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One-year mortality in COVID-19 is associated with patients’ comorbidities rather than pneumonia severity - 24/11/22

Doi : 10.1016/j.resmer.2022.100976 
Luca Novelli a, Federico Raimondi a, b, , Greta Carioli c, Alessandra Carobbio c, Simone Pappacena a, b, Roberta Biza a, b, Roberta Trapasso a, b, Marisa Anelli a, b, Mariangela Amoroso a, b, Chiara Allegri a, b, Luca Malandrino a, b, Gianluca Imeri a, Caterina Conti a, Marta Beretta a, Mauro Gori d, Emilia D'Elia d, Michele Senni d, e, Ferdinando Luca Lorini e, f, Marco Rizzi g, Roberto Cosentini h, Alessandro Rambaldi b, i, Arianna Masciulli c, Antonello Gavazzi c, Paolo Solidoro l, Sandro Sironi e, m, Stefano Fagiuoli e, n, Tiziano Barbui c, Fabiano Di Marco a, b
on behalf of

HPG23 Covid19 Study Group

a Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy 
b Department of Health Sciences, University of Milan, Milan, Italy 
c Fondazione per la Ricerca Ospedale Maggiore di Bergamo (FROM), Bergamo, Italy 
d Cardiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy 
e Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy 
f Department of Intensive Critical Care, ASST Papa Giovanni XXIII, Bergamo, Italy 
g Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy 
h Emergency Department, ASST Papa Giovanni XXIII, Bergamo, Italy 
i Hematology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy 
l Unit of Pneumology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Italy 
m Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy 
n Gastroenterlogy 1, Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy 

Corresponding Author. Federico Raimondi, MD, Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1 - 24127 Bergamo, Italy. Tel. +39 035.2673456 - Fax +39 035.2674889Pulmonary Medicine UnitMedicine DepartmentASST Papa Giovanni XXIIIPiazza OMSBergamo1 - 24127Italy

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ABSTRACT

Background

In patients with pneumonia or acute respiratory distress syndrome who survived hospitalization, one-year mortality can affect up to one third of discharged patients. Therefore, significant long-term mortality after COVID-19 respiratory failure could be expected. The primary outcome of the present study was one-year all-cause mortality in hospitalized COVID-19 patients.

Methods

Observational study of COVID-19 patients hospitalized at Papa Giovanni XXIII Hospital (Bergamo, Italy), during the first pandemic wave.

Results

A total of 1326 COVID-19 patients were hospitalized. Overall one-year mortality was 33.6% (N 446/1326), with the majority of deaths occurring during hospitalization (N=412, 92.4%). Thirty-four patients amongst the 914 discharged (3.7%) subsequentely died within one year. A third of these patients died for advanced cancer, while death without a cause other than COVID-19 was uncommon (8.8% of the overall post-discharge mortality). In-hospital late mortality (i.e. after 28 days of admission) interested a population with a lower age, and fewer comorbidities, more frequentely admitted in ICU. Independent predictors of post-discharge mortality were age over 65 years (HR 3.19; 95% CI 1.28-7.96, p-value=0.013), presence of chronic obstructive pulmonary disease (COPD) (HR 2.52; 95% CI 1.09-5.83, p-value=0.031) or proxy of cardiovascular disease (HR 4.93; 95% CI 1.45-16.75, p-value=0.010), and presence of active cancer (HR 3.64; 95% CI 1.50-8.84, p-value=0.004), but not pneumonia severity.

Conclusions

One-year post-discharge mortality depends on underlying patients’ comorbidities rather than COVID-19 pneumonia severity per se. Awareness among physicians of predictors of post-discharge mortality might be helpful in structuring a follow-up program for discharged patients.

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Keywords : COVID-19, pneumonia, respiratory failure, mortality, comorbidities


Plan


 Primary Funding Source: this work was supported by Fondazione Cariplo.


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