PLoS ONE (Jan 2021)

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

  • Tommaso Gili,
  • Giampaolo Benelli,
  • Elisabetta Buscarini,
  • Ciro Canetta,
  • Giuseppe La Piana,
  • Guido Merli,
  • Alessandro Scartabellati,
  • Giovanni Viganò,
  • Roberto Sfogliarini,
  • Giovanni Melilli,
  • Roberto Assandri,
  • Daniele Cazzato,
  • Davide Sebastiano Rossi,
  • Susanna Usai,
  • Guido Caldarelli,
  • Irene Tramacere,
  • Germano Pellegata,
  • Giuseppe Lauria

DOI
https://doi.org/10.1371/journal.pone.0248498
Journal volume & issue
Vol. 16, no. 3
p. e0248498

Abstract

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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.