Longitudinal investigation of Severe Acute Respiratory Syndrome Coronavirus 2 ({SARS}-{CoV}-2) infection in older patients in the province of Palermo (Southern-Italy) during the early wave of the pandemics

Abstract

Introduction: Clinical presentation of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in old adults from southern-Italy is little known. This study aims to investigate the mortality risk related to risk factors, therapy and clinical course and to suggest prognostic indicators based on day-to-day follow-up of clinical and laboratory findings. Material and methods: It was designed a retrospective longitudinal cohort study of SARS-CoV-2 adult patients admitted at Partinico COVID Hospital in Palermo, southern-Italy. Patients were recruited between 4th March and 25th April and followed-up until 31st May 2020, day-to-day until death or hospital discharge. Clinical data, laboratory tests and treatment data were extracted from medical records and epidemiologic information was drawn out by clinical history and the medical interview. Results: Forty-seven patients (median age=75 IQR=59.50-86.00) were followed up for 87 days, and contributed 1,035 person-days of observation. At the end of follow-up, 28 (60%) patients were discharged and 19 (40%) died, so that the estimated incidence density rate was 0.018 (18 new SARS-CoV-2-related deaths per 1,000 patients) per day. Diabetes (HR 8.13, 95%CI=[1.91-34.67]), chronic kidney failure (HR 5.86, 95%CI=[1.36-25.21]), dementia (HR 7.84, 95%CI=[1.80-34.20]), and Neutrophils/Lymphocytes Ratio>7 (HR 10.37, 95%CI=[2.24-48.14]) were found as significant prognostic factors. Conclusions: The joint evaluation of dementia, diabetes, chronic kidney failure and Neutrophils/Lymphocytes Ratio showed an optimal prognostic value already in the first week of follow-up. The day-to-day follow-up provides essential information for clinical monitoring and treatment of the disease in a hospital setting and improves the disease’s home management, especially for older patients with frailty.