ORIGINAL ARTICLE   Open access

Italian Journal of Emergency Medicine 2023 December;12(3):167-75

DOI: 10.23736/S2532-1285.23.00199-4

Copyright © 2023 THE AUTHORS

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language: English

SARS-CoV2 pneumonia complicated by acute respiratory failure: predictors for mortality

Paolo GIORGINI ¹ ✉, Roberto ALESSANDRONI ², Federica SILVESTRI ², Osvaldo B. FRATINI ², Mario MUSELLI ³, Stefano NECOZIONE ³, Gianluca MORONCINI ², Giuseppina PETRELLI ¹

¹ Emergency Room and Emergency Medicine, Madonna del Soccorso Hospital, AST Ascoli Piceno, Ascoli Piceno, Italy; ² Emergency Medicine Residency, Marche Polytechnic University, Ancona, Italy; ³ Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy

BACKGROUND: The aim of this paper was to identify clinical, laboratory, and therapeutic parameters related to the death outcome in a population of subjects hospitalized in the Emergency Medicine Unit of San Benedetto del Tronto for acute respiratory failure (ARF) related to SARS-CoV2 pneumonia.
METHODS: Retrospective analysis of a population of subjects consecutively hospitalized for ARF from SARS-CoV2 pneumonia, through descriptive statistical analyses and statistical comparisons between the categories (deceased/not deceased) of the quantitative (Wilcoxon Test) and qualitative (χ² test) variables, and through logistic regression with the variables dichotomized on the median values.
RESULTS: The analysis was conducted on 425 subjects (mean age 67 years, M 279, 65.6%), observed between 01/01/2021 and 04/06/2022. The associated conditions in the deceased group (DG) versus the non-DG (NDG) are the presence of three or more diseases (P<0.001), age (P<0.001), chronic renal failure (P<0.001), heart disease (P<0.0001), chronic obstructive pulmonary disease (P<0.01) hypertension (P<0.001), diabetes (P=0.005), obesity (P=0.01), and reduced GCS (P<0.001). A protective match was observed between subjects receiving remdesivir (P<0.001), monoclonal antibodies (P<0.01), enoxeparin (P<0.001), high-flow nasal cannulas (P<0.001), and CPAP (P<0.0001) in the NDG with respect to DG. Serial blood gas analysis statistics showed significance (P<0.05) for reductions in alkalosis, and P/F in both DG and NDG. Logistic regression analysis documented an increased risk of death among subjects with three or more co-morbidities (OR=3.4, P<0.005), with reduced GCS (OR=0.7, P<0.05), with fewer lymphocytes (OR=0.9, P<0.05), with increased LDH (OR=1.0, P=0.05) in therapy with high-flow nasal cannulas (OR=0.2, P>0.05).
CONCLUSIONS: With the limitations related to the retrospective analysis, our study demonstrates that severe comorbidity represents a negative prognostic factor for mortality in patients affected by SARS-CoV2 related interstitial pneumonia, while therapy with remdesevir and monoclonal antibodies constitutes a protective factor. Increased LDH and reduced lymphocyte levels appear to be valid predictors of fatal outcome.

KEY WORDS: SARS-CoV-2; Noninvasive ventilation; Comorbidity; Lactate dehydrogenase 5_lymphocyte