1
|
Veronese N, Di Gennaro F, Frallonardo L, Ciriminna S, Papagni R, Carruba L, Agnello D, De Iaco G, De Gennaro N, Di Franco G, Naro L, Brindicci G, Rizzo A, Bavaro DF, Garlisi MC, Santoro CR, Signorile F, Balena F, Mansueto P, Milano E, Giannitrapani L, Fiordelisi D, Mariani MF, Procopio A, Lattanzio R, Licata A, Vernuccio L, Amodeo S, Guido G, Segala FV, Barbagallo M, Saracino A. Real life experience on the use of Remdesivir in patients admitted to COVID-19 in two referral Italian hospital: a propensity score matched analysis. Sci Rep 2024; 14:9303. [PMID: 38654033 DOI: 10.1038/s41598-024-59957-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 04/17/2024] [Indexed: 04/25/2024] Open
Abstract
Remdesivir (RDV) was the first Food and Drug Administration (FDA)-approved medication for COVID-19, with discordant data on efficacy in reducing mortality risk and disease progression. In the context of a dynamic and rapidly changing pandemic landscape, the utilization of real-world evidence is of utmost importance. The objective of this study is to evaluate the impact of RDV on patients who have been admitted to two university referral hospitals in Italy due to COVID-19. All patients older than 18 years and hospitalized at two different universities (Bari and Palermo) were enrolled in this study. To minimize the effect of potential confounders, we used propensity score matching with one case (Remdesivir) and one control that never experienced this kind of intervention during hospitalization. Mortality was the primary outcome of our investigation, and it was recorded using death certificates and/or medical records. Severe COVID-19 was defined as admission to the intensive care unit or a qSOFAscore ≥ 2 or CURB65scores ≥ 3. After using propensity score matching, 365 patients taking Remdesivir and 365 controls were included. No significant differences emerged between the two groups in terms of mean age and percentage of females, while patients taking Remdesivir were less frequently active smokers (p < 0.0001). Moreover, the patients taking Remdesivir were less frequently vaccinated against COVID-19. All the other clinical, radiological, and pharmacological parameters were balanced between the two groups. The use of Remdesivir in our cohort was associated with a significantly lower risk of mortality during the follow-up period (HR 0.56; 95% CI 0.37-0.86; p = 0.007). Moreover, RDV was associated with a significantly lower incidence of non-invasive ventilation (OR 0.27; 95% CI 0.20-0.36). Furthermore, in the 365 patients taking Remdesivir, we observed two cases of mild renal failure requiring a reduction in the dosage of Remdesivir and two cases in which the physicians decided to interrupt Remdesivir for bradycardia and for QT elongation. Our study suggests that the use of Remdesivir in hospitalized COVID-19 patients is a safe therapy associated with improved clinical outcomes, including halving of mortality and with a reduction of around 75% of the risk of invasive ventilation. In a constantly changing COVID-19 scenario, ongoing research is necessary to tailor treatment decisions based on the latest scientific evidence and optimize patient outcomes.
Collapse
Affiliation(s)
- Nicola Veronese
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Francesco Di Gennaro
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Luisa Frallonardo
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy.
| | - Stefano Ciriminna
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Roberta Papagni
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Luca Carruba
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Diletta Agnello
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Giuseppina De Iaco
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Nicolò De Gennaro
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Giuseppina Di Franco
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Liliana Naro
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Gaetano Brindicci
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Angelo Rizzo
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Davide Fiore Bavaro
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Maria Chiara Garlisi
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Carmen Rita Santoro
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Fabio Signorile
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Flavia Balena
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Pasquale Mansueto
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Eugenio Milano
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Lydia Giannitrapani
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Deborah Fiordelisi
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Michele Fabiano Mariani
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Andrea Procopio
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Rossana Lattanzio
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Anna Licata
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Laura Vernuccio
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Simona Amodeo
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Giacomo Guido
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Francesco Vladimiro Segala
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| | - Mario Barbagallo
- Geriatrics Section, Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Annalisa Saracino
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Clinic of Infectious Diseases, University of Bari "Aldo Moro", Piazza Giulio Cesare N. 11 Cap, 70124, Bari, Italy
| |
Collapse
|
2
|
Veronese N, Segala FV, Carruba L, La Carrubba A, Pollicino F, Di Franco G, Guido G, Cormio M, Lugli A, De Santis L, Guerra V, Pepe M, Tritto R, Ciccone MM, Bavaro DF, Brindicci G, Mansueto P, Giannitrapani L, Di Gennaro F, Barbagallo M, Saracino A. Anemia as a risk factor for disease progression in patients admitted for COVID-19: data from a large, multicenter cohort study. Sci Rep 2023; 13:9035. [PMID: 37270578 DOI: 10.1038/s41598-023-36208-y] [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: 01/22/2023] [Accepted: 05/31/2023] [Indexed: 06/05/2023] Open
Abstract
In respiratory infections, anemia is both a consequence of acute inflammation and a predictor of poor clinical outcomes. There are few studies investigating the role of anemia in COVID-19, suggesting a potential role in predicting disease severity. In this study, we aimed to assess the association between the presence of anemia at admission and incidence of severe disease and death in patients hospitalized for COVID-19. Data from all adult patients admitted for COVID-19 in University Hospital "P. Giaccone" Palermo, and University Hospital of Bari, Italy, were retrospectively collected from 1st of September 2020 to 31 August 2022. The association between anemia (defined as Hb < 13 g/dl and < 12 g/dl in males and females, respectively), in-hospital mortality and severe COVID-19 was tested using a Cox's regression analysis. Severe COVID-19 forms were defined as admission to intensive or sub-intensive care unit or a qSOFAscore ≥ 2 or CURB65scores ≥ 3. p values were calculated using the Student's t test for continuous variables and the Mantel-Haenszel Chi-square test for categorical ones. The association between anemia and the mortality was made using a Cox's regression analysis, adjusted, in two models, for the potential confounders and using a propensity score. Among the 1562 patients included in the analysis, prevalence of anemia was 45.1% (95% CI 43-48%). Patients with anemia were significantly older (p < 0.0001), reported more co-morbidities, and presented higher baseline levels of procalcitonin, CRP, ferritin and IL-6. Overall, the crude incidence of mortality was about four times higher in patients with anemia compared to those without. After adjusting for 17 potential confounders, the presence of anemia significantly increased the risk of death (HR = 2.68; 95% CI: 1.59-4.52) and of risk of severe COVID-19 (OR = 2.31; 95% CI: 1.65-3.24). The propensity score analysis substantially confirmed these analyses. Our study provides evidence that, in patients hospitalized for COVID-19, anemia is both associated with a more pronounced baseline pro-inflammatory profile and higher incidence of in-hospital mortality and severe disease.
Collapse
Affiliation(s)
- Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | - Francesco Vladimiro Segala
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| | - Luca Carruba
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | - Anna La Carrubba
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | - Francesco Pollicino
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | - Giusi Di Franco
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | - Giacomo Guido
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy.
| | - Mariangela Cormio
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| | - Alessia Lugli
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| | - Laura De Santis
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| | - Vittorio Guerra
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| | - Martino Pepe
- Section of Cardiovascular Diseases, Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, Bari, Italy
| | - Rocco Tritto
- Section of Cardiovascular Diseases, Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, Bari, Italy
| | - Marco Matteo Ciccone
- Section of Cardiovascular Diseases, Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, Bari, Italy
| | - Davide Fiore Bavaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| | - Gaetano Brindicci
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| | - Pasquale Mansueto
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | - Lydia Giannitrapani
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), Via Ugo La Malfa 153, 90146, Palermo, Italy
| | - Francesco Di Gennaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| | - Mario Barbagallo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124, Bari, Italy
| |
Collapse
|
3
|
Cella A, Veronese N, Custodero C, Castagna A, Cammalleri LA, Capitano WM, Solimando L, Carruba L, Sabbà C, Ruotolo G, Barbagallo M, Pilotto A. Validation of Abbreviated Form of the Multidimensional Prognostic Index (MPI): The BRIEF-MPI Project. Clin Interv Aging 2022; 17:789-796. [PMID: 35592643 PMCID: PMC9112183 DOI: 10.2147/cia.s355801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/10/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Participants and Methods Results Conclusion
Collapse
Affiliation(s)
- Alberto Cella
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | | | - Lisa A Cammalleri
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy
| | - Walter M Capitano
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Luisa Solimando
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Luca Carruba
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Carlo Sabbà
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | | | - Mario Barbagallo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Ospedali Galliera, Genova, Italy
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
- Correspondence: Alberto Pilotto, Via delle Mura Capuccine, 14, Genova, 16128, Italy, Tel +39 010 5634400, Fax +39 010 5634400, Email
| |
Collapse
|