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Damanti S, Cilla M, Tuscano B, Pomaranzi C, Tiraferri V, Papaioannu R, Ponta G, DE Lorenzo R, Chiabrando F, Vitali G, Tresoldi M, Rovere Querini P. Muscle quality assessment in COVID-19 survivors: agreement between echointensity and stiffness. Panminerva Med 2024:S0031-0808.24.05122-X. [PMID: 38576305 DOI: 10.23736/s0031-0808.24.05122-x] [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] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Affiliation(s)
- Sarah Damanti
- IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy -
- Unit of Internal Medicine, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy -
| | - Marta Cilla
- Center for Liver Disease, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Bruno Tuscano
- Unit of Radiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Chiara Pomaranzi
- IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Valeria Tiraferri
- IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Rebecka Papaioannu
- IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
- Department of Infectious Diseases, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Giacomo Ponta
- IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
- Department of Infectious Diseases, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Rebecca DE Lorenzo
- IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
- Unit of Internal Medicine, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Filippo Chiabrando
- IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Giordano Vitali
- Unit of Internal Medicine, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Moreno Tresoldi
- Unit of Internal Medicine, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Patrizia Rovere Querini
- IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
- Unit of Internal Medicine, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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Franchini S, Mette F, Landoni G, Setti E, Ferrante L, Calcaterra B, Pagliula G, Barbieri A, Fontani D, Borio G, Citro M, Farolfi F, Suma G, Monti G, Colombo S, Dagna L, Rovere-Querini P, DE Cobelli F, Castagna A, Ciceri F, Zangrillo A, Tresoldi M, Secchi A, Etteri M. Gas-exchange deficit and systemic hypoperfusion in COVID-19 and non-COVID-19 young adult patients with pneumonia. Panminerva Med 2024; 66:27-35. [PMID: 35119247 DOI: 10.23736/s0031-0808.22.04562-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lung damage leading to gas-exchange deficit and sepsis leading to systemic hypoperfusion are well-known features of severe pneumonia. Although frequently described in COVID-19, their prognostic impact in COVID-19-related pneumonia versus COVID-19-unrelated pneumonia has never been compared. This study assesses fundamental gas-exchange and hemodynamic parameters and explores their prognostic impact in COVID-19 pneumonia and non-COVID-19 pneumonia. METHODS We prospectively evaluated arterial pO2/FiO2, alveolar to arterial O2 gradient, shock index, and serum lactate in 126 COVID-19 pneumonia patients, aged 18-65, presenting to the emergency department with acute, non-hypercapnic respiratory failure. As a control group we identified 1:1 age-, sex-, and pO2/FiO2-matched COVID-19-urelated pneumonia patients. Univariate and multivariable predictors of 30-day survival were identified in both groups. RESULTS COVID-19 patients showed lower arterial serum lactate concentration (P<0.001) and shock index (P<0.001) values as compared to non-COVID-19 patients. While we did not observe differences in lactate concentration or in shock index values in deceased vs. surviving COVID-19 patients (P=0.7 and P=0.6, respectively), non-COVID-19 deceased patients showed significantly higher lactate and shock index than non-COVID-19 survivors (P<0.001 and P=0.03). The pO2/FiO2 was the most powerful determinant of survival by Cox regression multivariate analysis in COVID-19 patients (P=0.006), while it was lactate in non-COVID-19 patients (P=0.001). CONCLUSIONS As compared to COVID19-unrelated pneumonia, COVID-19 pneumonia outcome seems more strictly correlated to the extent of lung damage, rather than to the systemic circulatory and metabolic derangements typical of sepsis.
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Affiliation(s)
- Stefano Franchini
- Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy -
| | - Francesca Mette
- Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Eleonora Setti
- Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Ferrante
- Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Calcaterra
- Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gaia Pagliula
- Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Dario Fontani
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Giorgia Borio
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Marta Citro
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Farolfi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Gloria Suma
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Giacomo Monti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sergio Colombo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Rovere-Querini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Internal Medicine, Diabetes, and Endocrinology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco DE Cobelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Infectious Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - Fabio Ciceri
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Moreno Tresoldi
- General Medicine and Advanced Care Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Antonio Secchi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Ramirez GA, Damanti S, Caruso PF, Mette F, Pagliula G, Cariddi A, Sartorelli S, Falbo E, Scotti R, Di Terlizzi G, Dagna L, Praderio L, Sabbadini MG, Bozzolo EP, Tresoldi M. Sustainability in Internal Medicine: A Year-Long Ward-Wide Observational Study. J Pers Med 2024; 14:115. [PMID: 38276237 PMCID: PMC10820757 DOI: 10.3390/jpm14010115] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/14/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Population aging and multimorbidity challenge health system sustainability, but the role of assistance-related variables rather than individual pathophysiological factors in determining patient outcomes is unclear. To identify assistance-related determinants of sustainable hospital healthcare, all patients hospitalised in an Internal Medicine Unit (n = 1073) were enrolled in a prospective year-long observational study and split 2:1 into a training (n = 726) and a validation subset (n = 347). Demographics, comorbidities, provenance setting, estimates of complexity (cumulative illness rating scale, CIRS: total, comorbidity, CIRS-CI, and severity, CIRS-SI subscores) and intensity of care (nine equivalents of manpower score, NEMS) were analysed at individual and Unit levels along with variations in healthcare personnel as determinants of in-hospital mortality, length of stay and nosocomial infections. Advanced age, higher CIRS-SI, end-stage cancer, and the absence of immune-mediated diseases were correlated with higher mortality. Admission from nursing homes or intensive care units, dependency on activity of daily living, community- or hospital-acquired infections, oxygen support and the number of exits from the Unit along with patient/physician ratios were associated with prolonged hospitalisations. Upper gastrointestinal tract disorders, advanced age and higher CIRS-SI were associated with nosocomial infections. In addition to demographic variables and multimorbidity, physician number and assistance context affect hospitalisation outcomes and healthcare sustainability.
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Affiliation(s)
- Giuseppe A. Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Sarah Damanti
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Pier Francesco Caruso
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Francesca Mette
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Gaia Pagliula
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Adriana Cariddi
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Silvia Sartorelli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Elisabetta Falbo
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Raffaella Scotti
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Gaetano Di Terlizzi
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
| | - Luisa Praderio
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Maria Grazia Sabbadini
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy (E.F.)
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Enrica P. Bozzolo
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy (G.D.T.); (M.T.)
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Tresoldi M, Zangrillo A, Belletti A, Ramirez GA, Bozzolo E, Guzzo F, Marinosci A, Fominskiy EV, DA Prat V, Marmiere M, Palumbo D, Del Prete L, D'Amico F, Bellino C, Morando D, Saracino M, Ortalda A, Castelli E, Rocchi M, Baiardo Redaelli M, Scotti R, DI Terlizzi G, Azzolini ML, Guaschino G, Avitabile E, Borghi G, Soddu D, Dagna L, Landoni G, DE Cobelli F. Two-year multidisciplinary follow-up of COVID-19 patients requiring invasive and noninvasive respiratory support. Minerva Med 2023; 114:773-784. [PMID: 37021472 DOI: 10.23736/s0026-4806.22.08397-5] [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] [Indexed: 04/07/2023]
Abstract
BACKGROUND COVID-19 patients frequently develop respiratory failure requiring mechanical ventilation. Data on long-term survival of patients who had severe COVID-19 are insufficient. We assessed and compared two-year survival, CT imaging, quality of life, and functional recovery of COVID-19 ARDS patients requiring respiratory support with invasive (IMV) versus noninvasive ventilation (NIV). METHODS Patients with COVID-19 pneumonia admitted up to May 28th, 2020, who required IMV or NIV, and survived to hospital discharge were enrolled. Patients were contacted two years after discharge to assess vital status, functional, psychological, and cognitive outcomes using validated scales. Patients with persistent respiratory symptoms or high burden of residual lung damage at previous CT scan received a two-year chest CT scan. RESULTS Out of 61 IMV survivors, 98% were alive at two-year follow-up, and 52 completed the questionnaire. Out of 82 survivors receiving NIV only, 94% were alive at two years, and 47 completed the questionnaire. We found no major differences between invasively and noninvasively ventilated patients, with overall acceptable functional recovery. Among the 99 patients completing the questionnaire, 23 have more than moderate exertional dyspnea. Chest CT scans showed that 4 patients (all received IMV) had fibrotic-like changes. CONCLUSIONS Patients who received mechanical ventilation due to COVID-19 and were discharged from hospital had a 96% survival rate at the two-year follow-up. There was no difference in overall recovery and quality of life between patients who did and did not require IMV, although respiratory morbidity remains high.
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Affiliation(s)
- Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe A Ramirez
- Unit of Immunology, Rheumatology, Allergy, and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrica Bozzolo
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Guzzo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Marinosci
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Evgeny V Fominskiy
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valentina DA Prat
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marilena Marmiere
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Diego Palumbo
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lidia Del Prete
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Filippo D'Amico
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Bellino
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Deodata Morando
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Saracino
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Ortalda
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena Castelli
- Cardiothoracic Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Margherita Rocchi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Baiardo Redaelli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Scotti
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gaetano DI Terlizzi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria L Azzolini
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy -
| | - Giulia Guaschino
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emma Avitabile
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Borghi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniele Soddu
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy, and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco DE Cobelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Landi A, Morici N, Vranckx P, Frigoli E, Bonacchini L, Omazzi B, Tresoldi M, Camponovo C, Moccetti T, Valgimigli M. Edoxaban and/or colchicine in outpatients with COVID-19: rationale and design of the CONVINCE trial. J Cardiovasc Med (Hagerstown) 2023; 24:920-930. [PMID: 37942793 DOI: 10.2459/jcm.0000000000001556] [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] [Indexed: 11/10/2023]
Abstract
BACKGROUND An excessive inflammatory response and a hypercoagulable state are not infrequent in patients with coronavirus disease-2019 (COVID-19) and are associated with adverse clinical outcomes. However, the optimal treatment strategy for COVID-19 patients managed in the out-of-hospital setting is still uncertain. DESIGN The CONVINCE (NCT04516941) is an investigator-initiated, open-label, blinded-endpoint, 2 × 2 factorial design randomized trial aimed at assessing two independently tested hypotheses (anticoagulation and anti-inflammatory ones) in COVID-19 patients. Adult symptomatic patients (≥18 years of age) within 7 days from reverse transcription-PCR (RT-PCR) diagnosis of SARS-CoV-2 infection managed at home or in nursery settings were considered for eligibility. Eligible patients fulfilling all inclusion and no exclusion criteria were randomized to edoxaban versus no treatment (anticoagulation hypothesis) and colchicine versus no treatment (anti-inflammatory hypothesis) in a 1 : 1:1 : 1 ratio. The study had two co-primary endpoints (one for each randomization), including the composite of major vascular thrombotic events at 25 ± 3 days for the anticoagulation hypothesis and the composite of SARS-CoV-2 detection rates at 14 ± 3 days by RT-PCR or freedom from death or hospitalizations (anti-inflammatory hypothesis). Study endpoints will be adjudicated by a blinded Clinical Events Committee. With a final sample size of 420 patients, this study projects an 80% power for each of the two primary endpoints appraised separately. CONCLUSION The CONVINCE trial aims at determining whether targeting anticoagulation and/or anti-inflammatory pathways may confer benefit in COVID-19 patients managed in the out-of-hospital setting. TRIAL REGISTRATION ClinicalTrials.gov number, NCT04516941.
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Affiliation(s)
- Antonio Landi
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC)
- Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Nuccia Morici
- IRCCS S. Maria Nascente - Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Pascal Vranckx
- the Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Enrico Frigoli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC)
| | - Luca Bonacchini
- Emergency Department, ASST Great Metropolitan Hospital Niguarda, Milan
| | - Barbara Omazzi
- Emergency Unit, ASST Rhodense, Garbagnate Milanese, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Hospital, Milan
| | - Claudio Camponovo
- Department of Anesthesiology, Clinica Ars Medica, Genolier Swiss Medical Network, Gravesano
| | | | - Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC)
- Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
- University of Bern, Bern, Switzerland
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6
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Capogrosso P, Bertini A, Pontillo M, Ferrara AM, Cotelessa A, Carenzi C, Ramirez GA, Tresoldi C, Locatelli M, Castagna A, De Cobelli F, Tresoldi M, Zangrillo A, Landoni G, Rovere-Querini P, Ciceri F, Montorsi F, Monti G, Salonia A. Is SARS-CoV-2-induced disease a decisive factor influencing testosterone in males? Findings from a case-control ex post facto study. Andrology 2023. [PMID: 37987031 DOI: 10.1111/andr.13558] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/29/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Whether the observed lower total testosterone (tT) levels in male patients with COVID-19 are caused by a direct impact of SARS-CoV-2 infection or are collateral phenomena shared by other systemic inflammatory conditions has not yet been clarified. OBJECTIVES To investigate the independent role of COVID-19 in reducing circulating tT levels in men. MATERIALS AND METHODS We compared demographic, clinical, and hormonal values of patients with laboratory confirmed COVID-19 admitted during the first wave of the pandemic with a cohort of consecutive male patients admitted to the intensive care unit (ICU) of the same academic center because of severe acute respiratory distress syndrome (ARDS) but without SARS-CoV-2 infection and no previous history of COVID-19. Linear regression model tested the independent impact of COVID-19 on circulating tT levels. Logistic regression model was used to test predictors of death in the entire cohort. RESULTS Of 286 patients with COVID-19, 70 men had been admitted to the ICU ( = cases) and were compared to 79 patients equally admitted to ICU because of severe ARDS but negative for SARS-CoV-2 infection and without previous history of COVID-19 ( = controls). Controls were further grouped into noninfective (n = 49) and infective-ARDS (n = 30) patients. At baseline, controls were older (p = 0.01) and had more comorbidities (p < 0.0001). Overall, cases admitted to ICU had significantly lower circulating tT levels compared to controls (0.9 nmol/L vs. 2.1 nmol/L; vs. 1.2 nmol/L; p = 0.03). At linear regression, being negative for COVID-19 was associated with higher tT levels (Coeff: 2.13; 95% confidence interval - CI 0.71-3.56; p = 0.004) after adjusting for age, BMI, comorbidities and IL-6 levels. Only age and IL-6 levels emerged to be associated with higher risk of death regardless of COVID-19 status. CONCLUSIONS This case-control ex post facto study showed lower tT levels in men with COVID-19 compared to those without COVID-19 despite both groups have been equally admitted to ICU for severe ARDS, thus suggesting a possible direct impact of SARS-CoV-2 infection toward circulating tT levels and a consequent more severe clinical outcome.
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Affiliation(s)
- Paolo Capogrosso
- Department of Urology, Circolo and Fondazione Macchi Hospital - ASST Sette Laghi, Varese, Italy
| | - Alessandro Bertini
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Marina Pontillo
- Laboratory Medicine Service, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Anna Maria Ferrara
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alice Cotelessa
- Laboratory Medicine Service, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Cristina Carenzi
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppe A Ramirez
- Division of Immunology, Transplantation and Infectious Diseases, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Cristina Tresoldi
- Molecular Hematology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Locatelli
- Laboratory Medicine Service, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antonella Castagna
- University Vita-Salute San Raffaele, Milan, Italy
- Department of Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Moreno Tresoldi
- General Medicine and Advanced Care Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Zangrillo
- University Vita-Salute San Raffaele, Milan, Italy
- Anesthesia and Intensive Care Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giovanni Landoni
- University Vita-Salute San Raffaele, Milan, Italy
- Anesthesia and Intensive Care Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Patrizia Rovere-Querini
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Immunology, Transplantation and Infectious Diseases, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Fabio Ciceri
- University Vita-Salute San Raffaele, Milan, Italy
- Hematology and Bone Marrow Transplant Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Giacomo Monti
- University Vita-Salute San Raffaele, Milan, Italy
- Anesthesia and Intensive Care Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
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7
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Monti G, Rezoagli E, Calini A, Nova A, Marchesi S, Nattino G, Carrara G, Morra S, Cortellaro F, Savioli M, Capra Marzani F, Tresoldi M, Villa P, Greco S, Bonfanti P, Spitoni MG, Vesconi S, Caironi P, Fumagalli R. Effect of a quality improvement program on compliance to the sepsis bundle in non-ICU patients: a multicenter prospective before and after cohort study. Front Med (Lausanne) 2023; 10:1215341. [PMID: 38020128 PMCID: PMC10680451 DOI: 10.3389/fmed.2023.1215341] [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: 05/01/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Sepsis and septic shock are major challenges and economic burdens to healthcare, impacting millions of people globally and representing significant causes of mortality. Recently, a large number of quality improvement programs focused on sepsis resuscitation bundles have been instituted worldwide. These educational initiatives have been shown to be associated with improvements in clinical outcomes. We aimed to evaluate the impact of a multi-faceted quality implementing program (QIP) on the compliance of a "simplified 1-h bundle" (Sepsis 6) and hospital mortality of severe sepsis and septic shock patients out of the intensive care unit (ICU). Methods Emergency departments (EDs) and medical wards (MWs) of 12 academic and non-academic hospitals in the Lombardy region (Northern Italy) were involved in a multi-faceted QIP, which included educational and organizational interventions. Patients with a clinical diagnosis of severe sepsis or septic shock according to the Sepsis-2 criteria were enrolled in two different periods: from May 2011 to November 2011 (before-QIP cohort) and from August 2012 to June 2013 (after-QIP cohort). Measurements and main results The effect of QIP on bundle compliance and hospital mortality was evaluated in a before-after analysis. We enrolled 467 patients in the before-QIP group and 656 in the after-QIP group. At the time of enrollment, septic shock was diagnosed in 50% of patients, similarly between the two periods. In the after-QIP group, we observed increased compliance to the "simplified rapid (1 h) intervention bundle" (the Sepsis 6 bundle - S6) at three time-points evaluated (1 h, 13.7 to 18.7%, p = 0.018, 3 h, 37.1 to 48.0%, p = 0.013, overall study period, 46.2 to 57.9%, p < 0.001). We then analyzed compliance with S6 and hospital mortality in the before- and after-QIP periods, stratifying the two patients' cohorts by admission characteristics. Adherence to the S6 bundle was increased in patients with severe sepsis in the absence of shock, in patients with serum lactate <4.0 mmol/L, and in patients with hypotension at the time of enrollment, regardless of the type of admission (from EDs or MWs). Subsequently, in an observational analysis, we also investigated the relation between bundle compliance and hospital mortality by logistic regression. In the after-QIP cohort, we observed a lower in-hospital mortality than that observed in the before-QIP cohort. This finding was reported in subgroups where a higher adherence to the S6 bundle in the after-QIP period was found. After adjustment for confounders, the QIP appeared to be independently associated with a significant improvement in hospital mortality. Among the single S6 procedures applied within the first hour of sepsis diagnosis, compliance with blood culture and antibiotic therapy appeared significantly associated with reduced in-hospital mortality. Conclusion A multi-faceted QIP aimed at promoting an early simplified bundle of care for the management of septic patients out of the ICU was associated with improved compliance with sepsis bundles and lower in-hospital mortality.
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Affiliation(s)
- Gianpaola Monti
- Department of Anesthesia and Intensive Care, ASST GOM Niguarda Ca’ Granda, Milan, Italy
| | - Emanuele Rezoagli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Anesthesia and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Angelo Calini
- Department of Anesthesia and Intensive Care, ASST GOM Niguarda Ca’ Granda, Milan, Italy
| | - Alice Nova
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Silvia Marchesi
- Intensiv och perioperativ vard, Skane Universitetssjukhus, Malmo, Sweden
| | - Giovanni Nattino
- Istituto di ricerche farmacologiche Mario Negri IRCCS, Ranica, Bergamo, Italy
| | - Greta Carrara
- Istituto di ricerche farmacologiche Mario Negri IRCCS, Ranica, Bergamo, Italy
| | - Sergio Morra
- Department of Anesthesia and Intensive Care, ASST Ovest Milano, Legnano, Italy
| | | | - Monica Savioli
- Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCSC Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Federico Capra Marzani
- Department of Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Villa
- Department of Emergency, ASST FBF - Sacco, Ospedale L. Sacco, Milan, Italy
| | - Stefano Greco
- Department of Anesthesia and Intensive Care, ASST Valle Olona, Ospedale Busto Arsitio, Busto Arsitio, Italy
| | - Paolo Bonfanti
- Infectious Diseases, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Sergio Vesconi
- Department of Anesthesia and Intensive Care, ASST GOM Niguarda Ca’ Granda, Milan, Italy
| | - Pietro Caironi
- Department of Anesthesia and Intensive Care, AOU S. Luigi Gonzaga, Università degli Studi di Torino, Orbassano, Italy
| | - Roberto Fumagalli
- Department of Anesthesia and Intensive Care, ASST GOM Niguarda Ca’ Granda, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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8
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Damanti S, Cilla M, Vitali G, Tiraferri V, Pomaranzi C, De Rubertis G, De Lorenzo R, Di Lucca G, Scotti R, Messina E, Dell’Acqua R, Guffanti M, Cinque P, Castagna A, Rovere-Querini P, Tresoldi M. Exploring the Association between Delirium and Malnutrition in COVID-19 Survivors: A Geriatric Perspective. Nutrients 2023; 15:4727. [PMID: 38004121 PMCID: PMC10674410 DOI: 10.3390/nu15224727] [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: 09/25/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Older individuals face an elevated risk of developing geriatric syndromes when confronted with acute stressors like COVID-19. We assessed the connection between in-hospital delirium, malnutrition, and frailty in a cohort of COVID-19 survivors. Patients aged ≥65, hospitalized in a tertiary hospital in Milan for SARS-CoV-2 pneumonia, were enrolled and screened for in-hospital delirium with the 4 'A's Test (4AT) performed twice daily (morning and evening) during hospital stay. Malnutrition was assessed with the malnutrition universal screening tool (MUST) at hospital admission and with the mini-nutritional assessment short-form (MNA-SF) one month after hospital discharge. Frailty was computed with the frailty index one month after hospital discharge. Fifty patients (median age 78.5, 56% male) were enrolled. At hospital admission, 10% were malnourished. The 13 patients (26%) who developed delirium were frailer (7 vs. 4), experienced a higher in-hospital mortality (5 vs. 3), and were more malnourished one month after discharge (3 of the 4 patients with delirium vs. 6 of the 28 patients without delirium who presented at follow up). The 4AT scores correlated with the MNA-SF scores (r = -0.55, p = 0.006) and frailty (r = 0.35, p = 0.001). Frailty also correlated with MUST (r = 0.3, p = 0.04), MNA-SF (r = -0.42, p = 0.02), and hospitalization length (r = 0.44, p = 0.001). Delirium, malnutrition, and frailty are correlated in COVID-19 survivors. Screening for these geriatric syndromes should be incorporated in routine clinical practice.
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Affiliation(s)
- Sarah Damanti
- Vita Salute University, 20100 Milan, Italy; (V.T.); (C.P.); (G.D.R.); (R.D.L.); (A.C.); (P.R.-Q.)
- General Medicine and Continuity of Care Unit, IRCCS San Raffaele Hospital, 20132 Milan, Italy;
| | - Marta Cilla
- Center for Liver Disease, Division of Internal Medicine and Hepatology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy;
| | - Giordano Vitali
- General Medicine and Continuity of Care Unit, IRCCS San Raffaele Hospital, 20132 Milan, Italy;
| | - Valeria Tiraferri
- Vita Salute University, 20100 Milan, Italy; (V.T.); (C.P.); (G.D.R.); (R.D.L.); (A.C.); (P.R.-Q.)
| | - Chiara Pomaranzi
- Vita Salute University, 20100 Milan, Italy; (V.T.); (C.P.); (G.D.R.); (R.D.L.); (A.C.); (P.R.-Q.)
| | - Giulia De Rubertis
- Vita Salute University, 20100 Milan, Italy; (V.T.); (C.P.); (G.D.R.); (R.D.L.); (A.C.); (P.R.-Q.)
| | - Rebecca De Lorenzo
- Vita Salute University, 20100 Milan, Italy; (V.T.); (C.P.); (G.D.R.); (R.D.L.); (A.C.); (P.R.-Q.)
| | - Giuseppe Di Lucca
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; (G.D.L.); (R.S.); (M.T.)
| | - Raffaella Scotti
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; (G.D.L.); (R.S.); (M.T.)
| | - Emanuela Messina
- Infectious Diseases Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (E.M.); (M.G.); (P.C.)
| | - Raffaele Dell’Acqua
- Infectious Diseases Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (E.M.); (M.G.); (P.C.)
| | - Monica Guffanti
- Infectious Diseases Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (E.M.); (M.G.); (P.C.)
| | - Paola Cinque
- Infectious Diseases Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (E.M.); (M.G.); (P.C.)
| | - Antonella Castagna
- Vita Salute University, 20100 Milan, Italy; (V.T.); (C.P.); (G.D.R.); (R.D.L.); (A.C.); (P.R.-Q.)
- Infectious Diseases Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (E.M.); (M.G.); (P.C.)
| | - Patrizia Rovere-Querini
- Vita Salute University, 20100 Milan, Italy; (V.T.); (C.P.); (G.D.R.); (R.D.L.); (A.C.); (P.R.-Q.)
- General Medicine and Continuity of Care Unit, IRCCS San Raffaele Hospital, 20132 Milan, Italy;
- Division of Immunology, Transplantation & Infectious Diseases, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; (G.D.L.); (R.S.); (M.T.)
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9
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Nemola G, Russi A, Cozzani G, Leo G, Vetrugno L, Sparasci FM, Parlati AL, Della Bella P, Montorfano M, Tresoldi M, Salerno A, Cera M, Mattiello P, Comi G, Maisano F, Zangrillo A, Gaspardone C, Melillo F, Margonato A, Godino C. Baseline Characteristics and 3-Year Outcome of Nonvalvular Atrial Fibrillation Patients Treated with the Four Direct Oral Anticoagulants (DOACs). Am J Cardiol 2023; 206:125-131. [PMID: 37703678 DOI: 10.1016/j.amjcard.2023.07.181] [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: 04/26/2023] [Revised: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 09/15/2023]
Abstract
Direct oral anticoagulants (DOACs) represent the cornerstone therapy for cardioembolic events prevention in patients with nonvalvular atrial fibrillation (NVAF). In practice, the choice of one DOAC over another is guided by the decision-making process of the physician, which considers specific patient and drug characteristics. This study aimed to evaluate the clinical features and long-term outcomes of a real-world population treated with DOACs, where the use of the 4 different DOACs is quite equal. We conducted a retrospective observational, single-center, multidisciplinary study enrolling consecutive NVAF patients treated with one of the 4 DOACs. From an initial number of 753 patients, we excluded 72 patients because of loss to follow-up, at the end we enrolled 681:174 (23%) treated with dabigatran, 175 (23%) with apixaban, 190 (25%) with rivaroxaban, and 214 (29%) with edoxaban. Patients treated with apixaban were significantly older, more women represented (p <0.001), and with a higher cardioembolic and bleeding risk (p <0.001). Dabigatran was preferred in patients with liver failure (p = 0.008), whereas Apixaban and Edoxaban were chosen in chronic kidney disease (p = 0.002). At 3-year follow-up, 20 patients (2.7%) experienced a systemic thromboembolic event without significant differences in the 4 DOACs. In the same period, an International Society of Thrombosis and Hemostasis classification major bleeding event occurred in 26 patients (3.6%), more statistically correlated to edoxaban (6.1%) (p = 0.038). Thromboembolic events or major bleeding were higher in the edoxaban group (10%) compared with the others (p = 0.014). In our single-center real-world experience, the choice of the DOAC for a patient with NVAF was tailored to specific clinical features and drug pharmacokinetics of the patient. As a result, a small number of adverse events were observed.
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Affiliation(s)
- Giulia Nemola
- Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anita Russi
- Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gianmarco Cozzani
- Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Leo
- Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Vetrugno
- Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Paolo Della Bella
- Arrhythmia and Electrophysiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiovascular Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- Internal Medicine Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Salerno
- Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michela Cera
- Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Mattiello
- Data analyst, Database and Data Warehouse Specialist, San Raffaele Scientific Institute, Milan, Italy
| | - Giancarlo Comi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Maisano
- Cardiac Surgery Unit, Heart Valve Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Gaspardone
- Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Melillo
- Echo Lab, Clinica Montevergine, GVM Care and Research, Mercogliano (AV), Italy
| | - Alberto Margonato
- Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cosmo Godino
- Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Heart Valve Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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10
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Consolo F, Marmiere M, Ramirez GA, Marinosci A, Tresoldi M, Landoni G, Zangrillo A. Platelet prothrombotic activity in COVID-19 survivors with persisting respiratory symptoms after 2 years from hospital discharge. Minerva Med 2023:S0026-4806.23.08661-5. [PMID: 37204784 DOI: 10.23736/s0026-4806.23.08661-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Affiliation(s)
| | - Marilena Marmiere
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giuseppe A Ramirez
- Unit of Immunology, Rheumatology, Allergology and Rare Diseases, IRCCS San Raffaele Hospital, Milano, Italy
| | - Alessandro Marinosci
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Hospital, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giovanni Landoni
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alberto Zangrillo
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Hospital, Milan, Italy
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11
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Da Prat V, Galli L, Cichero P, Castiglioni B, Oltolini C, Tassan Din C, Andolina A, Bruzzesi E, Poli A, Moro M, Mancini N, Clementi M, Tresoldi M, Castagna A, Scarpellini P, Ripa M. Antibiotic appropriateness for Gram-negative bloodstream infections: impact of infectious disease consultation. Infect Dis (Lond) 2023; 55:255-262. [PMID: 36694444 DOI: 10.1080/23744235.2023.2169345] [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] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND We investigated the role of infectious disease consultation (IDC) on therapeutic appropriateness in Gram-negative bloodstream infections (GNBSIs) in a setting with a high proportion of antibiotic resistance. Secondary outcomes were in-hospital mortality and the impact of rapid diagnostic tests (RDTs). METHODS Retrospective study on hospitalised patients with GNBSIs. Therapy was deemed appropriate if it had the narrowest spectrum considering infection and patients' characteristics. Interventional-IDC (I-IDC) group included patients with IDC-advised first appropriate or last non-appropriate therapy. Time to first appropriate therapy and survival were evaluated by Kaplan-Meier curves. Factors associated with therapy appropriateness were assessed by multivariate Cox proportional-hazard models. RESULTS 471 patients were included. High antibiotic resistance rates were detected: quinolones 45.5%, third-generation cephalosporins 37.4%, carbapenems 7.9%. I-IDC was performed in 31.6% of patients (149/471), RDTs in 70.7% (333/471). The 7-day probability of appropriate treatment was 91.9% (95% confidence interval [95%CI]: 86.4-95.8%) vs. 75.8% (95%CI: 70.9-80.4%) with and without I-IDC, respectively (p-value = 0.0495); 85.5% (95%CI: 81.3-89.1%) vs. 69.4% (95%CI: 61.3-77.2%) with and without RDTs, respectively (p-value = 0.0023). Compared to RDTs alone, the combination with I-IDC was associated with a higher proportion of appropriate therapies at day 7: 81.9% (95%CI: 76.4-86.7%) vs. 92.6% (95%CI: 86.3-96.7%). At multivariate analysis, I-IDC and RDTs were associated with time to first appropriate therapy [adjusted hazard-ratio 1.292 (95%CI: 1.014-1.647) and 1.383 (95%CI: 1.080-1.771), respectively], with no impact on mortality. CONCLUSIONS In a setting with a high proportion of antibiotic resistance, IDC and RDTs were associated with earlier prescription of appropriate therapy in GNBSIs, without impact on mortality.
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Affiliation(s)
- Valentina Da Prat
- General Medicine and Advanced Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Galli
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Cichero
- Microbiology and Virology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Castiglioni
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Oltolini
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Tassan Din
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Andolina
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Andrea Poli
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Moro
- Hospital Management, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicasio Mancini
- Microbiology and Virology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Clementi
- Microbiology and Virology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Moreno Tresoldi
- General Medicine and Advanced Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Scarpellini
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Ripa
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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12
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Damanti S, Bozzolo E, Franchini S, Frangi C, Ramirez GA, Pedroso C, Di Lucca G, Scotti R, Valsecchi D, Cilla M, Cinel E, Santini C, Castellani J, Manzo E, Vadruccio S, Spessot M, Borghi G, Monti G, Landoni G, Rovere-Querini P, Yacoub MR, Tresoldi M. Predictors and outcomes of delirium in the emergency department during the first wave of the COVID-19 pandemic in Milan. Emerg Med J 2023; 40:202-209. [PMID: 36522147 DOI: 10.1136/emermed-2021-211749] [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: 06/09/2021] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Respiratory infections can be complicated by acute brain failure. We assessed delirium prevalence, predictors and outcomes in COVID-19 ED patients. METHODS This was a retrospective observational study conducted at the San Raffaele ED (Italy). Patients age >18 years attending the ED between 26 February 2020 and 30 May 2020 and who had a positive molecular nasopharyngeal swab for SARS-CoV-2 were included. The Chart-Based Delirium Identification Instrument (CHART-DEL) was used to retrospectively assess delirium. Univariable and multivariable logistic regression analyses were used to evaluate delirium predictors. Univariable binary logistic regression analyses, linear regression analyses and Cox regression analyses were used to assess the association between delirium and clinical outcomes. Age-adjusted and sex-adjusted models were then run for the significant predictors of the univariable models. RESULTS Among the 826 included patients, 123 cases (14.9%) of delirium were retrospectively detected through the CHART-DEL method. Patients with delirium were older (76.9±13.15 vs 61.3±14.27 years, p<0.001) and more frequently living in a long-term health facility (32 (26%) vs 22 (3.1%), p<0.001). Age (OR 1.06, 95% CI 1.04 to 1.09, p<0.001), dementia (OR 17.5, 95% CI 7.27 to 42.16, p<0.001), epilepsy (OR 6.96, 95% CI 2.48 to 19.51, p<0.001) and the number of chronic medications (OR 1.09, 95% CI 1.01 to 1.17, p=0.03) were significant predictors of delirium in multivariable analyses. Delirium was associated with increased in-hospital mortality (adjusted HR 2.16, 95% CI 1.55 to 3.03, p<0.001) and with a reduced probability of being discharged home compared with being institutionalised (adjusted OR 0.39, 95% CI 0.25 to 0.61, p<0.001). CONCLUSIONS Chart review frequently identified ED delirium in patients with COVID-19. Age, dementia, epilepsy and polypharmacy were significant predictors of ED delirium. Delirium was associated with an increased in-hospital mortality and with a reduced probability of being discharged home after hospitalisation. The findings of this single-centre retrospective study require validation in future studies.
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Affiliation(s)
- Sarah Damanti
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Institute, Milan, Italy
| | - Enrica Bozzolo
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Institute, Milan, Italy
| | - Stefano Franchini
- Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Giuseppe Alvise Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carla Pedroso
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Institute, Milan, Italy
| | - Giuseppe Di Lucca
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Institute, Milan, Italy
| | - Raffaella Scotti
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Institute, Milan, Italy
| | - Davide Valsecchi
- Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marta Cilla
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Institute, Milan, Italy
| | - Elena Cinel
- Vita-Salute San Raffaele University, Milan, Italy
| | | | | | | | | | - Marzia Spessot
- Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Borghi
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giacomo Monti
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Institute, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Rovere-Querini
- Vita-Salute San Raffaele University, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mona-Rita Yacoub
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Institute, Milan, Italy
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13
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Hajjar LA, Ancona MB, Filho RK, Tresoldi M, Caldas JG, Monti G, Carnevale FC, De Cobelli F, Moreira de Assis A, Ciceri F, Landoni G, Dijkstra J, Moroni F, Abizaid AAC, Willemann Ungaretti F, Carvalho Carmona MJ, De Backer D, Pompilio CE, de Britto FS, Campos CM, Zangrillo A, Montorfano M. Microvascular lung vessels obstructive thromboinflammatory syndrome in patients with COVID-19: Insights from lung intravascular optical coherence tomography. Front Med (Lausanne) 2023; 10:1050531. [PMID: 36873865 PMCID: PMC9978141 DOI: 10.3389/fmed.2023.1050531] [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: 09/26/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
Background Microvascular lung vessels obstructive thromboinflammatory syndrome has been proposed as a possible mechanism of respiratory failure in COVID-19 patients. However, it has only been observed in post-mortem studies and has never been documented in vivo, probably because of a lack of CT scan sensitivity in small pulmonary arteries. The aim of the present study was to assess the safety, tolerability, and diagnostic value of optical coherence tomography (OCT) for the assessment of patients with COVID-19 pneumonia for pulmonary microvascular thromboinflammatory syndrome. Methods The COVID-OCT trial was a multicenter, open-label, prospective, interventional clinical study. Two cohorts of patients were included in the study and underwent pulmonary OCT evaluation. Cohort A consisted of patients with COVID-19 with a negative CT scan for pulmonary thrombosis and elevated thromboinflammatory markers (D-dimer > 10,000 ng/mL or 5,000 < D-dimer < 10,000 ng/mL and one of: C-reactive Protein > 100 mg/dL, IL-6 > 6 pg/mL, or ferritin > 900 ng/L). Cohort B consisted of patients with COVID-19 and a CT scan positive for pulmonary thrombosis. The primary endpoints of the study were: (i) to evaluate the overall safety of OCT investigation in patients with COVID-19 pneumonia, and (ii) to report on the potential value of OCT as a novel diagnostic tool for the diagnosis of microvascular pulmonary thrombosis in COVID-19 patients. Results A total of 13 patients were enrolled. The mean number of OCT runs performed in each patient was 6.1 ± 2.0, both in ground glass and healthy lung areas, achieving a good evaluation of the distal pulmonary arteries. Overall, OCT runs identified microvascular thrombosis in 8 patients (61.5%): 5 cases of red thrombus, 1 case of white thrombus, and 2 cases of mixed thrombus. In Cohort A, the minimal lumen area was 3.5 ± 4.6 mm2, with stenosis of 60.9 ± 35.9% of the area, and the mean length of thrombus-containing lesions was 5.4 ± 3.0 mm. In Cohort B, the percentage area obstruction was 92.6 ± 2.6, and the mean thrombus-containing lesion length was 14.1 ± 13.9 mm. No peri-procedural complications occurred in any of the 13 patients. Conclusion OCT appears to be a safe and accurate method of evaluating the distal pulmonary arteries in hospitalized COVID-19 patients. Here, it enabled the first in vivo documentation of distal pulmonary arterial thrombosis in patients with elevated thromboinflammatory markers, even when their CT angiogram was negative for pulmonary thrombosis. Clinical trial registration ClinicalTrial.gov, identifier NCT04410549.
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Affiliation(s)
| | - Marco B Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Kalil Filho
- Heart Institute Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - José Guilherme Caldas
- Department of Interventional Neuroradiology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Giacomo Monti
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francisco Cesar Carnevale
- Interventional Radiology Department, Radiology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Francesco De Cobelli
- Radiology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - André Moreira de Assis
- Interventional Radiology Department, Radiology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fabio Ciceri
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Jouke Dijkstra
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Francesco Moroni
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Maria José Carvalho Carmona
- Discipline of Anesthesiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Daniel De Backer
- Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Carlos Eduardo Pompilio
- Department of Intensive Care, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fábio S de Britto
- Heart Institute Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Carlos M Campos
- Heart Institute Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alberto Zangrillo
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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14
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Salonia A, Pontillo M, Capogrosso P, Pozzi E, Ferrara AM, Cotelessa A, Belladelli F, Corsini C, Gregori S, Rowe I, Carenzi C, Ramirez GA, Tresoldi C, Locatelli M, Cavalli G, Dagna L, Castagna A, Zangrillo A, Tresoldi M, Landoni G, Rovere‐Querini P, Ciceri F, Montorsi F. Testosterone in males with COVID-19: a 12-month cohort study. Andrology 2023; 11:17-23. [PMID: 36251583 PMCID: PMC9874525 DOI: 10.1111/andr.13322] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 08/12/2022] [Revised: 09/18/2022] [Accepted: 10/11/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Male patients with COVID-19 have been found with reduced serum total testosterone (tT) levels and with more severe clinical outcomes. OBJECTIVES To assess total testosterone (tT) levels and the probability of recovering eugonadal tT levels during a minimum 12-month timespan in a cohort of men who have been followed over time after the recovery from laboratory-confirmed COVID-19. MATERIALS AND METHODS Demographic, clinical and hormonal values were collected for the overall cohort. Hypogonadism was defined as tT ≤9.2 nmol/l. The Charlson Comorbidity Index was used to score health-significant comorbidities. Descriptive statistics was used to compare hormonal levels at baseline versus 7-month (FU1) versus 12-month (FU2) follow-up, respectively. Multivariate cox proportional hazards regression model was used to identify the potential predictors of eugonadism recovery over time among patients with hypogonadism at the time of infection. RESULTS Of the original cohort of 286 patients, follow-up data were available for 121 (42.3%) at FU1 and 63 (22%) patients at FU2, respectively. Higher median interquartile range (IQR) tT levels were detected at FU2 (13.8 (12.3-15.3) nmol/L) versus FU1 (10.2 [9.3-10.9] nmol/L) and versus baseline (3.6 [3.02-4.02] nmol/L) (all p < 0.0001), whilst both LH and E2 levels significantly decreased over the same time frame (all p ≤ 0.01). Circulating IL-6 levels further decreased at FU2 compared to FU1 levels (19.3 vs. 72.8 pg/ml) (p = 0.02). At multivariable cox regression analyses, baseline tT level (HR 1.19; p = 0.03 [1.02-1.4]) was independently associated with the probability of tT level normalization over time, after adjusting for potential confounders. CONCLUSIONS Circulating tT levels keep increasing over time in men after COVID-19. Still, almost 30% of men who recovered from COVID-19 had low circulating T levels suggestive for a condition of hypogonadism at a minimum 12-month follow-up.
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Affiliation(s)
- Andrea Salonia
- Division of Experimental Oncology/Unit of UrologyURI; IRCCS Ospedale San RaffaeleMilanItaly,University Vita‐Salute San RaffaeleMilanItaly
| | - Marina Pontillo
- Laboratory Medicine ServiceIRCCS Ospedale San RaffaeleMilanItaly
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of UrologyURI; IRCCS Ospedale San RaffaeleMilanItaly,Department of Urology and AndrologyOspedale di Circolo and Macchi FoundationVareseItaly
| | - Edoardo Pozzi
- Division of Experimental Oncology/Unit of UrologyURI; IRCCS Ospedale San RaffaeleMilanItaly,University Vita‐Salute San RaffaeleMilanItaly
| | - Anna Maria Ferrara
- Division of Experimental Oncology/Unit of UrologyURI; IRCCS Ospedale San RaffaeleMilanItaly
| | - Alice Cotelessa
- Laboratory Medicine ServiceIRCCS Ospedale San RaffaeleMilanItaly
| | - Federico Belladelli
- Division of Experimental Oncology/Unit of UrologyURI; IRCCS Ospedale San RaffaeleMilanItaly,University Vita‐Salute San RaffaeleMilanItaly
| | - Christian Corsini
- Division of Experimental Oncology/Unit of UrologyURI; IRCCS Ospedale San RaffaeleMilanItaly,University Vita‐Salute San RaffaeleMilanItaly
| | - Silvia Gregori
- San Raffaele Telethon Institute for Gene Therapy (SR‐TIGET)IRCCS Ospedale San RaffaeleMilanItaly
| | - Isaline Rowe
- Division of Experimental Oncology/Unit of UrologyURI; IRCCS Ospedale San RaffaeleMilanItaly
| | - Cristina Carenzi
- Division of Experimental Oncology/Unit of UrologyURI; IRCCS Ospedale San RaffaeleMilanItaly
| | - Giuseppe A. Ramirez
- University Vita‐Salute San RaffaeleMilanItaly,Immunology, Rheumatology, Allergology and Rare Diseases UnitIRCCS Ospedale San RaffaeleMilanItaly
| | | | | | - Giulio Cavalli
- University Vita‐Salute San RaffaeleMilanItaly,Immunology, Rheumatology, Allergology and Rare Diseases UnitIRCCS Ospedale San RaffaeleMilanItaly
| | - Lorenzo Dagna
- University Vita‐Salute San RaffaeleMilanItaly,Immunology, Rheumatology, Allergology and Rare Diseases UnitIRCCS Ospedale San RaffaeleMilanItaly
| | - Antonella Castagna
- University Vita‐Salute San RaffaeleMilanItaly,Department of Infectious DiseasesIRCCS Ospedale San RaffaeleMilanItaly
| | - Alberto Zangrillo
- University Vita‐Salute San RaffaeleMilanItaly,Anesthesia and Intensive Care DepartmentIRCCS Ospedale San RaffaeleMilanItaly
| | - Moreno Tresoldi
- General Medicine and Advanced Care UnitIRCCS Ospedale San RaffaeleMilanItaly
| | - Giovanni Landoni
- University Vita‐Salute San RaffaeleMilanItaly,Anesthesia and Intensive Care DepartmentIRCCS Ospedale San RaffaeleMilanItaly
| | - Patrizia Rovere‐Querini
- University Vita‐Salute San RaffaeleMilanItaly,Internal Medicine, Diabetes, and Endocrinology UnitIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Fabio Ciceri
- University Vita‐Salute San RaffaeleMilanItaly,Hematology and Bone Marrow Transplant UnitIRCCS Ospedale San RaffaeleMilanItaly
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of UrologyURI; IRCCS Ospedale San RaffaeleMilanItaly,University Vita‐Salute San RaffaeleMilanItaly
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15
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Amodio G, Capogrosso P, Pontillo M, Tassara M, Boeri L, Carenzi C, Cignoli D, Ferrara AM, Ramirez GA, Tresoldi C, Locatelli M, Santoleri L, Castagna A, Zangrillo A, De Cobelli F, Tresoldi M, Landoni G, Rovere‐Querini P, Ciceri F, Montorsi F, Salonia A, Gregori S. Combined plasma levels of IL-10 and testosterone, but not soluble HLA-G5, predict the risk of death in COVID-19 patients. Andrology 2023; 11:32-44. [PMID: 36323494 PMCID: PMC9877736 DOI: 10.1111/andr.13334] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 06/29/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The identification of biomarkers correlated with coronavirus disease 2019 (COVID-19) outcomes is a relevant need for clinical management. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is characterized by elevated interleukin (IL)-6, IL-10, HLA-G, and impaired testosterone production. OBJECTIVES We aimed at defining the combined impact of sex hormones, interleukin-10, and HLA-G on COVID-19 pathophysiology and their relationship in male patients. MATERIALS AND METHODS We measured by chemiluminescence immunoassay, electrochemiluminescent assays, and enzyme-linked immunosorbent assay circulating total testosterone, 17β-estradiol (E2 ), IL-10, and -HLAG5 as well as SARS-CoV-2 S1/S2 Immunoglobulin G from 292 healthy controls and 111 COVID-19 patients with different disease severity at hospital admission, and in 53 COVID-19 patients at 7-month follow-up. RESULTS AND DISCUSSION We found significantly higher levels of IL-10, HLA-G, and E2 in COVID-19 patients compared to healthy controls and an inverse correlation between IL-10 and testosterone, with IL-10, progressively increasing and testosterone progressively decreasing with disease severity. This correlation was lost at the 7-month follow-up. The risk of death in COVID-19 patients with low testosterone increased in the presence of high IL-10. A negative correlation between SARS-CoV-2 Immunoglobulin G and HLA-G or IL-10 at hospitalization was observed. At the 7-month follow-up, IL-10 and testosterone normalized, and HLA-G decreased. CONCLUSION Our findings indicate that combined evaluation of IL-10 and testosterone predicts the risk of death in men with COVID-19 and support the hypothesis that IL-10 fails to suppress excessive inflammation by promoting viral spreading.
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Affiliation(s)
- Giada Amodio
- San Raffaele Telethon Institute for Gene Therapy (SR‐TIGET)IRCCS Ospedale San RaffaeleMilanItaly
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of UrologyURI, IRCCS Ospedale San RaffaeleMilanItaly,Department of Urology and AndrologyOspedale di Circolo and Macchi FoundationVareseItaly
| | - Marina Pontillo
- Laboratory Medicine ServiceIRCCS Ospedale San RaffaeleMilanItaly
| | - Michela Tassara
- Laboratory Medicine ServiceIRCCS Ospedale San RaffaeleMilanItaly
| | - Luca Boeri
- Division of Experimental Oncology/Unit of UrologyURI, IRCCS Ospedale San RaffaeleMilanItaly,IRCCS Foundation Ca’ Granda, Maggiore Policlinico Hospital, Department of UrologyUniversity of MilanMilanItaly
| | - Cristina Carenzi
- Division of Experimental Oncology/Unit of UrologyURI, IRCCS Ospedale San RaffaeleMilanItaly
| | - Daniele Cignoli
- Division of Experimental Oncology/Unit of UrologyURI, IRCCS Ospedale San RaffaeleMilanItaly,University Vita‐Salute San RaffaeleMilanItaly
| | - Anna Maria Ferrara
- Division of Experimental Oncology/Unit of UrologyURI, IRCCS Ospedale San RaffaeleMilanItaly
| | - Giuseppe A. Ramirez
- University Vita‐Salute San RaffaeleMilanItaly,Immunology, Rheumatology, Allergology and Rare Diseases UnitIRCCS Ospedale San RaffaeleMilanItaly
| | | | | | - Luca Santoleri
- Immunohematology and Transfusion MedicineIRRCS Ospedale San RaffaeleMilanItaly
| | - Antonella Castagna
- University Vita‐Salute San RaffaeleMilanItaly,Department of Infectious DiseasesIRCCS Ospedale San RaffaeleMilanItaly
| | - Alberto Zangrillo
- University Vita‐Salute San RaffaeleMilanItaly,Anesthesia and Intensive Care DepartmentIRCCS Ospedale San RaffaeleMilanItaly
| | - Francesco De Cobelli
- University Vita‐Salute San RaffaeleMilanItaly,Department of RadiologyIRCCS Ospedale San RaffaeleMilanItaly
| | - Moreno Tresoldi
- General Medicine and Advanced Care UnitIRCCS Ospedale San RaffaeleMilanItaly
| | - Giovanni Landoni
- University Vita‐Salute San RaffaeleMilanItaly,Anesthesia and Intensive Care DepartmentIRCCS Ospedale San RaffaeleMilanItaly
| | - Patrizia Rovere‐Querini
- University Vita‐Salute San RaffaeleMilanItaly,Internal Medicine, Diabetes, and Endocrinology UnitIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Fabio Ciceri
- University Vita‐Salute San RaffaeleMilanItaly,Hematology and Bone Marrow Transplant UnitIRCCS Ospedale San RaffaeleMilanItaly
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of UrologyURI, IRCCS Ospedale San RaffaeleMilanItaly,University Vita‐Salute San RaffaeleMilanItaly
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of UrologyURI, IRCCS Ospedale San RaffaeleMilanItaly,University Vita‐Salute San RaffaeleMilanItaly
| | - Silvia Gregori
- San Raffaele Telethon Institute for Gene Therapy (SR‐TIGET)IRCCS Ospedale San RaffaeleMilanItaly
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16
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Damanti S, Cristel G, Ramirez GA, Bozzolo EP, Da Prat V, Gobbi A, Centurioni C, Di Gaeta E, Del Prete A, Calabrò MG, Calvi MR, Borghi G, Zangrillo A, De Cobelli F, Landoni G, Tresoldi M. Influence of reduced muscle mass and quality on ventilator weaning and complications during intensive care unit stay in COVID-19 patients. Clin Nutr 2022; 41:2965-2972. [PMID: 34465493 PMCID: PMC8364854 DOI: 10.1016/j.clnu.2021.08.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [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: 04/22/2021] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS Sarcopenia, a loss of muscle mass, quality and function, which is particularly evident in respiratory muscles, has been associated with many clinical adverse outcomes. In this study, we aimed at evaluating the role of reduced muscle mass and quality in predicting ventilation weaning, complications, length of intensive care unit (ICU) and of hospital stay and mortality in patients admitted to ICU for SARS-CoV-2-related pneumonia. METHODS This was an observational study based on a review of medical records of all adult patients admitted to the ICU of a tertiary hospital in Milan and intubated for SARS-CoV-2-related pneumonia during the first wave of the COVID-19 pandemic. Muscle mass and quality measurement were retrieved from routine thoracic CT scans, when sections passing through the first, second or third lumbar vertebra were available. RESULTS A total of 81 patients were enrolled. Muscle mass was associated with successful extubation (OR 1.02, 95% C.I. 1.00-1.03, p = 0.017), shorter ICU stay (OR 0.97, 95% C.I. 0.95-0.99, p = 0.03) and decreased hospital mortality (HR 0.98, 95% C.I. 0.96-0.99, p = 0.02). Muscle density was associated with successful extubation (OR 1.07, 95% C.I. 1.01-1.14; p = 0.02) and had an inverse association with the number of complications in ICU (Β -0.07, 95% C.I. -0.13 - -0.002, p = 0.03), length of hospitalization (Β -1.36, 95% C.I. -2.21 - -0.51, p = 0.002) and in-hospital mortality (HR 0.88, 95% C.I. 0.78-0.99, p = 0.046). CONCLUSIONS Leveraging routine CT imaging to measure muscle mass and quality might constitute a simple, inexpensive and powerful tool to predict survival and disease course in patients with COVID-19. Preserving muscle mass during hospitalisation might have an adjuvant role in facilitating remission from COVID-19.
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Affiliation(s)
- Sarah Damanti
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Italy,Corresponding author. Unit of General Medicine and Advanced Care, IRCCS San Raffaele Hospital, Via Olgettina 60, Milan, Italy
| | - Giulia Cristel
- Department of Radiology, Centre for Experimental Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Alvise Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrica Paola Bozzolo
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Italy
| | - Valentina Da Prat
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Italy
| | - Agnese Gobbi
- Vita-Salute San Raffaele University, Milano, Italy
| | | | - Ettore Di Gaeta
- Department of Radiology, Centre for Experimental Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy,Vita-Salute San Raffaele University, Milano, Italy
| | - Andrea Del Prete
- Department of Radiology, Centre for Experimental Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy,Vita-Salute San Raffaele University, Milano, Italy
| | - Maria Grazia Calabrò
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Rosa Calvi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Borghi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Vita-Salute San Raffaele University, Milano, Italy,Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, Centre for Experimental Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Vita-Salute San Raffaele University, Milano, Italy,Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Italy
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17
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Spagnuolo V, Voarino M, Tonelli M, Galli L, Poli A, Bruzzesi E, Racca S, Clementi N, Oltolini C, Tresoldi M, Rovere Querini P, Dagna L, Zangrillo A, Ciceri F, Clementi M, Castagna A. Impact of Remdesivir on SARS-CoV-2 Clearance in a Real-Life Setting: A Matched-Cohort Study. Drug Des Devel Ther 2022; 16:3645-3654. [PMID: 36268521 PMCID: PMC9578770 DOI: 10.2147/dddt.s369473] [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] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022] Open
Abstract
Background Evidence regarding the impact of remdesivir (RDV) on SARS-CoV-2 viral clearance (VC) is scarce. The aim of this study was to compare VC timing in hospitalized COVID-19 patients who did or did not receive RDV. Methods This was a matched-cohort study of patients hospitalized with pneumonia, a SARS-CoV-2-positive nasopharyngeal swab (NPS) at admission, and at least one NPS during follow-up. Patients who received RDV (cases) and those who did not (controls) were matched in a 1:2 ratio by age, sex, and PaO2/FiO2 (P/F) values at admission. NPSs were analyzed using real-time polymerase chain reaction. Time to VC (within 30 days after hospital discharge) was estimated using the Kaplan-Meier curve. A multivariable Cox proportional hazard model was fitted to determine factors associated with VC. Results There were 648 patients enrolled in the study (216 cases and 432 controls). VC was observed in 490 patients (75.6%), with a median time of 25 (IQR 16-34) days. Overall, time to VC was similar between cases and controls (p = 0.519). However, time to VC was different when considering both RDV treatment status and age (p = 0.007). A significant finding was also observed when considering both RDV treatment status and P/F values at admission (p = 0.007). A multivariate analysis showed that VC was associated with a younger age (aHR = 0.990, 95% CI 0.983-0.998 per every 10-year increase in age; p = 0.009) and a higher baseline P/F ratio (aHR=1.275, 95% CI 1.029-1.579; p=0.026), but not with RDV treatment status. Conclusion Time to VC was similar in cases and controls. However, there was a benefit associated with using RDV in regard to time to VC in younger patients and in those with a P/F ratio ≤200 mmHg at hospital admission.
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Affiliation(s)
- Vincenzo Spagnuolo
- Unit of Infectious Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy,Correspondence: Vincenzo Spagnuolo, Unit of Infectious Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy, Tel +390226437907, Fax +390226437903, Email
| | - Marta Voarino
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Tonelli
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy,Unit of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Galli
- Unit of Infectious Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Poli
- Unit of Infectious Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy
| | - Elena Bruzzesi
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Sara Racca
- Unit of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Clementi
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy,Unit of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Oltolini
- Unit of Infectious Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- General Medicine and Advanced Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Rovere Querini
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy,Internal Medicine, Diabetes, and Endocrinology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy,Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy,Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Clementi
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy,Unit of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Unit of Infectious Diseases, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy,Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
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18
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Damanti S, Tresoldi M, de Souto Barreto P, Rolland Y, Cesari M. Z-drugs and falls in nursing home patients: data from the INCUR study. Aging Clin Exp Res 2022; 34:3145-3149. [PMID: 36125730 DOI: 10.1007/s40520-022-02237-2] [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: 06/29/2022] [Accepted: 08/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Z-drugs are the most prescribed treatment for insomnia, but their negative effect on the body sway can increase the risk of falls. AIMS Evaluating the association between Z-drugs and falls in a resident cohort. METHODS Prospective observational study using the data collected in the Incidence of pNeumonia and related ConseqUences in nursing home Residents (INCUR) study. RESULTS During the one-year follow-up, among the 800 participants (median age 87), 93 individuals fell (64 fracturing and 29 without fracturing). Lower calf circumference (adjusted OR 0.92, 95% CI 0.86-0.97, p = 0.006) and the use of selective serotonin reuptake inhibitors (adjusted OR 1.86, 95% CI 1.1-3.05, p = 0.01) predicted falls, whereas the use of Z-drugs (adjusted OR 2.37, 95% CI 1.13-4.94, p = 0.02) and lower body mass index (adjusted OR 0.9, 95% CI 0.84-0.97, p = 0.005) were associated with falls without fractures. CONCLUSIONS Z-drugs predicted falls without fractures in residents. Alternative strategies to promote sleep in residents should be pursued.
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Affiliation(s)
- Sarah Damanti
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Institute, Milan, Italy.
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Institute, Milan, Italy
| | - Philipe de Souto Barreto
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), 31000, Toulouse, France.,UMR INSERM 1027, University of Toulouse III, 31000, Toulouse, France
| | - Yves Rolland
- Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), 31000, Toulouse, France.,UMR INSERM 1027, University of Toulouse III, 31000, Toulouse, France
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
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Ripa M, Galli L, D’Angelo A, Apruzzi L, Palumbo D, Campochiaro C, Tassan Din C, Danise A, Da Prat V, Vitali G, Brugliera L, Poli A, Monardo R, Monti G, Baccellieri D, De Cobelli F, Clementi M, Iannaccone S, Dagna L, Rovere-Querini P, Ciceri F, Tresoldi M, Zangrillo A, Scarpellini P, Castagna A. High risk of secondary infections following thrombotic complications in patients with COVID-19. Open Forum Infect Dis 2022; 9:ofac454. [PMID: 36168552 PMCID: PMC9511118 DOI: 10.1093/ofid/ofac454] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/31/2022] [Indexed: 11/25/2022] Open
Abstract
Background This study’s primary aim was to evaluate the impact of thrombotic complications on the development of secondary infections. The secondary aim was to compare the etiology of secondary infections in patients with and without thrombotic complications. Methods This was a cohort study (NCT04318366) of coronavirus disease 2019 (COVID-19) patients hospitalized at IRCCS San Raffaele Hospital between February 25 and June 30, 2020. Incidence rates (IRs) were calculated by univariable Poisson regression as the number of cases per 1000 person-days of follow-up (PDFU) with 95% confidence intervals. The cumulative incidence functions of secondary infections according to thrombotic complications were compared with Gray's method accounting for competing risk of death. A multivariable Fine-Gray model was applied to assess factors associated with risk of secondary infections. Results Overall, 109/904 patients had 176 secondary infections (IR, 10.0; 95% CI, 8.8–11.5; per 1000-PDFU). The IRs of secondary infections among patients with or without thrombotic complications were 15.0 (95% CI, 10.7–21.0) and 9.3 (95% CI, 7.9–11.0) per 1000-PDFU, respectively (P = .017). At multivariable analysis, thrombotic complications were associated with the development of secondary infections (subdistribution hazard ratio, 1.788; 95% CI, 1.018–3.140; P = .043). The etiology of secondary infections was similar in patients with and without thrombotic complications. Conclusions In patients with COVID-19, thrombotic complications were associated with a high risk of secondary infections.
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Affiliation(s)
- Marco Ripa
- Unit of Infectious and Tropical Diseases IRCCS San Raffaele Scientific Institute , Milan , Italy
- Vita-Salute San Raffaele University , Milan , Italy
| | - Laura Galli
- Unit of Infectious and Tropical Diseases IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Armando D’Angelo
- Coagulation Service and Thrombosis Research Unit, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Luca Apruzzi
- Department of Vascular Surgery, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Diego Palumbo
- Vita-Salute San Raffaele University , Milan , Italy
- Unit of Radiology, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Chiara Tassan Din
- Unit of Infectious and Tropical Diseases IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Anna Danise
- Unit of Infectious and Tropical Diseases IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Valentina Da Prat
- General Medicine and Advanced Care Unit, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Giordano Vitali
- Internal Medicine, Diabetes and Endocrinology Unit, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Luigia Brugliera
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Andrea Poli
- Unit of Infectious and Tropical Diseases IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Roberta Monardo
- Unit of Infectious and Tropical Diseases IRCCS San Raffaele Scientific Institute , Milan , Italy
- Vita-Salute San Raffaele University , Milan , Italy
| | - Giacomo Monti
- Vita-Salute San Raffaele University , Milan , Italy
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Domenico Baccellieri
- Department of Vascular Surgery, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Francesco De Cobelli
- Vita-Salute San Raffaele University , Milan , Italy
- Unit of Radiology, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Massimo Clementi
- Vita-Salute San Raffaele University , Milan , Italy
- Microbiology and Virology Department, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Sandro Iannaccone
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Lorenzo Dagna
- Vita-Salute San Raffaele University , Milan , Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Patrizia Rovere-Querini
- Vita-Salute San Raffaele University , Milan , Italy
- Internal Medicine, Diabetes and Endocrinology Unit, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Fabio Ciceri
- Vita-Salute San Raffaele University , Milan , Italy
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Moreno Tresoldi
- General Medicine and Advanced Care Unit, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Alberto Zangrillo
- Vita-Salute San Raffaele University , Milan , Italy
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Paolo Scarpellini
- Unit of Infectious and Tropical Diseases IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Antonella Castagna
- Unit of Infectious and Tropical Diseases IRCCS San Raffaele Scientific Institute , Milan , Italy
- Vita-Salute San Raffaele University , Milan , Italy
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20
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Damanti S, Cilla M, Cilona M, Fici A, Merolla A, Pacioni G, De Lorenzo R, Martinenghi S, Vitali G, Magnaghi C, Fumagalli A, Gennaro Mazza M, Benedetti F, Tresoldi M, Rovere Querini P. Prevalence of Long COVID-19 Symptoms After Hospital Discharge in Frail and Robust Patients. Front Med (Lausanne) 2022; 9:834887. [PMID: 35911387 PMCID: PMC9329529 DOI: 10.3389/fmed.2022.834887] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/10/2022] [Indexed: 12/12/2022] Open
Abstract
Background A motley postacute symptomatology may develop after COVID-19, irrespective of the acute disease severity, age, and comorbidities. Frail individuals have reduced physiological reserves and manifested a worse COVID-19 course, during the acute setting. However, it is still unknown, whether frailty may subtend some long COVID-19 manifestations. We explored the prevalence of long COVID-19 disturbs in COVID-19 survivals. Methods This was an observational study. Patients aged 65 years or older were followed-up 1, 3, and 6 months after hospitalization for COVID-19 pneumonia. Results A total of 382 patients were enrolled. Frail patients were more malnourished (median Mini Nutritional Assessment Short Form score 8 vs. 9, p = 0.001), at higher risk of sarcopenia [median Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls (SARC-F) score 3 vs. 1.5, p = 0.003], and manifested a worse physical performance [median Short Physical Performance Battery (SPPB) score 10 vs. 11, p = 0.0007] than robust individuals, after hospital discharge following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. Frailty was significantly associated with: (i) confusion, as a presenting symptom of COVID-19 [odds ratio (OR) 77.84, 95% CI 4.23–1432.49, p = 0.003]; (ii) malnutrition (MNA-SF: adjusted B –5.63, 95% CI –8.39 to –2.87, p < 0.001), risk of sarcopenia (SARC-F: adjusted B 9.11, 95% CI 3.10–15.13, p = 0.003), impaired muscle performance (SPPB: B –3.47, 95% CI –6.33 to –0.61, p = 0.02), complaints in mobility (adjusted OR 1674200.27, 95% CI 4.52–619924741831.25, p = 0.03), in self-care (adjusted OR 553305.56, 95% CI 376.37–813413358.35, p < 0.001), and in performing usual activities of daily living (OR 71.57, 95% CI 2.87–1782.53, p = 0.009) at 1-month follow-up; (iii) dyspnea [modified Medical Research Council (mMRC): B 4.83, 95% CI 1.32–8.33, p = 0.007] and risk of sarcopenia (SARC-F: B 7.12, 95% CI 2.17–12.07, p = 0.005) at 3-month follow-up; and (iv) difficulties in self-care (OR 2746.89, 95% CI 6.44–1172310.83, p = 0.01) at the 6-month follow-up. In a subgroup of patients (78 individuals), the prevalence of frailty increased at the 1-month follow-up compared to baseline (p = 0.009). Conclusion The precocious identification of frail COVID-19 survivors, who manifest more motor and respiratory complaints during the follow-up, could improve the long-term management of these COVID-19 sequelae.
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Affiliation(s)
- Sarah Damanti
- Unit of General Medicine and Advanced Care, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Institute, Milan, Italy
- *Correspondence: Sarah Damanti,
| | - Marta Cilla
- Unit of General Medicine and Advanced Care, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Institute, Milan, Italy
| | - Maria Cilona
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Aldo Fici
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Aurora Merolla
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Giacomo Pacioni
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Rebecca De Lorenzo
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Sabina Martinenghi
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giordano Vitali
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Cristiano Magnaghi
- Department of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Anna Fumagalli
- COVID Trial Unit, Department of Internal Medicine, IRCCS San Raffaele Institute, Milan, Italy
| | - Mario Gennaro Mazza
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milan, Italy
| | - Francesco Benedetti
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Institute, Milan, Italy
| | - Patrizia Rovere Querini
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
- Department of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
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21
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Vinciguerra A, Rampi A, Yacoub MR, Tresoldi M, Tanzini U, Bussi M, Trimarchi M. Hypereosinophilia management in patients with type 2 chronic rhinosinusitis treated with dupilumab: preliminary results. Eur Arch Otorhinolaryngol 2022; 279:5231-5238. [PMID: 35445858 DOI: 10.1007/s00405-022-07389-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 01/25/2022] [Accepted: 04/02/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Biological therapies are gaining relevance in the management of CRSwNP with few adverse events reported. Among these, dupilumab, an anti-IL4-Ra monoclonal antibody, is frequently associated with hypereosinophilia (HE) which usually remains silent and progressively resolves, although some cases of systemic involvement occurs. The aim of this paper is to describe our experience and propose a management flowchart for HE during therapy with dupilumab. METHODS Patients with CRSwNP who satisfied EPOS2020 criteria for biological therapies were included in this prospective study. Each case was discussed in a multidisciplinary meeting with subsequent prescription of dupilumab; all patients were candidates to follow-up bi-monthly for 6 months, while additional blood tests were scheduled in the event of HE. RESULTS A total of 21 patients with a mean age of 48.4 years were enrolled. Of these, 15 of 21 presented an asthma comorbidity and 9 of 21 ASA sensitivity. Four patients (19%) developed HE with AEC > 1.5 × 109/L, whereas it occurred in 9.5% (two patients) if considered AEC > 3 × 109/L. No cases of hypereosinophilic syndrome were recorded. Following our decision-making flowchart, two patients received short-term corticosteroid therapy, whereas the other two were only eligible for closer follow-up. CONCLUSIONS During dupilumab therapy, HE may occur and should be considered benign when < 3 × 109/L in the absence of organ involvement. Conversely, in case of HE ≥ 3 × 109/L, an empirical approach with short-term corticosteroid therapy should be considered to debulk the blood from eosinophils and prevent potential organ involvement.
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Affiliation(s)
- Alessandro Vinciguerra
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, School of Medicine, Vita-Salute San Raffaele University, Via Olgettina, 68, 20100, Milan, Italy
| | - Andrea Rampi
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, School of Medicine, Vita-Salute San Raffaele University, Via Olgettina, 68, 20100, Milan, Italy
| | - Mona-Rita Yacoub
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Moreno Tresoldi
- General Medicine and Advanced Care Unit, All at IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Tanzini
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, School of Medicine, Vita-Salute San Raffaele University, Via Olgettina, 68, 20100, Milan, Italy
| | - Mario Bussi
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, School of Medicine, Vita-Salute San Raffaele University, Via Olgettina, 68, 20100, Milan, Italy
| | - Matteo Trimarchi
- Otorhinolaryngology Unit, Division of Head and Neck Department, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Division of Otolaryngology, Department of Surgical Sciences, IRCCS San Raffaele Hospital, School of Medicine, Vita-Salute San Raffaele University, Via Olgettina, 68, 20100, Milan, Italy.
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22
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Damanti S, Ramirez GA, Da Prat V, Bertola A, Manzo E, Vadruccio S, Tresoldi M, Barreto PDS, Rolland Y. Selective serotonin reuptake inhibitors and fractures in older nursing home residents: Data from the INCUR study. Maturitas 2022; 158:37-39. [DOI: 10.1016/j.maturitas.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 01/10/2023]
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23
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Damanti S, Ramirez GA, Bozzolo EP, Da Prat V, Di Lucca G, Di Terlizzi G, Marinosci A, Scotti R, Strada S, Scarpellini P, Castiglioni B, Oltolini C, Ripa M, Din CT, Centurioni CE, Di Scala F, Gobbi A, Alba AC, Casiraghi GM, Morgillo A, Tresoldi M. Frailty as a predictor of mortality in COVID-19 patients receiving CPAP for respiratory insufficiency. Aging Clin Exp Res 2022; 34:945-949. [PMID: 35298829 PMCID: PMC8927756 DOI: 10.1007/s40520-021-02070-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/29/2021] [Indexed: 01/16/2023]
Abstract
Objective Exploring the association between frailty and mortality in a cohort of patients with COVID-19 respiratory insufficiency treated with continuous positive airway pressure. Methods Frailty was measured using a Frailty Index (FI) created by using the baseline assessment data on comorbidities and body mass index and baseline blood test results (including pH, lactate dehydrogenase, renal and liver function, inflammatory indexes and anemia). FI > 0.25 identified frail individuals. Results Among the 159 included individuals (81% men, median age of 68) frailty was detected in 69% of the patients (median FI score 0.3 ± 0.08). Frailty was associated to an increased mortality (adjusted HR 1.99, 95% CI 1.02–3.88, p = 0.04). Conclusions Frailty is highly prevalent among patients with COVID-19, predicts poorer outcomes independently of age. A personalization of care balancing the risk and benefit of treatments (especially the invasive ones) in such complex patients is pivotal. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-021-02070-z.
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Consolo F, Della Valle P, Saracino M, Bonora M, Donadoni G, Ciceri F, Tresoldi M, D'Angelo A, Landoni G, Zangrillo A. Platelet activation state in early stages of Covid-19. Minerva Anestesiol 2022; 88:472-478. [PMID: 35315619 DOI: 10.23736/s0375-9393.22.16054-2] [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] [Indexed: 11/08/2022]
Abstract
BACKGROUND Platelet activation at the early stage of COVID-19 is poorly described. The need for antiplatelet therapy in patients with COVID-19 remains controversial. We characterized the platelet activation profile in hospitalized patients at the early stage of COVID-19 using the modified prothrombinase Platelet Activation State (PAS) assay. METHODS Sixteen patients admitted to the emergency department of the IRCCS San Raffaele Scientific Institute (Milano, Italy) between February 8 and April 2021 were enrolled. All patients presented with respiratory symptoms and tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Platelet activation was measured via the PAS assay within 24 hours from patients' hospital admission. Data were compared with those measured in n=24 healthy subjects (controls). RESULTS Platelet activation was significantly higher in COVID-19 patients with respect to controls (PAS = 0.63 [0.58-0.98]% vs. 0.46 [0.40-0.65]%, respectively; p=0.03). Of note, highest PAS values were measured in the two patients with the worst clinical outcome, i.e., death because of respiratory failure (PAS = 2.09% and 1.20%, respectively). No differences in standard coagulation parameters were noted between these two patients and those who were later discharged home. CONCLUSIONS This study provides evidences of significant platelet activation state at the early stage of COVID-19 and suggests that the patient-specific platelet activation profile is a reliable clinical marker to stratify COVID-19 patients at high risk of poor clinical outcome who might potentially benefit from antiplatelet therapy.
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Affiliation(s)
- Filippo Consolo
- Università Vita Salute San Raffaele, Milano, Italy - .,Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milano, Italy -
| | - Patrizia Della Valle
- Coagulation Service and Thrombosis Research Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Marco Saracino
- Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Marta Bonora
- Università Vita Salute San Raffaele, Milano, Italy
| | - Giovanni Donadoni
- Emergency Department, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Fabio Ciceri
- Università Vita Salute San Raffaele, Milano, Italy.,Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Moreno Tresoldi
- General Medicine and Advanced Care Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Armando D'Angelo
- Coagulation Service and Thrombosis Research Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Giovanni Landoni
- Università Vita Salute San Raffaele, Milano, Italy.,Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Alberto Zangrillo
- Università Vita Salute San Raffaele, Milano, Italy.,Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milano, Italy
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25
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Frangi C, Damanti S, Bozzolo EP, Scotti R, Di Lucca G, Tresoldi M. Dyspnea as a symptom of progressive chronic myeloproliferative disease: a rare case of hemorrhagic alveolitis and pulmonary fibrosis, due to extramedullary erythropoiesis. JGG 2022. [DOI: 10.36150/2499-6564-n479] [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: 11/06/2022]
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26
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Bravi CA, Cazzaniga W, Simonini M, Larcher A, Messaggio E, Zagato L, Carenzi C, Bertini R, Briganti A, Manunta P, Vezzoli G, Salonia A, Lanzani C, Capitanio U, Zangrillo A, Landoni G, Rovere-Querini P, Tresoldi M, Montorsi F, Ciceri F. Acute Kidney Injury at Hospital Admission for SARS-CoV-2 Infection as a Marker of Poor Prognosis: Clinical Implications for Triage Risk Stratification. Kidney Blood Press Res 2022; 47:147-150. [PMID: 35158352 PMCID: PMC8805049 DOI: 10.1159/000518271] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/02/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS The new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes a wide spectrum of effects, including acute kidney injury (AKI) in up to 40% of hospitalized patients. Given the established relationship between AKI and poor prognosis, whether AKI might be a prognostic indicator for patients admitted to the hospital for SARS-CoV-2 infection would allow for a straightforward risk stratification of these patients. METHODS We analyzed data of 623 patients admitted to San Raffaele Hospital (Milan, IT) between February 25 and April 19, 2020, for laboratory-confirmed SARS-CoV-2 infection. Incidence of AKI at hospital admission was calculated, with AKI defined according to the KDIGO criteria. Multivariable Cox regression models assessed the association between AKI and overall mortality and admission to the intensive care unit (ICU). RESULTS Overall, 108 (17%) patients had AKI at hospital admission for SARS-CoV-2 infection. After a median follow-up for survivors of 14 days (interquartile range: 8, 23), 123 patients died, while 84 patients were admitted to the ICU. After adjusting for confounders, patients who had AKI at hospital admission were at increased risk of overall mortality compared to those who did not have AKI (hazards ratio [HR]: 2.00; p = 0.0004), whereas we did not find evidence of an association between AKI and ICU admission (HR: 0.95; p = 0.9). CONCLUSIONS These data suggest that AKI might be an indicator of poor prognosis for patients with SARS-CoV-2 infection, and as such, given its readily availability, it might be used to improve risk stratification at hospital admission.
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Affiliation(s)
- Carlo Andrea Bravi
- Division of Oncology/Unit of Urology, Urological Research Institute, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Walter Cazzaniga
- Division of Oncology/Unit of Urology, Urological Research Institute, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Marco Simonini
- Nephrology and Dialysis Unit, Genomics of Renal Diseases and Hypertension Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Larcher
- Division of Oncology/Unit of Urology, Urological Research Institute, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Elisabetta Messaggio
- Nephrology and Dialysis Unit, Genomics of Renal Diseases and Hypertension Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Zagato
- Nephrology and Dialysis Unit, Genomics of Renal Diseases and Hypertension Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cristina Carenzi
- Division of Oncology/Unit of Urology, Urological Research Institute, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Roberto Bertini
- Division of Oncology/Unit of Urology, Urological Research Institute, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, Urological Research Institute, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paolo Manunta
- Nephrology and Dialysis Unit, Genomics of Renal Diseases and Hypertension Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Vezzoli
- Nephrology and Dialysis Unit, Genomics of Renal Diseases and Hypertension Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Salonia
- Division of Oncology/Unit of Urology, Urological Research Institute, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Chiara Lanzani
- Nephrology and Dialysis Unit, Genomics of Renal Diseases and Hypertension Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Capitanio
- Division of Oncology/Unit of Urology, Urological Research Institute, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Patrizia Rovere-Querini
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- Department of General Medicine and Advanced Care, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, Urological Research Institute, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Fabio Ciceri
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Della-Torre E, Lanzillotta M, Ramirez GA, Dagna L, Tresoldi M. Serum IgG4 elevation in hyper-inflamed COVID-19 patients. Author's reply. Eur J Intern Med 2022; 95:98-99. [PMID: 34711472 PMCID: PMC8531494 DOI: 10.1016/j.ejim.2021.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/13/2021] [Accepted: 10/20/2021] [Indexed: 01/28/2023]
Affiliation(s)
- Emanuel Della-Torre
- IRCCS San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, via Olgettina 60, Milan 20132, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Milan, Italy.
| | - Marco Lanzillotta
- IRCCS San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, via Olgettina 60, Milan 20132, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Milan, Italy
| | - Giuseppe Alvise Ramirez
- IRCCS San Raffaele Scientific Institute, Università Vita-Salute San Raffaele, via Olgettina 60, Milan 20132, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Milan, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Milan, Italy
| | - Moreno Tresoldi
- General Medicine and Advanced Care Unit. All at IRCCS San Raffaele Scientific Institute, Milan, Italy
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28
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Bodega F, Russi A, Melillo F, Blunda F, Rubino C, Leo G, Cappelletti A, Mazzone P, Mattiello P, Della Bella P, Castiglioni A, Alfieri O, De Bonis M, Montorfano M, Tresoldi M, Filippi M, Salerno A, Cera M, Zangrillo A, Alberto M, Godino C. Direct oral anticoagulants in patients with nonvalvular atrial fibrillation and extreme body weight. Eur J Clin Invest 2022; 52:e13658. [PMID: 34310688 DOI: 10.1111/eci.13658] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 06/24/2021] [Revised: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Limited clinical data exist describing the use of direct oral anticoagulants (DOACs) in patient with extreme body weight. Thus, the International Society of Thrombosis and Haemostasis (ISTH) recommends avoiding DOACs in patients with weight >120 Kg, and on the contrary, no restrictions exist for underweight patients. OBJECTIVE To evaluate the effects of extreme body weight on DOAC activity and to compare the clinical outcomes of patients with an extreme body weight versus patients with a normal weight (61-119 Kg) treated with DOACs. METHODS Single tertiary care Italian centre multidisciplinary registry including nonvalvular atrial fibrillation (NVAF) patients treated with DOACs. Based on weight, three subcohorts were defined: (i) underweight patients (≤60 Kg); (ii) patients with a normal weight (61-119 Kg, as control group); and (iii) overweight patients (≥120 Kg). Primary efficacy endpoint was 2-year rate of thromboembolic events. Primary safety endpoint was 2-year rate of major bleeding. Event-free survival curves among groups were compared using Cox-Mantel test. RESULTS 812 NVAF patients were included, 108 patients weighed ≤60 Kg (13%, underweight), 688 weighed between 61 and 119 Kg (85%, normal weight), and 16 weighed ≥120 Kg (2%, overweight). In particular, among underweight patients, dabigatran was prescribed in 26% patients, apixaban in 27%, rivaroxaban in 28% and edoxaban in 22% ones. Instead, among overweight patients, 44% were treated with dabigatran, 25% with apixaban, 25% with rivaroxaban and 4% with edoxaban. Underweight patients were older, more frequently women, with lower creatinine clearance and a history of previous strokes, resulting in higher CHA2DS2-VASc score than in both remaining groups. Up to 2 years, no statistically significant difference was observed between the three groups of weight for thromboembolic events (P = .765) and for overall bleeding (P = .125), but a trend towards decreased overall bleeding rates was noticed as weight increased (24.1% vs 16.7% vs 12.5%, respectively). CONCLUSION In this tertiary care centre registry, 15% of patients treated with DOACs presented an extreme weight. Compared to patients with a normal weight, no significant rates of thromboembolic events were observed for underweight or overweight patients. A trend towards decreased overall bleeding frequency as weight increased was highlighted up to 2 years. The present results should be considered as preliminary and hypothesis generating.
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Affiliation(s)
| | - Anita Russi
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Fabiana Blunda
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Claudia Rubino
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giulio Leo
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Patrizio Mazzone
- Arrhythmia and Electrophysiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Paolo Mattiello
- Information Systems Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Paolo Della Bella
- Arrhythmia and Electrophysiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Ottavio Alfieri
- Cardiac Surgery Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Matteo Montorfano
- Interventional Cardiovascular Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Moreno Tresoldi
- General Medicine and Advanced Care Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Anna Salerno
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Michela Cera
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alberto Zangrillo
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Cosmo Godino
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
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Damanti S, Cilla M, Tuscano B, De Lorenzo R, Manganaro G, Merolla A, Pacioni G, Pomaranzi C, Tiraferri V, Martinenghi S, Vitali G, Bosi E, Conte C, Giustina A, Tresoldi M, Rovere Querini P. Evaluation of Muscle Mass and Stiffness with Limb Ultrasound in COVID-19 Survivors. Front Endocrinol (Lausanne) 2022; 13:801133. [PMID: 35250860 PMCID: PMC8892603 DOI: 10.3389/fendo.2022.801133] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 10/24/2021] [Accepted: 01/25/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND acute illnesses, like COVID-19, can act as a catabolic stimulus on muscles. So far, no study has evaluated muscle mass and quality through limb ultrasound in post-COVID-19 patients. METHODS cross sectional observational study, including patients seen one month after hospital discharge for SARS-CoV-2 pneumonia. The patients underwent a multidimensional evaluation. Moreover, we performed dominant medial gastrocnemius ultrasound (US) to characterize their muscle mass and quality. RESULTS two hundred fifty-nine individuals (median age 67, 59.8% males) were included in the study. COVID-19 survivors with reduced muscle strength had a lower muscle US thickness (1.6 versus 1.73 cm, p =0.02) and a higher muscle stiffness (87 versus 76.3, p = 0.004) compared to patients with normal muscle strength. Also, patients with reduced Short Physical Performance Battery (SPPB) scores had a lower muscle US thickness (1.3 versus 1.71 cm, p = 0.01) and a higher muscle stiffness (104.9 versus 81.07, p = 0.04) compared to individuals with normal SPPB scores. The finding of increased muscle stiffness was also confirmed in patients with a pathological value (≥ 4) at the sarcopenia screening tool SARC-F (103.0 versus 79.55, p < 0.001). Muscle stiffness emerged as a significant predictor of probable sarcopenia (adjusted OR 1.02, 95% C.I. 1.002 - 1.04, p = 0.03). The optimal ultrasound cut-offs for probable sarcopenia were 1.51 cm for muscle thickness (p= 0.017) and 73.95 for muscle stiffness (p = 0.004). DISCUSSION we described muscle ultrasound characteristics in post COVID-19 patients. Muscle ultrasound could be an innovative tool to assess muscle mass and quality in this population. Our preliminary findings need to be confirmed by future studies comparing muscle ultrasound with already validated techniques for measuring muscle mass and quality.
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Affiliation(s)
- Sarah Damanti
- Unit of General Medicine and Advanced Care, Instituto di Ricovero e Cura a Carattere Scientifico (IRCSS) San Raffaele Institute, Milan, Italy
- *Correspondence: Sarah Damanti,
| | - Marta Cilla
- Unit of General Medicine and Advanced Care, Instituto di Ricovero e Cura a Carattere Scientifico (IRCSS) San Raffaele Institute, Milan, Italy
| | - Bruno Tuscano
- Unit of Radiology, IRCCS San Raffaele Institute, Milan, Italy
| | | | | | | | | | | | | | - Sabina Martinenghi
- San Raffaele Diabetes Research Institute, Instituto di Ricovero e Cura a Carattere Scientifico (IRCSS) Ospedale San Raffaele, Milan, Italy
| | - Giordano Vitali
- San Raffaele Diabetes Research Institute, Instituto di Ricovero e Cura a Carattere Scientifico (IRCSS) Ospedale San Raffaele, Milan, Italy
| | - Emanuele Bosi
- Vita-Salute San Raffaele University, Milan, Italy
- San Raffaele Diabetes Research Institute, Instituto di Ricovero e Cura a Carattere Scientifico (IRCSS) Ospedale San Raffaele, Milan, Italy
| | - Caterina Conte
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
- Department of Endocrinology, Nutrition and Metabolic Diseases, Instituto di Ricovero e Cura a Carattere Scientifico (IRCSS) MultiMedica, Milan, Italy
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University, Instituto di Ricovero e Cura a Carattere Scientifico (IRCSS) San Raffaele Hospital, Ospedale San Raffaele, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, Instituto di Ricovero e Cura a Carattere Scientifico (IRCSS) San Raffaele Institute, Milan, Italy
| | - Patrizia Rovere Querini
- Unit of Radiology, IRCCS San Raffaele Institute, Milan, Italy
- Department of Immunology, Transplantation and Infectious Diseases, Instituto di Ricovero e Cura a Carattere Scientifico (IRCSS) Ospedale San Raffaele, Milan, Italy
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30
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Melillo F, Napolano A, Loffi M, Regazzoni V, Boccellino A, Danzi GB, Cappelletti AM, Rovere-Querini P, Landoni G, Ingallina G, Stella S, Ancona F, Dagna L, Scarpellini P, Ripa M, Castagna A, Tresoldi M, Zangrillo A, Ciceri F, Agricola E. Myocardial injury in patients with SARS-CoV-2 pneumonia: Pivotal role of inflammation in COVID-19. Eur J Clin Invest 2022; 52:e13703. [PMID: 34706062 PMCID: PMC8646244 DOI: 10.1111/eci.13703] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 08/13/2021] [Revised: 09/25/2021] [Accepted: 10/25/2021] [Indexed: 01/01/2023]
Abstract
AIMS Infection by SARS-CoV-2 may result in a systemic disease and a proportion of patients ranging 15%-44% experienced cardiac injury (CI) diagnosed by abnormal troponin levels. The aim of the present study was to analyse the clinical characteristics of a large series of hospitalized patients for COVID-19 in order to identify predisposing and/or protective factors of CI and the outcome. METHODS AND RESULTS This is an observational, retrospective study on patients hospitalized in two Italian centres (San Raffaele Hospital and Cremona Hospital) for COVID-19 and at least one high-sensitivity cardiac troponin (hs-cTnt) measurement during hospitalization. CI was defined if at least one hs-cTnt value was above the 99th percentile. The primary end-point was the occurrence of CI during hospitalization. We included 750 patients (median age 67, IQR 56-77 years; 69% males), of whom 46.9% had history of hypertension, 14.7% of chronic coronary disease and 22.3% of chronic kidney disease (CKD). Abnormal troponin levels (median troponin 74, IQR 34-147 ng/l) were detected in 390 patients (52%) during the hospitalization. At multivariable analysis age, CKD, cancer, C-reactive protein (CRP) levels were independently associated with CI. Independent predictors of very high troponin levels were chronic kidney disease and CRP levels. Patients with CI showed higher rate of all-cause mortality (40.0% vs. 9.1%, p = 0.001) compared to those without CI. CONCLUSION This large, multicentre Italian study confirmed the high prevalence of CI and its prognostic role in hospitalized patients with COVID-19, highlighting the leading role of systemic inflammation for the occurrence of CI.
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Affiliation(s)
- Francesco Melillo
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Napolano
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Scientific Institute, Milan, Italy
| | - Marco Loffi
- Division of Cardiology, Cremona Hospital, Cremona, Italy
| | | | - Antonio Boccellino
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Patrizia Rovere-Querini
- Internal Medicine, Diabetes and Endocrinology Unit, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Giovanni Landoni
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy
| | - Giacomo Ingallina
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Stella
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Ancona
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- Vita-Salute San Raffaele University, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Scarpellini
- Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Marco Ripa
- Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- Department of Internal Medicine and Advanced Therapies, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- Vita-Salute San Raffaele University, Milan, Italy.,Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, Cardiothoracic Department, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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31
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Spagnuolo V, Voarino M, Tonelli M, Galli L, Poli A, Bruzzesi E, Racca S, Clementi N, Oltolini C, Tresoldi M, Querini PR, Dagna L, Zangrillo A, Ciceri F, Clementi M, Castagna A. 505. Impact of Remdesivir on SARS-CoV-2 Clearance in a Real-Life Setting: A Matched-Cohort Study. Open Forum Infect Dis 2021. [PMCID: PMC8644947 DOI: 10.1093/ofid/ofab466.704] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Evidence regarding the impact of remdesivir (RDV) on SARS-CoV-2 viral clearance (VC) is scarce. Aim of this study was to compare VC timing in COVID-19 patients who received RDV with those who did not. Methods Matched-cohort study conducted (25 February 2020-15 April 2021) at the IRCSS San Raffaele, Milan, Italy. The study enrolled hospitalized patients with pneumonia and a SARS-CoV-2 positive nasopharyngeal swab (NPS) at admission and at least one NPS during follow-up. Follow-up started at hospital admission and ended at the date of the first negative NPS (within 30 days after discharge). Patients who received RDV (cases) and patients who did not (controls) were matched based on age (±5 years), sex and PaO2/FiO2 (P/F; ±10 mmHg) values at admission. NPS were analyzed with RT-PCR. Results described as median (IQR) or frequency (%). Time to VC was estimated with Kaplan-Meier curve and compared with log-rank test. Results 648 patients were enrolled: 216 cases and 432 controls. Patients’ characteristics at admission are reported in Table 1. VC was observed in 490 patients (75.6%) in a median time of 25 (16-34) days. Overall, time to VC was similar in patients receiving or not receiving remdesivir (p=0.519). However, time to VC was different when considering both the use of RDV (yes vs no) and age (≤ or > 63 years), as shown in Figure 1A. A significant finding was also observed considering the use of RDV and P/F values at admission (≤ or > 200 mmHg), as reported in Figure 1B. Among the 490 patients who reached VC during follow-up, overall time to VC was similar in patients receiving or not receiving RDV (p=0.075; Figure 2A); however, RDV use was associated with a higher probability of VC in the subgroup of patients with P/F admission values ≤ 200mmHg (p=0.035; Figure 2B), in the age group 55-65 years (p=0.025; Figure 2C) and in patients with comorbidities (p=0.028). ![]()
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Time to viral clearance among the 490 patients who reached VC during follow-up. Panel A: time to VC according to RDV use. Panel B: time to VC according to RDV and P/F ratio value at admission. Panel C: time to VC according to RDV in the age group 55-65 years. Conclusion Time to viral clearance was similar in patients receiving or not receiving remdesivir; however the use of RDV was associated with a benefit on time to viral clearance in younger patients and in those with a P/F ratio at admission ≤200 mmHg. Disclosures Vincenzo Spagnuolo, MD, ViiV Healthcare (Other Financial or Material Support, Preparation of educational material) Antonella Castagna, MD, Gilead Sciences (Other Financial or Material Support, Speaking fee)Jansenn-Cilag (Other Financial or Material Support, Speaking fee)MSD (Other Financial or Material Support, Speaking fee)Theratechnologies (Other Financial or Material Support, Speaking fee)ViiV Healthcare (Other Financial or Material Support, Speaking fee)
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Affiliation(s)
- Vincenzo Spagnuolo
- Vita-Salute San Raffaele University; Unit of Infectious Diseases, IRCCS, San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Marta Voarino
- Vita-Salute San Raffaele University, Milan, Lombardia, Italy
| | - Marco Tonelli
- Vita Salute San Raffaele University; Unit of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Laura Galli
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Andrea Poli
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Elena Bruzzesi
- Vita-Salute San Raffaele University; Unit of Infectious Diseases, IRCCS, San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Sara Racca
- Unit of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Nicola Clementi
- Vita Salute San Raffaele University; Unit of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Chiara Oltolini
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Moreno Tresoldi
- General Medicine and Advanced Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Patrizia Rovere Querini
- Vita-Salute San Raffaele University; Internal Medicine, Diabetes, and Endocrinology Unit, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Lorenzo Dagna
- Vita-Salute San Raffaele University; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Alberto Zangrillo
- Vita-Salute San Raffaele University; Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Fabio Ciceri
- Vita-Salute San Raffaele University; Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Massimo Clementi
- Vita Salute San Raffaele University; Unit of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Lombardia, Italy
| | - Antonella Castagna
- IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milano, Lombardia, Italy
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32
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Zangrillo A, Belletti A, Palumbo D, Calvi MR, Guzzo F, Fominskiy EV, Ortalda A, Nardelli P, Ripa M, Baiardo Redaelli M, Borghi G, Landoni G, D'Amico F, Marmiere M, Righetti B, Rocchi M, Saracino M, Tresoldi M, Dagna L, De Cobelli F. One-Year Multidisciplinary Follow-Up of Patients With COVID-19 Requiring Invasive Mechanical Ventilation. J Cardiothorac Vasc Anesth 2021; 36:1354-1363. [PMID: 34973891 PMCID: PMC8626145 DOI: 10.1053/j.jvca.2021.11.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 07/24/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 12/12/2022]
Abstract
Objectives Patients with COVID-19 frequently develop acute respiratory distress syndrome (ARDS) requiring intensive care unit (ICU) admission. Data on long-term survival of these patients are lacking. The authors investigated 1-year survival, quality of life, and functional recovery of patients with COVID-19 ARDS requiring invasive mechanical ventilation. Design Prospective observational study. Setting Tertiary-care university hospital. Participants All patients with COVID-19 ARDS receiving invasive mechanical ventilation and discharged alive from hospital. Interventions Patients were contacted by phone after 1 year. Functional, cognitive, and psychological outcomes were explored through a questionnaire and assessed using validated scales. Patients were offered the possibility to undergo a follow-up chest computed tomography (CT) scan. Measurements and Main Results The study included all adult (age ≥18 years) patients with COVID-19–related ARDS admitted to an ICU of the authors’ institution between February 25, 2020, and April 27, 2020, who received at least 1 day of invasive mechanical ventilation (IMV). Of 116 patients who received IMV, 61 (52.6%) survived to hospital discharge. These survivors were assessed 1 year after discharge and 56 completed a battery of tests of cognition, activities of daily living, and interaction with family members. They had overall good functional recovery, with >80% reporting good recovery and no difficulties in usual activities. A total of 52 (93%) of patients had no dyspnea at rest. Severe anxiety/depression was reported by 5 (8.9%) patients. Comparing 2-month and 1-year data, the authors observed the most significant improvements in the areas of working status and exertional dyspnea. One-year chest CT scans were available for 36 patients; fibrotic-like changes were present in 4 patients. Conclusions All patients who survived the acute phase of COVID-19 and were discharged from the hospital were alive at the 1-year follow up, and the vast majority of them had good overall recovery and quality of life.
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Affiliation(s)
- Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Diego Palumbo
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Rosa Calvi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Guzzo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Evgeny V Fominskiy
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Ortalda
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pasquale Nardelli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Ripa
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Baiardo Redaelli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Borghi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Filippo D'Amico
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marilena Marmiere
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Beatrice Righetti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Margherita Rocchi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Saracino
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Unit of Immunology, Rheumatology, Allergy, and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Della-Torre E, Lanzillotta M, Strollo M, Ramirez GA, Dagna L, Tresoldi M. Serum IgG4 level predicts COVID-19 related mortality. Eur J Intern Med 2021; 93:107-109. [PMID: 34598853 PMCID: PMC8461218 DOI: 10.1016/j.ejim.2021.09.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/31/2021] [Accepted: 09/16/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Emanuel Della-Torre
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Marco Lanzillotta
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marta Strollo
- Laboratory Medicine Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Alvise Ramirez
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- General Medicine and Advanced Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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34
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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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35
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Italia L, Ingallina G, Napolano A, Boccellino A, Belli M, Cannata F, Rolando M, Ancona F, Melillo F, Stella S, Ripa M, Scarpellini P, Tresoldi M, Ortalda A, Righetti B, De Cobelli F, Esposito A, Ciceri F, Castagna A, Rovere PQ, Fragasso G, Agricola E. Subclinical myocardial dysfunction in patients recovered from COVID-19. Echocardiography 2021; 38:1778-1786. [PMID: 34672005 PMCID: PMC8652678 DOI: 10.1111/echo.15215] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/29/2021] [Accepted: 09/22/2021] [Indexed: 01/15/2023] Open
Abstract
Background Myocardial injury (MI) can be detected during the acute phase of Coronavirus disease 19 (COVID‐19) and is associated with a dismal prognosis. Recent imaging studies described the persistence of cardiac abnormalities after the recovery. The aim of the study was to investigate the spectrum of cardiac abnormalities at mid‐term follow‐up in patients recovered from COVID‐19 using clinical assessment, laboratory tests, and imaging evaluation with comprehensive echocardiography. Methods This is an observational, cross‐sectional study assessing an unselected cohort of consecutive patients recovered from COVID‐19. MI was defined by elevated plasma levels of high sensitive troponin T (hsTnT). At the follow‐up, a complete examination including echocardiography was performed. Results The 123 patients included were divided into two groups according to the presence of MI during hospitalization: group A (without MI) and group B (with MI). After a median of 85 days, group B patients were more frequently symptomatic for dyspnea and had significantly higher values of hsTnT and N‐Terminal prohormone of Brain Natriuretic Peptide (NT‐proBNP), compared to Group A. No differences between the two groups in left nor right ventricle dimension and ejection fraction were found. However, in group B a significant reduction of mean left ventricle global longitudinal strain was observed (‐15.7±.7 vs ‐18.1± .3 in group A, p < 0.001), together with higher frequency of impaired diastolic function and higher values of pulmonary pressure. Conclusions In patients recovered from COVID‐19, echocardiography with speckle‐tracking analysis may be an useful imaging tool to identify subclinical myocardial dysfunction and potentially guide management strategies.
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Affiliation(s)
- Leonardo Italia
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Giacomo Ingallina
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Napolano
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Boccellino
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Martina Belli
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Cannata
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Marco Rolando
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Ancona
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Melillo
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Stella
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Marco Ripa
- Department of Infectious Disease, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Scarpellini
- Department of Infectious Disease, San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- Department of General Medicine and Advanced Care, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Ortalda
- Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy
| | - Beatrice Righetti
- Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Vita-Salute San Raffaele University, Milan, Italy.,Experimental Imaging Center, Radiology Department, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Esposito
- Vita-Salute San Raffaele University, Milan, Italy.,Experimental Imaging Center, Radiology Department, San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- Vita-Salute San Raffaele University, Milan, Italy.,Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Department of Infectious Disease, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Patrizia Querini Rovere
- Vita-Salute San Raffaele University, Milan, Italy.,Internal Medicine, Diabetes and Endocrinology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Gabriele Fragasso
- Heart Failure Clinic, Clinical Cardiology, San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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36
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Calvisi SL, Ramirez GA, Scavini M, Da Prat V, Di Lucca G, Laurenzi A, Gallina G, Cavallo L, Borio G, Farolfi F, Pascali M, Castellani J, Lampasona V, D'Angelo A, Landoni G, Ciceri F, Querini PR, Tresoldi M, Piemonti L. Thromboembolism risk among patients with diabetes/stress hyperglycemia and COVID-19. Metabolism 2021; 123:154845. [PMID: 34364927 PMCID: PMC8340557 DOI: 10.1016/j.metabol.2021.154845] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/19/2021] [Accepted: 08/02/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Individuals with diabetes/stress hyperglycemia carry an increased risk for adverse clinical outcome in case of SARS-CoV-2 infection. The purpose of this study was to evaluate whether this risk is, at least in part, modulated by an increase of thromboembolic complications. METHODS We prospectively followed 180 hospitalized patients with confirmed COVID-19 pneumonia admitted to the Internal Medicine Units of San Raffaele Hospital. Data from 11 out of 180 patients were considered incomplete and excluded from the analysis. We analysed inflammation, tissue damage biomarkers, hemostatic parameters, thrombotic events (TEs) and clinical outcome according to the presence of diabetes/stress hyperglycemia. RESULTS Among 169 patients, 51 (30.2%) had diabetes/stress hyperglycemia. Diabetes/stress hyperglycemia and fasting blood glucose (FBG) were associated with increased inflammation and tissue damage circulating markers, higher D-dimer levels, increased prothrombin time and lower antithrombin III activity. Forty-eight venous and 10 arterial TEs were identified in 49 (29%) patients. Diabetes/stress hyperglycemia (HR 2.71, p = 0.001), fasting blood glucose (HR 4.32, p < 0.001) and glucose variability (HR 1.6, p < 0.009) were all associated with an increased risk of thromboembolic complication. TEs significantly increased the risk for an adverse clinical outcome only in the presence of diabetes/stress hyperglycemia (HR 3.05, p = 0.010) or fasting blood glucose ≥7 mmol/L (HR 3.07, p = 0.015). CONCLUSIONS Thromboembolism risk is higher among patients with diabetes/stress hyperglycemia and COVID-19 pneumonia and is associated to poor clinical outcome. In case of SARS-Cov-2 infection patients with diabetes/stress hyperglycemia could be considered for a more intensive prophylactic anticoagulation regimen.
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Affiliation(s)
- Stefania L Calvisi
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppe A Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Marina Scavini
- Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Unit of Internal Medicine and Endocrinology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Valentina Da Prat
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppe Di Lucca
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Laurenzi
- Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Unit of Internal Medicine and Endocrinology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Gabriele Gallina
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Ludovica Cavallo
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Giorgia Borio
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Federica Farolfi
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Maria Pascali
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Jacopo Castellani
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Vito Lampasona
- Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Armando D'Angelo
- Università Vita-Salute San Raffaele, Milan, Italy; Coagulation service and Thrombosis Research Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giovanni Landoni
- Università Vita-Salute San Raffaele, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- Università Vita-Salute San Raffaele, Milan, Italy; Hematology and Bone Marrow Transplantation Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Patrizia Rovere Querini
- Università Vita-Salute San Raffaele, Milan, Italy; Unit of Internal Medicine and Endocrinology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Lorenzo Piemonti
- Università Vita-Salute San Raffaele, Milan, Italy; Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
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37
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Salonia A, Pontillo M, Capogrosso P, Gregori S, Carenzi C, Ferrara AM, Rowe I, Boeri L, Larcher A, Ramirez GA, Tresoldi C, Locatelli M, Cavalli G, Dagna L, Castagna A, Zangrillo A, Tresoldi M, Landoni G, Rovere-Querini P, Ciceri F, Montorsi F. Testosterone in males with COVID-19: A 7-month cohort study. Andrology 2021; 10:34-41. [PMID: 34409772 PMCID: PMC8444879 DOI: 10.1111/andr.13097] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [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: 06/21/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 02/06/2023]
Abstract
Background Circulating testosterone levels have been found to be reduced in men with severe acute respiratory syndrome coronavirus 2 infection, COVID‐19, with lower levels being associated with more severe clinical outcomes. Objectives We aimed to assess total testosterone levels and the prevalence of total testosterone still suggesting for hypogonadism at 7‐month follow‐up in a cohort of 121 men who recovered from laboratory‐confirmed COVID‐19. Materials and methods Demographic, clinical, and hormonal values were collected for all patients. Hypogonadism was defined as total testosterone ≤9.2 nmol/L. The Charlson Comorbidity Index was used to score health‐significant comorbidities. Descriptive statistics and multivariable linear and logistic regression models tested the association between clinical and laboratory variables and total testosterone levels at follow‐up assessment. Results Circulating total testosterone levels increased at 7‐month follow‐up compared to hospital admittance (p < 0.0001), while luteinizing hormone and 17β‐estradiol levels significantly decreased (all p ≤ 0.02). Overall, total testosterone levels increased in 106 (87.6%) patients, but further decreased in 12 (9.9%) patients at follow‐up, where a total testosterone level suggestive for hypogonadism was still observed in 66 (55%) patients. Baseline Charlson Comorbidity Index score (OR 0.36; p = 0.03 [0.14, 0.89]) was independently associated with total testosterone levels at 7‐month follow‐up, after adjusting for age, BMI, and IL‐6 at hospital admittance. Conclusions Although total testosterone levels increased over time after COVID‐19, more than 50% of men who recovered from the disease still had circulating testosterone levels suggestive for a condition of hypogonadism at 7‐month follow‐up. In as many as 10% of cases, testosterone levels even further decreased. Of clinical relevance, the higher the burden of comorbid conditions at presentation, the lower the probability of testosterone levels recovery over time.
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Affiliation(s)
- Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Marina Pontillo
- Laboratory Medicine Service, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy
| | - Silvia Gregori
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Cristina Carenzi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Anna Maria Ferrara
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Isaline Rowe
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luca Boeri
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,IRCCS Foundation Ca' Granda, Maggiore Policlinico Hospital, Department of Urology, University of Milan, Milan, Italy
| | - Alessandro Larcher
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppe A Ramirez
- University Vita-Salute San Raffaele, Milan, Italy.,Immunology, Rheumatology, Allergology and Rare Diseases Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Cristina Tresoldi
- Molecular Hematology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Locatelli
- Laboratory Medicine Service, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giulio Cavalli
- University Vita-Salute San Raffaele, Milan, Italy.,Immunology, Rheumatology, Allergology and Rare Diseases Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Lorenzo Dagna
- University Vita-Salute San Raffaele, Milan, Italy.,Immunology, Rheumatology, Allergology and Rare Diseases Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antonella Castagna
- University Vita-Salute San Raffaele, Milan, Italy.,Department of Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Zangrillo
- University Vita-Salute San Raffaele, Milan, Italy.,Anesthesia and Intensive Care Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Moreno Tresoldi
- General Medicine and Advanced Care Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giovanni Landoni
- University Vita-Salute San Raffaele, Milan, Italy.,Anesthesia and Intensive Care Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Patrizia Rovere-Querini
- University Vita-Salute San Raffaele, Milan, Italy.,Internal Medicine, Diabetes, and Endocrinology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- University Vita-Salute San Raffaele, Milan, Italy.,Hematology and Bone Marrow Transplant Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
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38
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Palumbo D, Zangrillo A, Belletti A, Guazzarotti G, Calvi MR, Guzzo F, Pennella R, Monti G, Gritti C, Marmiere M, Rocchi M, Colombo S, Valsecchi D, Scandroglio AM, Dagna L, Rovere-Querini P, Tresoldi M, Landoni G, De Cobelli F. A radiological predictor for pneumomediastinum/pneumothorax in COVID-19 ARDS patients. J Crit Care 2021; 66:14-19. [PMID: 34392131 PMCID: PMC8357628 DOI: 10.1016/j.jcrc.2021.07.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 05/07/2021] [Revised: 07/19/2021] [Accepted: 07/27/2021] [Indexed: 12/14/2022]
Abstract
Purpose To determine whether Macklin effect (a linear collection of air contiguous to the bronchovascular sheath) on baseline CT imaging is an accurate predictor for subsequent pneumomediastinum (PMD)/pneumothorax (PNX) development in invasively ventilated patients with COVID-19-related acute respiratory distress syndrome (ARDS). Materials and methods This is an observational, case-control study. From a prospectively acquired database, all consecutive invasively ventilated COVID-19 ARDS patients who underwent at least one baseline chest CT scan during the study time period (February 25th, 2020–December 31st, 2020) were identified; those who had tracheal lesion or already had PMD/PNX at the time of the first available chest imaging were excluded. Results 37/173 (21.4%) patients enrolled had PMD/PNX; specifically, 20 (11.5%) had PMD, 10 (5.8%) PNX, 7 (4%) both. 33/37 patients with subsequent PMD/PNX had Macklin effect on baseline CT (89.2%, true positives) 8.5 days [range, 1–18] before the first actual radiological evidence of PMD/PNX. Conversely, 6/136 patients without PMD/PNX (4.4%, false positives) demonstrated Macklin effect (p < 0.001). Macklin effect yielded a sensitivity of 89.2% (95% confidence interval [CI]: 74.6–96.9), a specificity of 95.6% (95% CI: 90.6–98.4), a positive predictive value (PV) of 84.5% (95% CI: 71.3–92.3), a negative PV of 97.1% (95% CI: 74.6–96.9) and an accuracy of 94.2% (95% CI: 89.6–97.2) in predicting PMD/PNX (AUC:0.924). Conclusions Macklin effect accurately predicts, 8.5 days in advance, PMD/PNX development in COVID-19 ARDS patients.
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Affiliation(s)
- Diego Palumbo
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Zangrillo
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgia Guazzarotti
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Rosa Calvi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Guzzo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Renato Pennella
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Giacomo Monti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Gritti
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Marilena Marmiere
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Margherita Rocchi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sergio Colombo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Davide Valsecchi
- Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Rovere-Querini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Internal Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Internal Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Francesco De Cobelli
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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39
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Gulletta S, Della Bella P, Pannone L, Falasconi G, Cianfanelli L, Altizio S, Cinel E, Da Prat V, Napolano A, D'Angelo G, Brugliera L, Agricola E, Landoni G, Tresoldi M, Rovere PQ, Ciceri F, Zangrillo A, Vergara P. QTc interval prolongation, inflammation, and mortality in patients with COVID-19. J Interv Card Electrophysiol 2021; 63:441-448. [PMID: 34291390 PMCID: PMC8295006 DOI: 10.1007/s10840-021-01033-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/05/2021] [Indexed: 01/08/2023]
Abstract
Purpose Systemic inflammation has been associated with corrected QT (QTc) interval prolongation. The role of inflammation on QTc prolongation in COVID-19 patients was investigated. Methods Patients with a laboratory-confirmed SARS-CoV-2 infection admitted to IRCCS San Raffaele Scientific Institute (Milan, Italy) between March 14, 2020, and March 30, 2020 were included. QTc-I was defined as the QTc interval by Bazett formula in the first ECG performed during the hospitalization, before any new drug treatment; QTc-II was the QTc in the ECG performed after the initiation of hydroxychloroquine drug treatment. Results QTc-I was long in 45 patients (45%) and normal in 55 patients (55%). Patients with long QTc-I were older and more frequently males. C-Reactive protein (CRP) and white blood cell (WBC) count at hospitalization were higher in patients with long QTc-I and long QTc-II. QTc-I was significantly correlated with CRP levels at hospitalization. After a median follow-up of 83 days, 14 patients (14%) died. There were no deaths attributed to ventricular arrhythmias. Patients with long QTc-I and long QTc-II had a shorter survival, compared with normal QTc-I and QTc-II patients, respectively. In Cox multivariate analysis, independent predictors of mortality were age (HR = 1.1, CI 95% 1.04–1.18, p = 0.002) and CRP at ECG II (HR 1.1, CI 95% 1.0–1.1, p = 0.02). Conclusions QTc at hospitalization is a simple risk marker of mortality risk in COVID-19 patients and reflects the myocardial inflammatory status.
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Affiliation(s)
- Simone Gulletta
- Arrhythmia Unit and Electrophysiology Laboratories, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Della Bella
- Arrhythmia Unit and Electrophysiology Laboratories, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Pannone
- IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Giulio Falasconi
- IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Lorenzo Cianfanelli
- IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Savino Altizio
- IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Elena Cinel
- IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Valentina Da Prat
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Napolano
- IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Giuseppe D'Angelo
- Arrhythmia Unit and Electrophysiology Laboratories, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigia Brugliera
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.,Cardiac Imaging Unit, Cardio-Thoracic Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.,Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Querini Rovere
- IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.,Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.,Department of Hematology and Stem Cell Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.,Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pasquale Vergara
- Arrhythmia Unit and Electrophysiology Laboratories, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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40
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Conte C, Esposito A, De Lorenzo R, Di Filippo L, Palmisano A, Vignale D, Leone R, Nicoletti V, Ruggeri A, Gallone G, Secchi A, Bosi E, Tresoldi M, Castagna A, Landoni G, Zangrillo A, De Cobelli F, Ciceri F, Camici P, Rovere-Querini P. Epicardial adipose tissue characteristics, obesity and clinical outcomes in COVID-19: A post-hoc analysis of a prospective cohort study. Nutr Metab Cardiovasc Dis 2021; 31:2156-2164. [PMID: 34059384 PMCID: PMC8091800 DOI: 10.1016/j.numecd.2021.04.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 12/08/2020] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Obesity-related cardiometabolic risk factors associate with COVID-19 severity and outcomes. Epicardial adipose tissue (EAT) is associated with cardiometabolic disturbances, is a source of proinflammatory cytokines and a marker of visceral adiposity. We investigated the relation between EAT characteristics and outcomes in COVID-19 patients. METHODS AND RESULTS This post-hoc analysis of a large prospective investigation included all adult patients (≥18 years) admitted to San Raffaele University Hospital in Milan, Italy, from February 25th to April 19th, 2020 with confirmed SARS-CoV-2 infection who underwent a chest computed tomography (CT) scan for COVID-19 pneumonia and had anthropometric data available for analyses. EAT volume and attenuation (EAT-At, a marker of EAT inflammation) were measured on CT scan. Primary outcome was critical illness, defined as admission to intensive care unit (ICU), invasive ventilation or death. Cox regression and regression tree analyses were used to assess the relationship between clinical variables, EAT characteristics and critical illness. One-hundred and ninety-two patients were included (median [25th-75th percentile] age 60 years [53-70], 76% men). Co-morbidities included overweight/obesity (70%), arterial hypertension (40%), and diabetes (16%). At multivariable Cox regression analysis, EAT-At (HR 1.12 [1.04-1.21]) independently predicted critical illness, while increasing PaO2/FiO2 was protective (HR 0.996 [95% CI 0.993; 1.00]). CRP, plasma glucose on admission, EAT-At and PaO2/FiO2 identified five risk groups that significantly differed with respect to time to death or admission to ICU (log-rank p < 0.0001). CONCLUSION Increased EAT attenuation, a marker of EAT inflammation, but not obesity or EAT volume, predicts critical COVID-19. TRIAL REGISTRATION NCT04318366.
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Affiliation(s)
- Caterina Conte
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Antonio Esposito
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Experimental Imaging Center, Unit of Experimental and Clinical Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Luigi Di Filippo
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Anna Palmisano
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Experimental Imaging Center, Unit of Experimental and Clinical Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Davide Vignale
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Experimental Imaging Center, Unit of Experimental and Clinical Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Leone
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Experimental Imaging Center, Unit of Experimental and Clinical Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valeria Nicoletti
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Experimental Imaging Center, Unit of Experimental and Clinical Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Annalisa Ruggeri
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Guglielmo Gallone
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Antonio Secchi
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Emanuele Bosi
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Giovanni Landoni
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Experimental Imaging Center, Unit of Experimental and Clinical Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Camici
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Rovere-Querini
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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41
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Rubino C, Blunda F, Bodega F, Melillo F, Russi A, Mattiello P, Salerno A, Cera M, Margonato D, Mazzone P, Della Bella P, Castiglioni A, Alfieri O, DE Bonis M, Montorfano M, Filippi M, Tresoldi M, Cappelletti A, Zangrillo A, Margonato A, Godino C. Safety and efficacy of Direct Oral Anticoagulants (DOACs) in very elderly patients (≥ 85 years old) with non-valvular atrial fibrillation. The Experience of an Italian tertiary care center. Minerva Med 2021; 114:137-147. [PMID: 34180639 DOI: 10.23736/s0026-4806.21.07432-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Limited real-world data are available regarding the comparison about safety and efficacy of DOACs prescription in very elderly patients (≥85 years) with non-valvular atrial fibrillation (NVAF). Concern about the risk of bleeding with anticoagulation in very older patients still represents an important challenge for clinicians. OBJECTIVE To evaluate the different prevalence of major bleeding and thromboembolic events between very elderly NVAF patients (≥85 years) compared to those non very elderly (<85 years). METHODS Single center multidisciplinary registry including NVAF patients treated with DOACs. Primary safety endpoint was 2-year rate of major bleeding. Primary efficacy endpoint was 2-year rate of thromboembolic events. Event-free survival curves among groups were compared using Cox-Mantel test. RESULTS 908 NVAF consecutive patients were included, of these, 805 patients were <85 years (89%) and 103 patients were very elderly patients with ≥85 years (11%). Compared to patients <85 years, those very elderly have higher CHA2DS2-VASc score (p=0.001), higher rate of hypertension (p=0.001), diabetes mellitus (p=0.030), previous bleeding events (p<0.001), previous stroke/TIA/SE (p=<0.001), heart failure (p=<0.001), and lower creatinine clearance (p<0.001). In terms of safety endpoints (overall ISTH-major bleeding) no significative difference between two groups (p=0.952) were observed up to 2-year follow-up. Systemic thromboembolic event (primary efficacy endpoint) was significantly higher in patients with ≥85 years (p=0.027). The incidence of all-cause death was significantly higher in very elderly patients (p<0.001). CONCLUSIONS This single center registry, showed that the use of DOACs in very elderly NVAF was safe and is a therapeutic option to be pursued for stroke prevention especially for those who are at high risk of ischemic events.
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Affiliation(s)
- Claudia Rubino
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy -
| | - Fabiana Blunda
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | - Anita Russi
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Paolo Mattiello
- Information Systems Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Anna Salerno
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Michela Cera
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Patrizio Mazzone
- Arrhythmia and Electrophysiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Paolo Della Bella
- Arrhythmia and Electrophysiology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alessandro Castiglioni
- Cardiac Surgery Unit, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Ottavio Alfieri
- Cardiac Surgery Unit, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Michele DE Bonis
- Cardiac Surgery Unit, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiovascular Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Massimo Filippi
- Vita-Salute San Raffaele University, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Moreno Tresoldi
- Vita-Salute San Raffaele University, Milan, Italy.,General Medicine and Advanced Care Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Alberto Zangrillo
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alberto Margonato
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Cosmo Godino
- Cardiology Unit, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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42
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Ramirez GA, Calvisi SL, DE Lorenzo R, DA Prat V, Borio G, Gallina G, Farolfi F, Cavallo L, Pascali M, Castellani J, Baccellieri D, Guzzo F, Baiardo Redaelli M, Azzolini ML, Alba AC, Zangrillo A, Bozzolo EP, Scotti R, DI Lucca G, Piemonti L, Rovere Querini P, D'Angelo A, Tresoldi M. A novel evidence-based algorithm to predict thromboembolism in patients with COVID-19: preliminary data from a single-centre cohort. Minerva Med 2021; 113:695-706. [PMID: 34114439 DOI: 10.23736/s0026-4806.21.07331-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-related disease (COVID-19) is an infectious disease characterised by systemic inflammation, which might enhance baseline thrombotic risk, especially in hospitalised patients. Little is, however, known about predictors of thrombotic complications in patients with COVID-19. METHODS We prospectively followed up 180 hospitalised COVID-19 patients. Demographics, clinical and laboratory features at presentation and past medical history were tested as predictors of the first thrombotic complication through multivariate Cox regression analysis and a categorical score generated based on the results. RESULTS Sixty-four thromboses were recorded in 54 patients, of whom seven with thrombosis on admission and 47 with thrombosis during hospitalisation. Patients with thrombosis were mainly Caucasian and diabetic, had marked baseline signs of inflammation and organ damage, lower PaO2/FiO2 ratio, higher D-dimer levels and history of major haemorrhages. The latter three variables were independently associated to thrombotic complications and concurred to a 0-5 score, which accounted for 80% of the total sample variability. Patients with three or more points of the newly generated score were at higher risk for thrombotic complications (HR=4.9, p<0.001). Patients with thrombotic complications were more likely to be admitted to intensive care and/or to die (HR=1.9, p=0.036). Five of 180 patients were diagnosed with disseminated intravascular coagulation and three of them died. Eleven minor and no major bleeding events were observed. CONCLUSIONS Patients with COVID-19 are at increased risk for thrombosis and might be stratified on admission based lower Pao2/FiO2 ratio, higher D-dimer levels and history of major haemorrhages.
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Affiliation(s)
- Giuseppe A Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Università Vita-Salute San Raffaele, Milan, Italy
| | - Stefania L Calvisi
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, Milan, Italy -
| | - Rebecca DE Lorenzo
- Università Vita-Salute San Raffaele, Milan, Italy.,Unit of Internal Medicine and Endocrinology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Valentina DA Prat
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgia Borio
- Università Vita-Salute San Raffaele, Milan, Italy.,Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Gabriele Gallina
- Università Vita-Salute San Raffaele, Milan, Italy.,Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federica Farolfi
- Università Vita-Salute San Raffaele, Milan, Italy.,Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ludovica Cavallo
- Università Vita-Salute San Raffaele, Milan, Italy.,Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Maria Pascali
- Università Vita-Salute San Raffaele, Milan, Italy.,Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Jacopo Castellani
- Università Vita-Salute San Raffaele, Milan, Italy.,Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Francesca Guzzo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Baiardo Redaelli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Luisa Azzolini
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ada C Alba
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Università Vita-Salute San Raffaele, Milan, Italy.,Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrica P Bozzolo
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Raffaella Scotti
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppe DI Lucca
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Lorenzo Piemonti
- Università Vita-Salute San Raffaele, Milan, Italy.,Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Patrizia Rovere Querini
- Università Vita-Salute San Raffaele, Milan, Italy.,Unit of Internal Medicine and Endocrinology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Armando D'Angelo
- Università Vita-Salute San Raffaele, Milan, Italy.,Coagulation Service and Thrombosis Research Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, Milan, Italy
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Godino C, Bodega F, Melillo F, Rubino F, Parlati ALM, Cappelletti A, Mazzone P, Mattiello P, Della Bella P, Castiglioni A, Alfieri O, De Bonis M, Montorfano M, Tresoldi M, Filippi M, Zangrillo A, Salerno A, Cera M, Margonato A. Inappropriate dose of nonvitamin-K antagonist oral anticoagulants: prevalence and impact on clinical outcome in patients with nonvalvular atrial fibrillation. J Cardiovasc Med (Hagerstown) 2021; 21:751-758. [PMID: 32740435 DOI: 10.2459/jcm.0000000000001043] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Limited real-world data are available regarding the outcome of patients treated with inappropriate dose of nonvitamin-K antagonist oral anticoagulants (NOACs). OBJECTIVE To assess the prevalence and factors associated with inappropriate dose prescription of NOACs and to evaluate adverse events that come from this inappropriate prescription. METHODS Single-center multidisciplinary registry including nonvalvular atrial fibrillation patients treated with NOACs. Based on guidelines criteria for dose reduction, two subcohorts were defined as treated with appropriate or inappropriate NOACs dose. Primary efficacy endpoint was 2-year rate of thromboembolic events. Primary safety endpoint was 2-year rate of major bleeding. Event-free survival curves among groups were compared using Cox-Mantel test. RESULTS A total of 760 nonvalvular atrial fibrillation patients were included; 32% patients were treated with dabigatran, 34% with apixaban, 24% with rivaroxaban and 10% with edoxaban. An inappropriate dose was prescribed in 96 patients (12.6%), and in most cases (68%) it was too low. Rivaroxaban (15%) and apixaban (18.5%) were the most frequently prescribed with an inappropriate dose. Patients treated with an inappropriate dose were elderly people, with low-creatinine clearance value, who had experienced previous bleeding and with a high CHADS2 VASc score. In 2 years, a trend for higher numbers of thromboembolic events (5.2 vs. 3.3%, P = 0.348) and less major bleeding (2.1 vs. 4.2%, P = 0.316) has been observed in patients with inappropriate NOACs prescriptions. CONCLUSION Nearly 13% of patients were treated with an inappropriate dose of NOACs, in this single-center study. A trend for higher numbers of thromboembolic events was observed in these patients. The results should be considered as hypothesis generating.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alberto Zangrillo
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Hospital, Milan, Italy
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Zangrillo A, Colombo S, Scandroglio AM, Fominskiy E, Pieri M, Calabrò MG, Beccaria PF, Pasculli N, Guzzo F, Calvi MR, Cipriani A, Sartini C, Nardelli P, Ortalda A, Lombardi G, Sartorelli M, Monti G, Assanelli A, Tresoldi M, Dagna L, Franchini S, Neto AS, Bellomo R, Landoni G. Angiotensin II infusion and markers of organ function in invasively ventilated COVID-19 patients. CRIT CARE RESUSC 2021; 23:215-224. [PMID: 38045523 PMCID: PMC10692502 DOI: 10.51893/2021.2.oa9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The use of angiotensin II in invasively ventilated patients with coronavirus disease 2019 (COVID-19) is controversial. Its effect on organ function is unknown. Design: Prospective observational study. Setting: Intensive care unit (ICU) of a tertiary academic hospital in Milan, Italy. Participants: Adult patients receiving mechanical ventilation due to COVID-19. Interventions: Use angiotensin II either as rescue vasopressor agent or as low dose vasopressor support. Main outcome measures: Patients treated before angiotensin II was available or treated in an adjacent COVID-19 ICU served as controls. For data analysis, we applied Bayesian modelling as appropriate. We assessed the effects of angiotensin II on organ function. Results: We compared 46 patients receiving angiotensin II therapy with 53 controls. Compared with controls, angiotensin II increased the mean arterial pressure (median difference, 9.05 mmHg; 95% CI, 1.87-16.22; P = 0.013) and the PaO2/FiO2 ratio (median difference, 23.17; 95% CI, 3.46-42.88; P = 0.021), and decreased the odds ratio (OR) of liver dysfunction (OR, 0.32; 95% CI, 0.09-0.94). However, angiotensin II had no effect on lactate, urinary output, serum creatinine, C-reactive protein, platelet count, or thromboembolic complications. In patients with abnormal baseline serum creatinine, Bayesian modelling showed that angiotensin II carried a 95.7% probability of reducing the use of renal replacement therapy (RRT). Conclusions: In ventilated patients with COVID-19, angiotensin II therapy increased blood pressure and PaO2/FiO2 ratios, decreased the OR of liver dysfunction, and appeared to decrease the risk of RRT use in patients with abnormal baseline serum creatinine. However, all of these findings are hypothesis-generating only. Trial registration:ClinicalTrials.gov NCT04318366.
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Affiliation(s)
- Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Sergio Colombo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Evgeny Fominskiy
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marina Pieri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Grazia Calabrò
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Federico Beccaria
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Pasculli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Guzzo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Rosa Calvi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Cipriani
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Sartini
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pasquale Nardelli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Ortalda
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gaetano Lombardi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marianna Sartorelli
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giacomo Monti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Assanelli
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Hospital, Milan, Italy
| | - Lorenzo Dagna
- Vita-Salute San Raffaele University, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Lombardia, Italy
| | - Stefano Franchini
- Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia
- Department of Intensive Care, Austin Hospital, Melbourne, VIB, Australia
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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45
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Corradini E, Ventura P, Ageno W, Cogliati CB, Muiesan ML, Girelli D, Pirisi M, Gasbarrini A, Angeli P, Querini PR, Bosi E, Tresoldi M, Vettor R, Cattaneo M, Piscaglia F, Brucato AL, Perlini S, Martelletti P, Pontremoli R, Porta M, Minuz P, Olivieri O, Sesti G, Biolo G, Rizzoni D, Serviddio G, Cipollone F, Grassi D, Manfredini R, Moreo GL, Pietrangelo A. Clinical factors associated with death in 3044 COVID-19 patients managed in internal medicine wards in Italy: results from the SIMI-COVID-19 study of the Italian Society of Internal Medicine (SIMI). Intern Emerg Med 2021; 16:1005-1015. [PMID: 33893976 PMCID: PMC8065333 DOI: 10.1007/s11739-021-02742-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [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: 02/19/2021] [Accepted: 04/09/2021] [Indexed: 12/15/2022]
Abstract
During the COVID-19 2020 outbreak, a large body of data has been provided on general management and outcomes of hospitalized COVID-19 patients. Yet, relatively little is known on characteristics and outcome of patients managed in Internal Medicine Units (IMU). To address this gap, the Italian Society of Internal Medicine has conducted a nationwide cohort multicentre study on death outcome in adult COVID-19 patients admitted and managed in IMU. This study assessed 3044 COVID-19 patients at 41 referral hospitals across Italy from February 3rd to May 8th 2020. Demographics, comorbidities, organ dysfunction, treatment, and outcomes including death were assessed. During the study period, 697 patients (22.9%) were transferred to intensive care units, and 351 died in IMU (death rate 14.9%). At admission, factors independently associated with in-hospital mortality were age (OR 2.46, p = 0.000), productive cough (OR 2.04, p = 0.000), pre-existing chronic heart failure (OR 1.58, p = 0.017) and chronic obstructive pulmonary disease (OR 1.17, p = 0.048), the number of comorbidities (OR 1.34, p = 0.000) and polypharmacy (OR 1.20, p = 0.000). Of note, up to 40% of elderly patients did not report fever at admission. Decreasing PaO2/FiO2 ratio at admission was strongly inversely associated with survival. The use of conventional oxygen supplementation increased with the number of pre-existing comorbidities, but it did not associate with better survival in patients with PaO2/FiO2 ratio < 100. The latter, significantly benefited by the early use of non-invasive mechanical ventilation. Our study identified PaO2/FiO2 ratio at admission and comorbidity as the main alert signs to inform clinical decisions and resource allocation in non-critically ill COVID-19 patients admitted to IMU.
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Affiliation(s)
- Elena Corradini
- Unit of Internal Medicine, University Hospital Policlinico di Modena, Modena, Italy
| | - Paolo Ventura
- Unit of Internal Medicine, University Hospital Policlinico di Modena, Modena, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia-Medicina 2, ASST Spedali Civili Brescia, Brescia, Italy
| | - Domenico Girelli
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy
| | - Mario Pirisi
- Internal Medicine Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Antonio Gasbarrini
- Department of Medical and Surgical Sciences, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del S. Cuore, Rome, Italy
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - Patrizia Rovere Querini
- Unit of Internal Medicine, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Emanuele Bosi
- Unit of Internal Medicine, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Moreno Tresoldi
- Unit of Internal Medicine, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Vettor
- Department of Medicine, Università degli Studi di Padova, Padua, Italy
| | - Marco Cattaneo
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Fabio Piscaglia
- Division of Internal Medicine, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy
| | | | - Stefano Perlini
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa and Policlinico San Martino, Genoa, Italy
| | - Massimo Porta
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Pietro Minuz
- Department of Internal Medicine, University of Verona, Verona, Italy
| | - Oliviero Olivieri
- Department of Medicine, Policlinico GB Rossi, University of Verona and AOUI Verona, Verona, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Gianni Biolo
- Department of Internal Medicine, Ospedale di Cattinara, University of Trieste, Trieste, Italy
| | - Damiano Rizzoni
- Department of Clinical and Experimental Sciences, Clinica Medica, University of Brescia, Brescia, Italy
| | - Gaetano Serviddio
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Francesco Cipollone
- Department of Medicine and Aging, Clinica Medica, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Davide Grassi
- Department of Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Guido Luigi Moreo
- Internal Medicine Department, San Carlo Hospital, Paderno Dugnano, Milan, Italy
| | - Antonello Pietrangelo
- Unit of Internal Medicine, University Hospital Policlinico di Modena, Modena, Italy.
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46
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Della-Torre E, Lanzillotta M, Campochiaro C, Cavalli G, De Luca G, Tomelleri A, Boffini N, De Lorenzo R, Ruggeri A, Rovere-Querini P, Castagna A, Landoni G, Tresoldi M, Ciceri F, Zangrillo A, Dagna L. Respiratory Impairment Predicts Response to IL-1 and IL-6 Blockade in COVID-19 Patients With Severe Pneumonia and Hyper-Inflammation. Front Immunol 2021; 12:675678. [PMID: 33995419 PMCID: PMC8117339 DOI: 10.3389/fimmu.2021.675678] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 03/03/2021] [Accepted: 04/16/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Restraining maladaptive inflammation is considered a rationale strategy to treat severe coronavirus disease-19 (COVID-19) but available studies with selective inhibitors of pro-inflammatory cytokines have not provided unequivocal evidence of survival advantage. Late administration is commonly regarded as a major cause of treatment failure but the optimal timing for anti-cytokine therapy initiation in COVID-19 patients has never been clearly established. OBJECTIVES To identify a window of therapeutic opportunity for maximizing the efficacy of interleukin (IL)-1 and IL-6 blockade in COVID-19. METHODS Survival at the longest available follow-up was assessed in severe hyper-inflamed COVID-19 patients treated with anakinra, tocilizumab, sarilumab, or standard of care, stratified according to respiratory impairment at the time of treatment initiation. RESULTS 107 patients treated with biologics and 103 contemporary patients treated with standard of care were studied. After a median of 106 days of follow-up (range 3-186), treatment with biologics was associated with a significantly higher survival rate compared to standard therapy when initiated in patients with a PaO2/FiO2 ≥ 100 mmHg (p < 0.001). Anakinra reduced mortality also in patients with PaO2/FiO2 < 100 mmHg (p = 0.04). CONCLUSIONS IL-1 and IL-6 blocking therapies are more likely to provide survival advantage in hyper-inflamed COVID-19 patients when initiated before the establishment of severe respiratory failure.
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Affiliation(s)
- Emanuel Della-Torre
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- *Correspondence: Emanuel Della-Torre, ; Lorenzo Dagna,
| | - Marco Lanzillotta
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Corrado Campochiaro
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Cavalli
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giacomo De Luca
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Tomelleri
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Boffini
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rebecca De Lorenzo
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Annalisa Ruggeri
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Rovere-Querini
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- General Medicine and Advanced Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- *Correspondence: Emanuel Della-Torre, ; Lorenzo Dagna,
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47
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Ramirez GA, Della-Torre E, Tresoldi M, Scarpellini P, Ciceri F, Dagna L, Yacoub MR. Drug reaction with eosinophilia and systemic symptoms (DRESS) in patients with COVID-19. Clin Microbiol Infect 2021; 27:1190-1192. [PMID: 34015530 PMCID: PMC8127514 DOI: 10.1016/j.cmi.2021.05.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Giuseppe A Ramirez
- Università Vita-Salute San Raffaele, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UniRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emanuel Della-Torre
- Università Vita-Salute San Raffaele, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UniRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Scarpellini
- Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- Università Vita-Salute San Raffaele, Milan, Italy; Unit of Haematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- Università Vita-Salute San Raffaele, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UniRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mona-Rita Yacoub
- Università Vita-Salute San Raffaele, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UniRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy.
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48
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Damanti S, Ramirez GA, Bozzolo EP, Rovere-Querini P, De Lorenzo R, Magnaghi C, Scotti R, Di Lucca G, Marinosci A, Strada S, Di Terlizzi G, Vitali G, Martinenghi S, Compagnone N, Landoni G, Tresoldi M. 6-Month Respiratory Outcomes and Exercise Capacity of COVID-19 Acute Respiratory Failure Patients Treated With CPAP. Intern Med J 2021; 51:1810-1815. [PMID: 33961728 PMCID: PMC8242499 DOI: 10.1111/imj.15345] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 03/08/2021] [Revised: 03/30/2021] [Accepted: 04/14/2021] [Indexed: 01/08/2023]
Abstract
Background COVID‐19 long‐term sequelae are ill‐defined since only a few studies have explored the long‐term consequences of this disease so far. Aims To evaluate the 6‐month respiratory outcome and exercise capacity of COVID‐19 acute respiratory failure (ARF) patients treated with continuous positive airway pressure (CPAP) during the first wave of the ongoing COVID‐19 pandemic. Methods A retrospective observational study included COVID‐19 patients with ARF. Interventions included CPAP during hospitalisation and 6‐month follow up. Frailty assessment was carried out through frailty index (FI), pO2/FiO2 during hospitalisation and at follow up, respiratory parameters, 6‐min walking test (6MWT) and the modified British Medical Research Council (mMRC) and Borg scale at follow up. Results More than half of the patients had no dyspnoea according to the mMRC scale. Lower in‐hospital pO2/FiO2 correlated with higher Borg scale levels after 6MWT (ρ 0.27; P 0.04) at the follow‐up visit. FI was positively correlated with length of hospitalisation (ρ 0.3; P 0.03) and negatively with the 6MWT distance walked (ρ −0.36; P 0.004). Conclusions Robust and frail patients with COVID‐19 ARF treated with CPAP outside the intensive care unit setting had good respiratory parameters and exercise capacity at 6‐month follow up, although more severe patients had slightly poorer respiratory performance compared with patients with higher PaO2/FiO2 and lower FI.
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Affiliation(s)
- Sarah Damanti
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Mali
| | - Giuseppe Alvise Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrica Paola Bozzolo
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Mali
| | - Patrizia Rovere-Querini
- Vita-Salute San Raffaele University, Milan, Italy.,Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Cristiano Magnaghi
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Scotti
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Mali
| | - Giuseppe Di Lucca
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Mali
| | - Alessandro Marinosci
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Mali
| | - Silvia Strada
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Mali
| | - Gaetano Di Terlizzi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Mali
| | - Giordano Vitali
- Internal Medicine, Diabetes and Endocrinology Unit, San Raffaele Hospital and Scientific Institute, San, Raffaele, Mali
| | - Sabina Martinenghi
- Internal Medicine, Diabetes and Endocrinology Unit, San Raffaele Hospital and Scientific Institute, San, Raffaele, Mali.,Diabetes Research Institute, San Raffaele Hospital and Scientific Institute, San Raffaele Vita Salute University, Milan, Italy
| | | | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Mali
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49
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Peretto G, Villatore A, Rizzo S, Esposito A, De Luca G, Palmisano A, Vignale D, Cappelletti AM, Tresoldi M, Campochiaro C, Sartorelli S, Ripa M, De Gaspari M, Busnardo E, Ferro P, Calabrò MG, Fominskiy E, Monaco F, Cavalli G, Gianolli L, De Cobelli F, Margonato A, Dagna L, Scandroglio M, Camici PG, Mazzone P, Della Bella P, Basso C, Sala S. The Spectrum of COVID-19-Associated Myocarditis: A Patient-Tailored Multidisciplinary Approach. J Clin Med 2021; 10:jcm10091974. [PMID: 34064463 PMCID: PMC8124580 DOI: 10.3390/jcm10091974] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 03/17/2021] [Revised: 04/08/2021] [Accepted: 04/22/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Myocarditis lacks systematic characterization in COVID-19 patients. METHODS We enrolled consecutive patients with newly diagnosed myocarditis in the context of COVID-19 infection. Diagnostic and treatment strategies were driven by a dedicated multidisciplinary disease unit for myocarditis. Multimodal outcomes were assessed during prospective follow-up. RESULTS Seven consecutive patients (57% males, age 51 ± 9 y) with acute COVID-19 infection received a de novo diagnosis of myocarditis. Endomyocardial biopsy was of choice in hemodynamically unstable patients (n = 4, mean left ventricular ejection fraction (LVEF) 25 ± 9%), whereas cardiac magnetic resonance constituted the first exam in stable patients (n = 3, mean LVEF 48 ± 10%). Polymerase chain reaction (PCR) analysis revealed an intra-myocardial SARS-CoV-2 genome in one of the six cases undergoing biopsy: in the remaining patients, myocarditis was either due to other viruses (n = 2) or virus-negative (n = 3). Hemodynamic support was needed for four unstable patients (57%), whereas a cardiac device implant was chosen in two of four cases showing ventricular arrhythmias. Medical treatment included immunosuppression (43%) and biological therapy (29%). By the 6-month median follow-up, no patient died or experienced malignant arrhythmias. However, two cases (29%) were screened for heart transplantation. CONCLUSIONS Myocarditis associated with acute COVID-19 infection is a spectrum of clinical manifestations and underlying etiologies. A multidisciplinary approach is the cornerstone for tailored management.
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Affiliation(s)
- Giovanni Peretto
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (P.M.); (P.D.B.); (S.S.)
- Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.E.); (G.D.L.); (A.P.); (D.V.); (C.C.); (S.S.); (E.B.)
- School of Medicine, San Raffaele Vita-Salute University, 20132 Milan, Italy; (A.V.); (F.D.C.); (L.D.); (P.G.C.)
- Correspondence: ; Tel./Fax: +39-02-2643-7484-7326
| | - Andrea Villatore
- School of Medicine, San Raffaele Vita-Salute University, 20132 Milan, Italy; (A.V.); (F.D.C.); (L.D.); (P.G.C.)
| | - Stefania Rizzo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Cardiovascular Pathology, Padua University, 35128 Padua, Italy; (S.R.); (M.D.G.); (C.B.)
| | - Antonio Esposito
- Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.E.); (G.D.L.); (A.P.); (D.V.); (C.C.); (S.S.); (E.B.)
- School of Medicine, San Raffaele Vita-Salute University, 20132 Milan, Italy; (A.V.); (F.D.C.); (L.D.); (P.G.C.)
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Giacomo De Luca
- Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.E.); (G.D.L.); (A.P.); (D.V.); (C.C.); (S.S.); (E.B.)
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Anna Palmisano
- Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.E.); (G.D.L.); (A.P.); (D.V.); (C.C.); (S.S.); (E.B.)
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Davide Vignale
- Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.E.); (G.D.L.); (A.P.); (D.V.); (C.C.); (S.S.); (E.B.)
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Alberto Maria Cappelletti
- Department of Clinical Cardiology and Intensive Care Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.M.C.); (A.M.)
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
- COVID-19 Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Corrado Campochiaro
- Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.E.); (G.D.L.); (A.P.); (D.V.); (C.C.); (S.S.); (E.B.)
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Silvia Sartorelli
- Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.E.); (G.D.L.); (A.P.); (D.V.); (C.C.); (S.S.); (E.B.)
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Marco Ripa
- COVID-19 Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
- Department of Infectious Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Monica De Gaspari
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Cardiovascular Pathology, Padua University, 35128 Padua, Italy; (S.R.); (M.D.G.); (C.B.)
| | - Elena Busnardo
- Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.E.); (G.D.L.); (A.P.); (D.V.); (C.C.); (S.S.); (E.B.)
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (P.F.); (L.G.)
| | - Paola Ferro
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (P.F.); (L.G.)
| | - Maria Grazia Calabrò
- Cardiac Surgery Intensive Care Unit, Division of Anesthesiology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (M.G.C.); (E.F.); (F.M.); (M.S.)
| | - Evgeny Fominskiy
- Cardiac Surgery Intensive Care Unit, Division of Anesthesiology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (M.G.C.); (E.F.); (F.M.); (M.S.)
| | - Fabrizio Monaco
- Cardiac Surgery Intensive Care Unit, Division of Anesthesiology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (M.G.C.); (E.F.); (F.M.); (M.S.)
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Luigi Gianolli
- Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (P.F.); (L.G.)
| | - Francesco De Cobelli
- School of Medicine, San Raffaele Vita-Salute University, 20132 Milan, Italy; (A.V.); (F.D.C.); (L.D.); (P.G.C.)
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Alberto Margonato
- Department of Clinical Cardiology and Intensive Care Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.M.C.); (A.M.)
| | - Lorenzo Dagna
- School of Medicine, San Raffaele Vita-Salute University, 20132 Milan, Italy; (A.V.); (F.D.C.); (L.D.); (P.G.C.)
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Mara Scandroglio
- Cardiac Surgery Intensive Care Unit, Division of Anesthesiology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (M.G.C.); (E.F.); (F.M.); (M.S.)
| | - Paolo Guido Camici
- School of Medicine, San Raffaele Vita-Salute University, 20132 Milan, Italy; (A.V.); (F.D.C.); (L.D.); (P.G.C.)
| | - Patrizio Mazzone
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (P.M.); (P.D.B.); (S.S.)
| | - Paolo Della Bella
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (P.M.); (P.D.B.); (S.S.)
| | - Cristina Basso
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Cardiovascular Pathology, Padua University, 35128 Padua, Italy; (S.R.); (M.D.G.); (C.B.)
| | - Simone Sala
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (P.M.); (P.D.B.); (S.S.)
- Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.E.); (G.D.L.); (A.P.); (D.V.); (C.C.); (S.S.); (E.B.)
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50
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Esposito A, Palmisano A, Cao R, Rancoita P, Landoni G, Grippaldi D, Boccia E, Cosenza M, Messina A, La Marca S, Palumbo D, Di Serio C, Spessot M, Tresoldi M, Scarpellini P, Ciceri F, Zangrillo A, De Cobelli F. Quantitative assessment of lung involvement on chest CT at admission: Impact on hypoxia and outcome in COVID-19 patients. Clin Imaging 2021; 77:194-201. [PMID: 33984670 PMCID: PMC8081746 DOI: 10.1016/j.clinimag.2021.04.033] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 04/14/2021] [Accepted: 04/18/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND The aim of this study was to quantify COVID-19 pneumonia features using CT performed at time of admission to emergency department in order to predict patients' hypoxia during the hospitalization and outcome. METHODS Consecutive chest CT performed in the emergency department between March 1st and April 7th 2020 for COVID-19 pneumonia were analyzed. The three features of pneumonia (GGO, semi-consolidation and consolidation) and the percentage of well-aerated lung were quantified using a HU threshold based software. ROC curves identified the optimal cut-off values of CT parameters to predict hypoxia worsening and hospital discharge. Multiple Cox proportional hazards regression was used to analyze the capability of CT quantitative features, demographic and clinical variables to predict the time to hospital discharge. RESULTS Seventy-seven patients (median age 56-years-old, 51 men) with COVID-19 pneumonia at CT were enrolled. The quantitative features of COVID-19 pneumonia were not associated to age, sex and time-from-symptoms onset, whereas higher number of comorbidities was correlated to lower well-aerated parenchyma ratio (rho = -0.234, p = 0.04) and increased semi-consolidation ratio (rho = -0.303, p = 0.008). Well-aerated lung (≤57%), semi-consolidation (≥17%) and consolidation (≥9%) predicted worst hypoxemia during hospitalization, with moderate areas under curves (AUC 0.76, 0.75, 0.77, respectively). Multiple Cox regression identified younger age (p < 0.01), female sex (p < 0.001), longer time-from-symptoms onset (p = 0.049), semi-consolidation ≤17% (p < 0.01) and consolidation ≤13% (p = 0.03) as independent predictors of shorter time to hospital discharge. CONCLUSION Quantification of pneumonia features on admitting chest CT predicted hypoxia worsening during hospitalization and time to hospital discharge in COVID-19 patients.
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Affiliation(s)
- Antonio Esposito
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Hospital, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Anna Palmisano
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Hospital, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberta Cao
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Hospital, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Rancoita
- University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Giovanni Landoni
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniele Grippaldi
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Hospital, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Edda Boccia
- Imaging analysis and post-processing, Experimental Imaging Center, IRCCS San Raffaele Hospital, Milan, Italy
| | - Michele Cosenza
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Hospital, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Messina
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Hospital, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Salvatore La Marca
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Hospital, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Diego Palumbo
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Hospital, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Clelia Di Serio
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Marzia Spessot
- Emergency Medicine, Emergency Department, IRCCS San Raffaele Hospital, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Scarpellini
- Infectious Diseases Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Italy
| | - Alberto Zangrillo
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Hospital, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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