SARS-COV-2 comorbidity network and outcome in hospitalized patients in Crema, Italy

  1. Tommaso Gili
  2. Giampaolo Benelli
  3. Elisabetta Buscarini
  4. Ciro Canetta
  5. Giuseppe La Piana
  6. Guido Merli
  7. Alessandro Scartabellati
  8. Giovanni Viganò
  9. Roberto Sfogliarini
  10. Giovanni Melilli
  11. Roberto Assandri
  12. Daniele Cazzato
  13. Davide Sebastiano Rossi
  14. Susanna Usai
  15. Guido Caldarelli
  16. Irene Tramacere
  17. Germano Pellegata
  18. Giuseppe Lauria

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Abstract

We report onset, course, correlations with comorbidities, and diagnostic accuracy of nasopharyngeal swab in 539 individuals suspected to carry SARS-COV-2 admitted to the hospital of Crema, Italy. All individuals underwent clinical and laboratory exams, SARS-COV-2 reverse transcriptase-polymerase chain reaction on nasopharyngeal swab, and chest X-ray and/or computed tomography (CT). Data on onset, course, comorbidities, number of drugs including angiotensin converting enzyme (ACE) inhibitors and angiotensin-II-receptor antagonists (sartans), follow-up swab, pharmacological treatments, non-invasive respiratory support, ICU admission, and deaths were recorded. Among 411 SARS-COV-2 patients (67.7% males) median age was 70.8 years (range 5–99). Chest CT was performed in 317 (77.2%) and showed interstitial pneumonia in 304 (96%). Fatality rate was 17.5% (74% males), with 6.6% in 60–69 years old, 21.1% in 70–79 years old, 38.8% in 80–89 years old, and 83.3% above 90 years. No death occurred below 60 years. Non-invasive respiratory support rate was 27.2% and ICU admission 6.8%. Charlson comorbidity index and high C-reactive protein at admission were significantly associated with death. Use of ACE inhibitors or sartans was not associated with outcomes. Among 128 swab negative patients at admission (63.3% males) median age was 67.7 years (range 1–98). Chest CT was performed in 87 (68%) and showed interstitial pneumonia in 76 (87.3%). Follow-up swab turned positive in 13 of 32 patients. Using chest CT at admission as gold standard on the entire study population of 539 patients, nasopharyngeal swab had 80% accuracy. Comorbidity network analysis revealed a more homogenous distribution 60–40 aged SARS-COV-2 patients across diseases and a crucial different interplay of diseases in the networks of deceased and survived patients. SARS-CoV-2 caused high mortality among patients older than 60 years and correlated with pre-existing multiorgan impairment.

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  1. Version published to 10.1371/journal.pone.0248498
  2. ScreenIT

    SciScore for 10.1101/2020.04.14.20053090: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The Institutional Review Board of the Hospital of Crema has approved the study.
    Consent: Written informed consent was obtained from all participants and legally authorized representatives of minors below 18 patients and dead patients gave consent for data that could be used for clinical studies.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    One limitation is the report of the events occurring soon after the outbreak, during a period in which many information on the disease course were not yet available, and with a hospital-based perspective. We examined 411 patients with laboratory-confirmed SARS-CoV-2 at nasopharyngeal swab and compared their clinical features and course to that of 128 swab negative patients. Overall, the percentage of SARS-CoV-2 patients that arrived at hospital with an ambulance and required non-invasive respiratory support or ICU admittance was as twice as that of swab negative patients. Nevertheless, the fatality rate was only about 4% higher in SARS-CoV-2 patients. At the same time, chest CT was reported as positive in nearly 60% of swab negative patients, as previously reported,9 and mainly among those who died. These findings indicate that a number of swab negative patients were admitted to the hospital because of an interstitial pneumonia, which could be attributed to SARS-CoV-2 in 13 of the 32 patients in whom it was possible to perform the follow-up nasopharyngeal swab that resulted positive. Even though no study has assessed the diagnostic accuracy of RT-PCR on nasopharyngeal swab in suspected SARS- CoV-2 patients, it has been reported 10,11 that it could be negative in patients eventually receiving this diagnosis. Because nasopharyngeal swab is currently used as screening tools in the population, its sensitivity value, namely the percentage of true positive, is important. We sought ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.04.14.20053090 on medRxiv