7% and 2%, with a sensitivity of 70% (95% CI 54% to 83%) and 95% (95% CI 84% to 99%), respectively. CONCLUSION This study represents the first validation analysis of CSRS outside Canada. The overall predictive accuracy of the CSRS is similar to the clinical judgement. However, patients at low risk according to clinical judgement had a lower incidence of adverse events as compared with patients at low risk according to the CSRS. Further studies showing that the adoption of the CSRS improve patients' outcomes is warranted before its widespread implementation.
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Affiliation(s)
- Monica Solbiati
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Dipartimento di Scienze Cliniche e di Comunita, Universita degli Studi di Milano, Milano, Italy
| | | | - Paolo Villa
- UOC Medicina d'Urgenza e Pronto Soccorso, Ospedale Luigi Sacco, Milano, Italy
| | - Franca Dipaola
- Department of Biomedical Sciences, Humanitas University IRCCS- Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Raffaello Furlan
- Department of Biomedical Sciences, Humanitas University IRCCS- Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Ludovico Furlan
- UOC Pronto Soccorso e Medicina d'Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | | | | | | | - Andrea Vicenzi
- UOC Medicina d'Urgenza e Pronto Soccorso, Ospedale Luigi Sacco, Milano, Italy
| | | | - Giorgio Costantino
- Dipartimento di Scienze Cliniche e di Comunita, Universita degli Studi di Milano, Milano, Italy .,UOC Pronto Soccorso e Medicina d'Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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35
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Castoldi L, Solbiati M, Costantino G, Casiraghi E. Variations in volume of emergency surgeries and emergency department access at a third level hospital in Milan, Lombardy, during the COVID-19 outbreak. BMC Emerg Med 2021; 21:59. [PMID: 33971826 PMCID: PMC8107771 DOI: 10.1186/s12873-021-00445-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/08/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND During the recent outbreak of COVID-19 (coronavirus disease 2019), Lombardy was the most affected region in Italy, with 87,000 patients and 15,876 deaths up to May 26, 2020. Since February 22, 2020, well before the Government declared a state of emergency, there was a huge reduction in the number of emergency surgeries performed at hospitals in Lombardy. A general decrease in attendance at emergency departments (EDs) was also observed. The aim of our study is to report the experience of the ED of a third-level hospital in downtown Milan, Lombardy, and provide possible explanations for the observed phenomena. METHODS This retrospective, observational study assessed the volume of emergency surgeries and attendance at an ED during the course of the pandemic, i.e. immediately before, during and after a progressive community lockdown in response to the COVID-19 pandemic. These data were compared with data from the same time periods in 2019. The results are presented as means, standard error (SE), and 95% studentized confidence intervals (CI). The Wilcoxon rank signed test at a 0.05 significance level was used to assess differences in per-day ED access distributions. RESULTS Compared to 2019, a significant overall drop in emergency surgeries (60%, p < 0.002) and in ED admittance (66%, p ≅ 0) was observed in 2020. In particular, there were significant decreases in medical (40%), surgical (74%), specialist (ophthalmology, otolaryngology, traumatology, and urology) (92%), and psychiatric (60%) cases. ED admittance due to domestic violence (59%) and individuals who left the ED without being seen (76%) also decreased. Conversely, the number of deaths increased by 196%. CONCLUSIONS During the COVID-19 outbreak the volume of urgent surgeries and patients accessing our ED dropped. Currently, it is not known if mortality of people who did not seek care increased during the pandemic. Further studies are needed to understand if such reductions during the COVID-19 pandemic will result in a rebound of patients left untreated or in unwanted consequences for population health.
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Affiliation(s)
- Laura Castoldi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOSD Chirurgia d'Urgenza,, Milano, Italy.
| | - Monica Solbiati
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOC Pronto Soccorso e Medicina d'Urgenza, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Giorgio Costantino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOC Pronto Soccorso e Medicina d'Urgenza, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Elena Casiraghi
- Anacleto Lab, Computer Science Department, Università degli Studi di Milano, Milan, Italy
- MIPS Lab, Computer Science Department, Università degli Studi di Milano, Milan, Italy
- CINI-AIIS, Italian National Laboratory in Artificial Intelligence and Intelligent Systems, University of Modena and Reggio Emilia, Modena, Italy
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Cugno M, Gualtierotti R, Casazza G, Tafuri F, Ghigliazza G, Torri A, Costantino G, Montano N, Peyvandi F. Mortality in Patients with COVID-19 on Renin Angiotensin System Inhibitor Long-Term Treatment: An Observational Study Showing that Things Are Not Always as They Seem. Adv Ther 2021; 38:2709-2716. [PMID: 33792889 PMCID: PMC8012518 DOI: 10.1007/s12325-021-01704-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 03/10/2021] [Indexed: 02/08/2023]
Abstract
Introduction At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, controversial data were reported concerning angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) that induced a number of physicians to stop using them in patients with COVID-19. Although large-scale studies have ruled out this concern, it is common experience that patients with COVID-19 taking ACE inhibitors or ARBs are at increased risk of death. The aim of this study was to investigate the reasons for this apparently high mortality rate. Methods During the first wave of the pandemic, we conducted a field study of 427 consecutive patients with COVID-19 upon their admission to the emergency department of a hospital in one of the most severely hit cities in northern Italy, and 30 days later. The disease was defined as being mild, moderate or severe on the basis of clinical, laboratory and imaging data, and a multivariate model was used to analyse the determinants of mortality. Results Within 30 days of admission, 31.6% of the patients treated with ACE inhibitors or ARBs and 15.2% of those not treated with these drugs had died. Multivariate analysis showed that the determinants of mortality were age (p = 0.0001), hypertension (p = 0.0120) and diabetes (p = 0.0129), whereas ACE inhibitors or ARBs had no effect on mortality. There was no significant difference between the patients treated with ACE inhibitors and those treated with ARBs. Conclusion The apparently increased mortality of patients with COVID-19 receiving long-term treatment with ACE inhibitors or ARBs is not due to the drugs themselves, but to the conditions associated with their use.
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Costantino G, Solbiati M, Elli S, Paganuzzi M, Massabò D, Montano N, Mancarella M, Cortellaro F, Cataudella E, Bellone A, Capsoni N, Bertolini G, Nattino G, Casazza G. Utility of hospitalization for elderly individuals affected by COVID-19. PLoS One 2021; 16:e0250730. [PMID: 33901228 PMCID: PMC8075227 DOI: 10.1371/journal.pone.0250730] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/31/2021] [Indexed: 12/29/2022] Open
Abstract
Background During the COVID-19 pandemic, the number of individuals needing hospital admission has sometimes exceeded the availability of hospital beds. Since hospitalization can have detrimental effects on older individuals, preference has been given to younger patients. The aim of this study was to assess the utility of hospitalization for elderly affected by COVID-19. We hypothesized that their mortality decreases when there is greater access to hospitals. Methods This study examined 1902 COVID-19 patients consecutively admitted to three large hospitals in Milan, Italy. Overall mortality data for Milan from the same period was retrieved. Based on emergency department (ED) data, both peak and off-peak phases were identified. The percentage of elderly patients admitted to EDs during these two phases were compared by calculating the standardized mortality ratio (SMR) of the individuals younger than, versus older than, 80 years. Results The median age of the patients hospitalized during the peak phase was lower than the median age during the off-peak phase (64 vs. 75 years, respectively; p <0.001). However, while the SMR for the younger patients was lower during the off-peak phase (1.98, 95% CI: 1.72–2.29 versus 1.40, 95% CI: 1.25–1.58, respectively), the SMR was similar between both phases for the elderly patients (2.28, 95% CI: 2.07–2.52 versus 2.48, 95% CI: 2.32–2.65, respectively). Conclusions Greater access to hospitals during an off-peak phase did not affect the mortality rate of COVID-19-positive elderly patients in Milan. This finding, if confirmed in other settings, should influence future decisions regarding resource management of health care organizations.
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Affiliation(s)
- Giorgio Costantino
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Monica Solbiati
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
- * E-mail:
| | - Silvia Elli
- Università degli Studi di Milano, Milan, Italy
| | | | | | - Nicola Montano
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Marta Mancarella
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Cortellaro
- ASST Santi Paolo e Carlo, Pronto Soccorso e Degenza Breve San Carlo, Milan, Italy
| | - Emanuela Cataudella
- ASST Santi Paolo e Carlo, Pronto Soccorso e Degenza Breve San Carlo, Milan, Italy
| | - Andrea Bellone
- ASST Grande Ospedale Metropolitano Niguarda, Medicina d’Urgenza e Pronto Soccorso, Milan, Italy
| | - Nicolò Capsoni
- ASST Grande Ospedale Metropolitano Niguarda, Medicina d’Urgenza e Pronto Soccorso, Milan, Italy
| | - Guido Bertolini
- Laboratorio di Epidemiologia Clinica, Dipartimento di Salute Pubblica, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Giovanni Nattino
- Laboratorio di Epidemiologia Clinica, Dipartimento di Salute Pubblica, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche “L. Sacco”, Università degli Studi di Milano, Milan, Italy
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Sheldon RS, Lei LY, Solbiati M, Chew DS, Raj SR, Costantino G, Morillo C, Sandhu RK. Electrophysiology studies for predicting atrioventricular block in patients with syncope: A systematic review and meta-analysis. Heart Rhythm 2021; 18:1310-1317. [PMID: 33887450 DOI: 10.1016/j.hrthm.2021.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/07/2021] [Accepted: 04/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Syncope may be caused by intermittent complete heart block in patients with bundle branch block. Electrophysiology studies (EPS) testing for infra-Hisian heart block are recommended by the European Society of Cardiology syncope guidelines on the basis of decades-old estimates of their negative predictive values (NPVs) for complete heart block. OBJECTIVE The aim of this study was to determine the NPV of EPS for complete heart block in patients with syncope and bundle branch block. METHODS We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL without language restriction from database inception to October 2019 for Medical Subject Headings terms and keywords related to "syncope," "heart block," and "programmed electrical stimulation." A random effects meta-analysis was conducted with a primary outcome of the proportion of patients with a negative EPS who later presented with complete heart block, diagnosed with surface electrocardiographic (ECG) recordings vs continuous implantable cardiac monitor (ICM). RESULTS Ten reports contained 12 cohorts with 639 patients who met the inclusion criteria. The mean age was 69 ± 7 years; 35% ± 10% were women; and 85% of patients had bifascicular block. Seven cohorts recorded clinical outcomes with external ECG recordings, and 5 cohorts featured ICMs. The mean prespecified His-to-ventricle interval criterion was ≥70 ms. In studies featuring surface ECG recordings, there were 7% (95% confidence interval 7%-17%) patients who developed complete heart block compared with 29% (95% confidence interval 24%-35%) in the studies featuring ICM (P = .0001). CONCLUSION The NPV of EPS in patients with syncope and bundle branch block is 0.71, sufficiently low to question its use.
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Affiliation(s)
- Robert S Sheldon
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
| | - Lucy Y Lei
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Monica Solbiati
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy
| | - Derek S Chew
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Satish R Raj
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Giorgio Costantino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy
| | - Carlos Morillo
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Roopinder K Sandhu
- University of Alberta, Edmonton, Alberta, Canada; Smidt Heart Institute, Cedars-Sinai Hospital, Los Angeles, California
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Milani GP, Marchisio P, Rocchi A, Bertolozzi G, Furlan L, La Vecchia A, Agostoni C, Costantino G. Frequency of asymptomatic carriers of SARS-CoV-2 among children and adults after school reopening. Ital J Pediatr 2021; 47:65. [PMID: 33712061 PMCID: PMC7953180 DOI: 10.1186/s13052-021-01016-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background Children often develop an asymptomatic form of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), but it is debated if children are at higher risk than adults to be asymptomatic carriers of SARS-CoV-2, especially during the school reopening. The main aim of this study was to investigate the frequency of SARS-CoV-2 asymptomatic carriers in children and adults during the reopening of the schools in Milan, Italy. Methods We conducted a cross-sectional study at the pediatric and adult Emergency Department (ED) of the Ca' Granda Ospedale Maggiore Policlinico (Milan) between October 1 and 31, 2020, i.e. 3 weeks after the reopening of schools. Patients admitted to the ED short stay observation and without any sign or symptom consistent with a SARS-CoV-2 were eligible. These patients underwent a nasopharyngeal swab specimen for the detection of SARS-CoV-2. The odds ratio and its 95% confidence interval (CI) was calculated to assess the risk of asymptomatically carrying the SARS-CoV-2 infection in children and adults. Results A total of 69 (27 females, median age 8.7 years) children and 251 (107 females, median age 71 years) adults were enrolled. Pediatric and adult subjects tested positive for SARS-CoV-2 with a similar frequency (1/69 [1.4%] vs 4/251 [1.6%]). Children had an odds ratio to be a carrier of 0.91 (CI 0.02– 9.38) compared to adults. Conclusions The frequency of asymptomatic SARS-CoV-2 carriers was similar among children and adults. Considering the emerging diffusion of new SARS-CoV-2 variants, the asymptomatic spread of SARS-CoV-2 infection among children and adults should be monitored.
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Affiliation(s)
- Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Paola Marchisio
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Alessia Rocchi
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Bertolozzi
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ludovico Furlan
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Adriano La Vecchia
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Carlo Agostoni
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. .,Department of Clinical Science and Community Health, University of Milan, Milan, Italy. .,Dipartimento di Emergenza e Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giorgio Costantino
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy.,Dipartimento di Emergenza e Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Erba L, Furlan L, Monti A, Marsala E, Cernuschi G, Solbiati M, Bracco C, Bandini G, Pecorino Meli M, Casazza G, Montano N, Sbrojavacca R, Costantino G. Short vs long-course antibiotic therapy in pyelonephritis: a comparison of systematic reviews and guidelines for the SIMI choosing wisely campaign. Intern Emerg Med 2021; 16:313-323. [PMID: 32566969 DOI: 10.1007/s11739-020-02401-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/06/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Italian Society of Internal Medicine (SIMI) Choosing Wisely Campaign has recently proposed, among its five items, to reduce the prescription of long-term intravenous antibiotics if not indicated. The aim of our study was to assess the available evidences on optimal duration of antibiotic treatment in pyelonephritis through a systematic review of secondary studies. MATERIALS AND METHODS We searched for all guidelines on pyelonephritis and systematic reviews assessing the optimal duration of antibiotic therapy in this type of infection. We compared the recommendations of the three most cited and recent guidelines on the topic of interest. We extracted data of non-duplicated RCT from the selected systematic reviews and performed meta-analyses for clinical and microbiological failure. A trial sequential analysis (TSA) was also achieved to identify the need for further evidence. RESULTS We identified 4 systematic reviews, including data from 10 non-duplicated RCTs (1536 patients). The meta-analysis showed a higher rate of clinical cure for short-course antibiotic treatment (RR for clinical failure 0.70, 95% CI [0.53-0.94]). No significant difference in the rate of microbiological failure (RR 1.06, 95% CI [0.75-1.49]) was observed. In terms of clinical cure, the TSA suggests that current evidence is sufficient to consider short course at least as effective as long-course treatment. Selected guidelines recommend considering shorter courses, but do not cite most of the published RCTs. CONCLUSIONS Short-course antibiotic treatment is at least as effective as longer courses for both microbiological and clinical success in the treatment of acute uncomplicated pyelonephritis.
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Affiliation(s)
- Luca Erba
- Università Degli Studi Di Milano, Milan, Italy.
| | | | - Alice Monti
- Università Degli Studi Di Milano, Milan, Italy
| | | | - Giulia Cernuschi
- UOC Pronto Soccorso E Medicina D'Urgenza, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Monica Solbiati
- UOC Pronto Soccorso E Medicina D'Urgenza, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Christian Bracco
- Department of Internal Medicine, Santa Croce and Carle General Hospital, Cuneo, Italy
| | - Giulia Bandini
- Medicina Interna, Università Degli Studi Di Firenze, AOU Careggi, Firenze, Italy
| | - Monica Pecorino Meli
- Dipartimento Delle Professioni Sanitarie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Casazza
- Dipartimento Di Scienze Biomediche E Cliniche "L. Sacco", Università Degli Studi Di Milano, Milan, Italy
| | - Nicola Montano
- Dipartimento Di Medicina Interna, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento Di Scienze Cliniche E Di Comunità, Università Degli Studi Di Milano, Milan, Italy
| | - Rodolfo Sbrojavacca
- Dipartimento Di Pronto Soccorso E Medicina D'Urgenza, Azienda Ospedaliera Universitaria Di Udine, Udine, Italy
| | - Giorgio Costantino
- UOC Pronto Soccorso E Medicina D'Urgenza, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento Di Scienze Cliniche E Di Comunità, Università Degli Studi Di Milano, Milan, Italy
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Paglia S, Nattino G, Occhipinti F, Sala L, Targetti E, Cortellaro F, Cosentini R, Costantino G, Fichtner F, Mancarella M, Marinaro C, Sorlini C, Bertolini G, Acquistapace G, Agostinis M, Bonzi M, Brena N, Caruso S, Mascolo M, Massabò D, Scrignoli F. The Quick Walk Test: A Noninvasive Test to Assess the Risk of Mechanical Ventilation During COVID-19 Outbreaks. Acad Emerg Med 2021; 28:244-247. [PMID: 33249678 PMCID: PMC7753836 DOI: 10.1111/acem.14180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 01/20/2023]
Affiliation(s)
| | - Giovanni Nattino
- the Laboratory of Clinical Epidemiology Department of Public Health Istituto di Ricerche Farmacologiche Mario Negri IRCCS Ranica (BG)Italy
| | - Federica Occhipinti
- the Laboratory of Clinical Epidemiology Department of Public Health Istituto di Ricerche Farmacologiche Mario Negri IRCCS Ranica (BG)Italy
| | - Luca Sala
- the Laboratory of Clinical Epidemiology Department of Public Health Istituto di Ricerche Farmacologiche Mario Negri IRCCS Ranica (BG)Italy
| | - Elena Targetti
- the Laboratory of Clinical Epidemiology Department of Public Health Istituto di Ricerche Farmacologiche Mario Negri IRCCS Ranica (BG)Italy
| | | | - Roberto Cosentini
- Emergency Department and Medicine ASST Papa Giovanni XXIII Bergamo (BG)Italy
| | - Giorgio Costantino
- Pronto Soccorso e Medicina d’Urgenza Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico MilanoItaly
- and the Università degli Studi di Milano Milano (MI) Italy
| | | | - Marta Mancarella
- Pronto Soccorso e Medicina d’Urgenza Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico MilanoItaly
| | - Claudia Marinaro
- Emergency Department and Medicine ASST Papa Giovanni XXIII Bergamo (BG)Italy
| | - Cristina Sorlini
- Accident and Emergency Services ASST Santi Paolo e Carlo Milano (MI)Italy
| | - Guido Bertolini
- the Laboratory of Clinical Epidemiology Department of Public Health Istituto di Ricerche Farmacologiche Mario Negri IRCCS Ranica (BG)Italy
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Milani GP, Bottino I, Rocchi A, Marchisio P, Elli S, Agostoni C, Costantino G. Frequency of Children vs Adults Carrying Severe Acute Respiratory Syndrome Coronavirus 2 Asymptomatically. JAMA Pediatr 2021; 175:193-194. [PMID: 32926119 PMCID: PMC7490740 DOI: 10.1001/jamapediatrics.2020.3595] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This case-control study compares the rates of test results indicating SARS-CoV-2 infection among children and adults admitted to a single hospital in Milan, Italy, for noninfectious reasons and without COVID-19 symptoms.
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Affiliation(s)
| | - Ilaria Bottino
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Alessia Rocchi
- Pediatric Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Marchisio
- Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Elli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Carlo Agostoni
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Costantino
- Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Clerici B, Muscatello A, Bai F, Pavanello D, Orlandi M, Marchetti GC, Castelli V, Casazza G, Costantino G, Podda GM. Sensitivity of SARS-CoV-2 Detection With Nasopharyngeal Swabs. Front Public Health 2021; 8:593491. [PMID: 33575241 PMCID: PMC7870983 DOI: 10.3389/fpubh.2020.593491] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 08/10/2020] [Accepted: 12/31/2020] [Indexed: 12/28/2022] Open
Abstract
Background: SARS-CoV-2-infected subjects have been proven contagious in the symptomatic, pre-symptomatic and asymptomatic phase. The identification of these patients is crucial in order to prevent virus circulation. No reliable data on the sensitivity of nasopharyngeal swabs (NPS) are available because of the lack of a shared reference standard to identify SARS-CoV-2 infected patients. The aim of our study was to collect data on patients with a known diagnosis of COVID-19 who underwent serial testing to assess NPS sensitivity. Methods: The study was a multi-center, observational, retrospective clinical study with consecutive enrollment. We enrolled patients who met all of the following inclusion criteria: clinical recovery, documented SARS-CoV-2 infection (≥1 positive rRT-PCR result) and ≥1 positive NPS among the first two follow-up swabs. A positive NPS not preceded by a negative nasopharyngeal swab collected 24-48 h earlier was considered a true positive. A negative NPS followed by a positive NPS collected 24-48 h later was regarded as a false negative. The primary outcome was to define sensitivity of SARS-CoV-2 detection with NPS. Results: Three hundred and ninety three NPS were evaluated in 233 patients; the sensitivity was 77% (95% CI, 73 to 81%). Sensitivity of the first follow-up NPS (n = 233) was 79% (95% CI, 73 to 84%) with no significant variations over time. We found no statistically significant differences in the sensitivity of the first follow-up NPS according to time since symptom onset, age, sex, number of comorbidities, and onset symptoms. Conclusions: NPS utility in the diagnostic algorithm of COVID-19 should be reconsidered.
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Affiliation(s)
- Bianca Clerici
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Antonio Muscatello
- Unità Operativa Complessa di Malattie Infettive, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Bai
- Dipartimento di Malattie Infettive, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan, Italy
| | - Donatella Pavanello
- U.O.C Pronto Soccorso e Medicina D'Urgenza, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Michela Orlandi
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Giulia C Marchetti
- Dipartimento di Malattie Infettive, ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan, Italy
| | - Valeria Castelli
- U.O.C Pronto Soccorso e Medicina D'Urgenza, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - Giorgio Costantino
- U.O.C Pronto Soccorso e Medicina D'Urgenza, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Gian Marco Podda
- Divisione di Medicina Generale II, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
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Gallioli A, Albo G, Lievore E, Boeri L, Longo F, Spinelli MG, Costantino G, Montanari E, De Lorenzis E. How the COVID-19 Wave Changed Emergency Urology: Results From an Academic Tertiary Referral Hospital in the Epicentre of the Italian Red Zone. Urology 2021; 147:43-49. [PMID: 33010292 PMCID: PMC7527349 DOI: 10.1016/j.urology.2020.09.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/07/2020] [Accepted: 09/20/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To quantify and characterize the burden of urological patients admitted to emergency department (ED) in Lombardy during Italian COVID-19 outbreak, comparing it to a reference population from 2019. METHODS We retrospectively analysed all consecutive admissions to ED from 1 January to 9 April in both 2019 and 2020. According to the ED discharge ICD-9-CM code, patients were grouped in urological and respiratory patients. We evaluated the type of access (self-presented/ambulance), discharge priority code, ED discharge (hospitalization, home), need for urological consultation or urgent surgery. RESULTS The number of urological diagnoses in ED was inversely associated to COVID-19 diagnoses (95% confidence interval -0.41/-0.19; Beta = -0.8; P < .0001). The average access per day was significantly lower after 10 March 2020 (1.5 ± 1.1 vs 6.5 ± 2.6; P < .0001), compared to reference period. From 11 March 2020, the inappropriate admissions to ED were reduced (10/45 vs 96/195; P = .001). Consequently, the patients admitted were generally more demanding, requiring a higher rate of urgent surgeries (4/45 vs 4/195; P = .02). This reflected in an increase of the hospitalization rate from 12.7% to 17.8% (Beta = 0.88; P < .0001) during 2020. CONCLUSION Urological admissions to ED during lockdown differed from the same period of 2019 both qualitatively and quantitatively. The spectrum of patients seems to be relatively more critical, often requiring an urgent management. These patients may represent a challenge due to the difficult circumstances caused by the pandemic.
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Affiliation(s)
- Andrea Gallioli
- Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Milan, Italy
| | - Giancarlo Albo
- Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Elena Lievore
- Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Milan, Italy
| | - Luca Boeri
- Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Milan, Italy
| | - Fabrizio Longo
- Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Giorgio Costantino
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Emergency Department & Emergency Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuele Montanari
- Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Elisa De Lorenzis
- Urology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
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Lombardi A, Trombetta E, Cattaneo A, Castelli V, Palomba E, Tirone M, Mangioni D, Lamorte G, Manunta M, Prati D, Ceriotti F, Gualtierotti R, Costantino G, Aliberti S, Scaravilli V, Grasselli G, Gori A, Porretti L, Bandera A. Early Phases of COVID-19 Are Characterized by a Reduction in Lymphocyte Populations and the Presence of Atypical Monocytes. Front Immunol 2020; 11:560330. [PMID: 33362757 PMCID: PMC7756112 DOI: 10.3389/fimmu.2020.560330] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 11/13/2020] [Indexed: 12/26/2022] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 is a recently discovered pathogen responsible of coronavirus disease 2019 (COVID-19). The immunological changes associated with this infection are largely unknown. Methods We evaluated the peripheral blood mononuclear cells profile of 63 patients with COVID-19 at diagnosis. We also assessed the presence of association with inflammatory biomarkers and the 28-day mortality. Results Lymphocytopenia was present in 51 of 63 (80.9%) patients, with a median value of 720 lymphocytes/µl (IQR 520-1,135). This reduction was mirrored also on CD8+ (128 cells/µl, IQR 55-215), natural killer (67 cells/µl, IQR 35-158) and natural killer T (31 cells/µl, IQR 11-78) cells. Monocytes were preserved in total number but displayed among them a subpopulation with a higher forward and side scatter properties, composed mainly of cells with a reduced expression of both CD14 and HLA-DR. Patients who died in the 28 days from admission (N=10, 15.9%), when compared to those who did not, displayed lower mean values of CD3+ (337.4 cells/µl vs 585.9 cells/µl; p=0.028) and CD4+ cells (232.2 cells/µl vs 381.1 cells/µl; p=0.042) and an higher percentage of CD8+/CD38+/HLA-DR+ lymphocytes (13.5% vs 7.6%; p=0.026). Discussion The early phases of COVID-19 are characterized by lymphocytopenia, predominance of Th2-like lymphocytes and monocytes with altered immune profile, which include atypical mononuclear cells.
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Affiliation(s)
- Andrea Lombardi
- Infectious Diseases Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Elena Trombetta
- Flow Cytometry and Cell Sorting Laboratory, Clinical Laboratory, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Alessandra Cattaneo
- Flow Cytometry and Cell Sorting Laboratory, Clinical Laboratory, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Valeria Castelli
- Infectious Diseases Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Emanuele Palomba
- Infectious Diseases Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Mario Tirone
- Flow Cytometry and Cell Sorting Laboratory, Clinical Laboratory, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Davide Mangioni
- Infectious Diseases Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milano, Milano, Italy
| | - Giuseppe Lamorte
- Translational Medicine and Biobank Unit, Department of Transfusion Medicine and Hematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Maria Manunta
- Translational Medicine and Biobank Unit, Department of Transfusion Medicine and Hematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Daniele Prati
- Department of Transfusion Medicine and Hematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Ferruccio Ceriotti
- Clinical Laboratory, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Roberta Gualtierotti
- Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Giorgio Costantino
- Emergency Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Stefano Aliberti
- Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy
- Respiratory Unit and Cystic Fibrosis Adult Center, Internal Medicine Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Vittorio Scaravilli
- Departement of Anaesthesia, Critical care and Emergency, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Giacomo Grasselli
- Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy
- Departement of Anaesthesia, Critical care and Emergency, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milano, Milano, Italy
- Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy
| | - Laura Porretti
- Flow Cytometry and Cell Sorting Laboratory, Clinical Laboratory, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milano, Milano, Italy
- Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy
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Quinn J, Chung S, Murchland A, Casazza G, Costantino G, Solbiati M, Furlan R. Association Between US Physician Malpractice Claims Rates and Hospital Admission Rates Among Patients With Lower-Risk Syncope. JAMA Netw Open 2020; 3:e2025860. [PMID: 33320263 PMCID: PMC7739124 DOI: 10.1001/jamanetworkopen.2020.25860] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
IMPORTANCE The US Government Accountability Office has changed its estimate of the annual costs of defensive medicine, largely because it has been difficult to objectively measure its impact. Evaluating the association of malpractice claims rates with hospital admission rates and the costs of admitting patients with low-risk conditions would help to document the impact of defensive medicine. Although syncope is a concerning symptom, most patients with syncope have a low risk of adverse outcomes. However, many low-risk patients are still admitted to the hospital, with associated costs of more than $2.5 billion per year in the US. OBJECTIVE To assess whether hospital admission rates after emergency department visits among patients with lower-risk syncope are associated with state-level variations in malpractice claims rates. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of emergency department visits among patients with lower-risk syncope used deidentified data from the Clinformatics Data Mart database (Optum). Lower-risk syncope visits were defined as those with a primary diagnosis of syncope and collapse based on International Classification of Diseases, Ninth Revision, Clinical Modification code 780.2 or International Classification of Diseases, Tenth Revision, Clinical Modification code R55 that did not include another major diagnostic code for a condition requiring hospital admission (such as heart disease, cancer, or medical shock) or an inpatient hospital stay of more than 3 days. These data were linked to publicly available data from the National Practitioner Data Bank pertaining to physician malpractice claims between January 1, 2008, and December 31, 2017. The 2 data sets were linked at the state-year level. Data were analyzed from October 2, 2019, to September 12, 2020. MAIN OUTCOMES AND MEASURES The association between the rate of hospital admission after emergency department visits among patients with lower-risk syncope and the rate of physician malpractice claims was assessed at the state-year level using a state-level fixed-effects model. Standardized costs obtained from the Clinformatics Data Mart database were adjusted for inflation and expressed in 2017 US dollars using the Consumer Price Index. RESULTS Among 40 482 813 emergency department visits between 2008 and 2017, 519 724 visits (1.3%) were associated with syncope. Of those, 234 750 visits (45.2%) met the criteria for lower-risk syncope. The mean (SD) age of patients in the lower-risk cohort was 71.8 (13.5) years; 141 050 patients (60.1%) were female, and 44 115 patients (18.8%) were admitted to the hospital, representing an extra cost of $6542 per admission. The mean rate of physician malpractice claims varied from 0.27 claims per 100 000 people to 8.63 claims per 100 000 people across states and across years within states. A state-level fixed-effects regression model indicated that, for every 1 in 100 000-person increase in the physician malpractice claims rate, there was an absolute increase of 6.70% (95% CI, 4.65%-8.75%) or a relative increase of 35.6% in the hospital admission rate, which represented an additional $102 million in costs associated with this lower-risk cohort. CONCLUSIONS AND RELEVANCE In this study, increases in physician malpractice claims rates were associated with increases in hospital admission rates and substantial health care costs for patients with lower-risk syncope, and these increases are likely associated with the practice of defensive medicine.
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Affiliation(s)
- James Quinn
- Department of Emergency Medicine, Stanford University, Stanford, California
| | - Sukyung Chung
- Stanford University School of Medicine, Stanford, California
| | | | - Giovanni Casazza
- Dipartimento di Scienze Biomedichee Cliniche “L. Sacco,” Universita' degli Studi di Milano, Milano, Italy
| | - Giorgio Costantino
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Monica Solbiati
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Rafaello Furlan
- Department of Internal Medicine, Humanitas University, Rozzano, Italy
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Bozzi G, Mangioni D, Minoia F, Aliberti S, Grasselli G, Barbetta L, Castelli V, Palomba E, Alagna L, Lombardi A, Ungaro R, Agostoni C, Baldini M, Blasi F, Cesari M, Costantino G, Fracanzani AL, Montano N, Monzani V, Pesenti A, Peyvandi F, Sottocorno M, Muscatello A, Filocamo G, Gori A, Bandera A. Anakinra combined with methylprednisolone in patients with severe COVID-19 pneumonia and hyperinflammation: An observational cohort study. J Allergy Clin Immunol 2020; 147:561-566.e4. [PMID: 33220354 PMCID: PMC7674131 DOI: 10.1016/j.jaci.2020.11.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/01/2020] [Accepted: 11/06/2020] [Indexed: 12/15/2022]
Abstract
Background Immunomodulants have been proposed to mitigate severe acute respiratory syndrome coronavirus 2–induced cytokine storm, which drives acute respiratory distress syndrome in coronavirus disease 2019 (COVID-19). Objective We sought to determine efficacy and safety of the association of IL-1 receptor antagonist anakinra plus methylprednisolone in severe COVID-19 pneumonia with hyperinflammation. Methods A secondary analysis of prospective observational cohort studies was carried out at an Italian tertiary health care facility. COVID-19 patients consecutively hospitalized (February 25, 2020, to March 30, 2020) with hyperinflammation (ferritin ≥1000 ng/mL and/or C-reactive protein >10 mg/dL) and respiratory failure (oxygen therapy from 0.4 FiO2 Venturi mask to invasive mechanical ventilation) were evaluated to investigate the effect of high-dose anakinra plus methylprednisolone on survival. Patients were followed from study inclusion to day 28 or death. Crude and adjusted (sex, age, baseline PaO2:FiO2 ratio, Charlson index, baseline mechanical ventilation, hospitalization to inclusion lapse) risks were calculated (Cox proportional regression model). Results A total of 120 COVID-19 patients with hyperinflammation (median age, 62 years; 80.0% males; median PaO2:FiO2 ratio, 151; 32.5% on mechanical ventilation) were evaluated. Of these, 65 were treated with anakinra and methylprednisolone and 55 were untreated historical controls. At 28 days, mortality was 13.9% in treated patients and 35.6% in controls (Kaplan-Meier plots, P = .005). Unadjusted and adjusted risk of death was significantly lower for treated patients compared with controls (hazard ratio, 0.33, 95% CI, 0.15-0.74, P = .007, and HR, 0.18, 95% CI, 0.07-0.50, P = .001, respectively). No significant differences in bloodstream infections or laboratory alterations were registered. Conclusions Treatment with anakinra plus methylprednisolone may be a valid therapeutic option in COVID-19 patients with hyperinflammation and respiratory failure, also on mechanical ventilation. Randomized controlled trials including the use of either agent alone are needed to confirm these results.
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Affiliation(s)
- Giorgio Bozzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Disease Unit, Milan, Italy
| | - Davide Mangioni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Disease Unit, Milan, Italy; Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy.
| | - Francesca Minoia
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOC Pediatria a Media Intensità di Cure, Milan, Italy
| | - Stefano Aliberti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giacomo Grasselli
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Anesthesia, Critical Care and Emergency, Milan, Italy
| | - Laura Barbetta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Acute Medical Unit, Milan, Italy
| | - Valeria Castelli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Disease Unit, Milan, Italy
| | - Emanuele Palomba
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Disease Unit, Milan, Italy
| | - Laura Alagna
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Disease Unit, Milan, Italy
| | - Andrea Lombardi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Disease Unit, Milan, Italy
| | - Riccardo Ungaro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Disease Unit, Milan, Italy
| | - Carlo Agostoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOC Pediatria a Media Intensità di Cure, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marina Baldini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Unit, Milan, Italy
| | - Francesco Blasi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Geriatric Unit, Milan, Italy
| | - Giorgio Costantino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Anesthesia, Critical Care and Emergency, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Anna Ludovica Fracanzani
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine and Metabolic Diseases Unit, Milan, Italy
| | - Nicola Montano
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine, Immunology and Allergology Unit, Milan, Italy
| | - Valter Monzani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Acute Medical Unit, Milan, Italy
| | - Antonio Pesenti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Anesthesia, Critical Care and Emergency, Milan, Italy
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine and Hemostasis and Thrombosis Unit, Milan, Italy
| | - Marcello Sottocorno
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Hospital Pharmacy, Milan, Italy
| | - Antonio Muscatello
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Disease Unit, Milan, Italy
| | - Giovanni Filocamo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOC Pediatria a Media Intensità di Cure, Milan, Italy
| | - Andrea Gori
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Disease Unit, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Alessandra Bandera
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Disease Unit, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
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Frassinelli L, Borghetti P, Giaj-Levra N, D'Angelo E, Bonù M, Salvestrini V, Costantino G, Mariotti M, Alongi F, Lohr F, Scotti V, Bruni A. PO-1000: Multicentric restrospective analysis of safety of SBRT to centrally located lesion of the lung. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01017-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Maddalo M, Altabella L, Pegurri L, Guerini A, Peretto G, Alghisi A, Turla O, Guaineri A, Costantino G, Spiazzi L, Costa L, Mozzetti C, Pasinetti N, Buglione M. PO-1572: Use of intravoxel incoherent motion (IVIM) MRI for predicting dysphagia in oropharyngeal carcinoma. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01590-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Costantino G, Peyvandi F, Montano N, Agostoni C. Romeo and Juliet: Revisited (at the time of COVID-19). Eur J Intern Med 2020; 81:94. [PMID: 32653154 PMCID: PMC7340036 DOI: 10.1016/j.ejim.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/06/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Giorgio Costantino
- Department of Clinical Sciences and Community Health, Milan, Italy; IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Francesco Sforza 28, 20122 Milan
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, University of Milan, Italy; IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Francesco Sforza 28, 20122 Milan
| | - Nicola Montano
- Department of Clinical Sciences and Community Health, Milan, Italy; IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Francesco Sforza 28, 20122 Milan.
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, Milan, Italy; IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Francesco Sforza 28, 20122 Milan
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