https://doi.org/10.4081/ecj.2022.10648
COVID-19 in sub-intensive care unit: An italian single-center experience along the three epidemic waves
Submitted: 31 May 2022
Accepted: 1 September 2022
Published: 27 September 2022
Accepted: 1 September 2022
Abstract Views: 482
PDF: 228
Supplementary Materials: 0
Supplementary Materials: 0
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
The goal was to characterize COVID-19 patients who needed treatment in Sub-Intensive Care Units (SICUs) for hypoxemic respiratory failure, describe their six-month mortality, and identify clinical and laboratory characteristics that were associated with death. Data from 216 consecutive patients admitted to the COVIDSICU of Turin’s San Giovanni Bosco Hospital were analyzed retrospectively. A total of 216 patients (24.5% of whom were female) were enrolled. The average age was 63±11.9 years. In the three waves, the six-month mortality rate was 32.8%, 35.1%, and 26.6%, respectively (p=0.52). The mortality rate was significantly higher in intubated patients compared to those not requiring intubation (60.8% versus 29.9%, p<0.01). On admission, deceased patients were older (69±7.7 versus 60.2±12.6 y.o., p<0.01), with a higher prevalence of dyslipidemia, coronary artery disease, chronic heart failure, and higher serum creatinine. However, only age was predictive of death at multivariate analysis (OR 5.29, p<0.01), with 63 years old as the best cut-point. At six months, mortality in COVID patients managed in a SICU is around 30%. Age is a significant negative prognostic factor, with 63 years of age being the best predicting cut-off.
Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020;395:565–74.
DOI: https://doi.org/10.1016/S0140-6736(20)30251-8
Remuzzi A, Remuzzi G. COVID-19 and Italy: what next? Lancet 2020;395:1225–8.
DOI: https://doi.org/10.1016/S0140-6736(20)30627-9
Lorettu L. Key words for 2020: Pandemic, emergency, anomie. Emerg Care J 2021;17:9436.
DOI: https://doi.org/10.4081/ecj.2021.9436
Poggiali E, Barbieri G, Salvatore V, Salinaro F. The Emergency Rooms and Emergency Medicine should not be the answer to the weakness of the Italian National Health System. Emerg Care J [Internet]. 2021 Dec 20;17(4 SE-Letters to the Editor). Available from: https://www.pagepressjournals.org/index.php/ecj/article/view/10304
DOI: https://doi.org/10.4081/ecj.2021.10304
Giostra F, Mirarchi MG, Farina G, et al. Impact of COVID-19 pandemic and lockdown on emergency room access in Northern and Central Italy. Emerg Care J 2021;17:9705
DOI: https://doi.org/10.4081/ecj.2021.9705
Henchi S, Conti CB, Vanoni N, et al. First COVID-19 sub-intensive respiratory unit in Europe: the Italian experience. Multidiscip Respir Med 2020;15:682.
DOI: https://doi.org/10.4081/mrm.2020.682
COVID-19 Clinical Research Coalition. Global coalition to accelerate COVID-19 clinical research in resource-limited settings. Lancet 2020;395:1322-5.
DOI: https://doi.org/10.1016/S0140-6736(20)30798-4
Grasselli G, Zangrillo A, Zanella A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA 2020;323:1574–81.
DOI: https://doi.org/10.1001/jama.2020.5394
Cattelan AM, Di Meco E, Trevenzoli M, et al. Clinical Characteristics and laboratory biomarkers changes in COVID-19 patients requiring or not intensive or sub-intensive care: a comparative study. BMC Infect Dis 2020;20:934.
DOI: https://doi.org/10.1186/s12879-020-05647-7
Bellani G, Grasselli G, Cecconi M, et al. Noninvasive ventilatory support of patients with COVID-19 outside the Intensive Care Units (WARd-COVID). Ann Am Thorac Soc 2021;18:1020–6.
DOI: https://doi.org/10.1513/AnnalsATS.202008-1080OC
Iapichino G, Radrizzani D, Rossi C, et al. Proposal of a flexible structural-organizing model for the Intensive Care Units. Minerva Anestesiol 2007;73:501–6.
Boodman C, Lagacé-Wiens P, Bullard J. Diagnostic testing for SARS-CoV-2. CMAJ 2020;192:E713.
DOI: https://doi.org/10.1503/cmaj.200858
Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507–13.
DOI: https://doi.org/10.1016/S0140-6736(20)30211-7
Santus P, Radovanovic D, Saderi L, , et al. Severity of respiratory failure at admission and in-hospital mortality in patients with COVID-19: a prospective observational multicentre study. BMJ Open 2020;10:e043651.
DOI: https://doi.org/10.1136/bmjopen-2020-043651
Zheng Z, Peng F, Xu B, et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J Infect 2020;81:e16–25.
DOI: https://doi.org/10.1016/j.jinf.2020.04.021
Carrillo Hernandez-Rubio J, Sanchez-Carpintero Abad M, Yordi Leon A, et al. Outcomes of an intermediate respiratory care unit in the COVID-19 pandemic. PLoS One 2020;15:e0243968.
DOI: https://doi.org/10.1371/journal.pone.0243968
Guan W-J, Ni Z-Y, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708–20.
DOI: https://doi.org/10.1056/NEJMoa2002032
Wang Y, Lu X, Li Y, et al. Clinical course and outcomes of 344 intensive care patients with COVID-19. Am J Respir Crit Care Med 2020;201:1430–4.
DOI: https://doi.org/10.1164/rccm.202003-0736LE
Grosgurin O, Leidi A, Farhoumand PD, et al. Role of intermediate care unit admission and noninvasive respiratory support during the COVID-19 pandemic: a retrospective cohort study. Respiration 2021;100:786–93.
DOI: https://doi.org/10.1159/000516329
Ciceri F, Ruggeri A, Lembo R, et al. Decreased in-hospital mortality in patients with COVID-19 pneumonia. Pathog Glob Health 2020;114:281–2.
DOI: https://doi.org/10.1080/20477724.2020.1785782
Ruggeri A, Landoni G, Ciceri F. Trend towards reduction in COVID-19 in-hospital mortality. Lancet Reg Heal Eur 2021;3:100059.
DOI: https://doi.org/10.1016/j.lanepe.2021.100059
Figliozzi S, Masci PG, Ahmadi N, et al. Predictors of adverse prognosis in COVID-19: A systematic review and meta-analysis. Eur J Clin Invest 2020;50:e13362.
DOI: https://doi.org/10.1111/eci.13362
Barbieri G, Cipriano A, Carrara S, et al. SARS-CoV-2 management in Emergency Department: risk stratification and care setting identification proposal based on first pandemic wave in Pisa University Hospital. Emerg Care J 2021;17:9859
DOI: https://doi.org/10.4081/ecj.2021.9859
Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA 2020;323:2052–9.
DOI: https://doi.org/10.1001/jama.2020.6775
Mancia G, Rea F, Ludergnani M, et al. Renin-angiotensin-aldosterone system blockers and the risk of Covid-19. N Engl J Med 2020;382:2431–40.
DOI: https://doi.org/10.1056/NEJMoa2006923
Biswas M, Kali MSK. Association of angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers with risk of mortality, severity or SARS-CoV-2 test positivity in COVID-19 patients: meta-analysis. Sci Rep 2021;11:5012.
DOI: https://doi.org/10.1038/s41598-021-84678-9
Salah HM, Mehta JL. Meta-analysis of the effect of aspirin on mortality in COVID-19. The Am J Cardiol 2021;142:158–9.
DOI: https://doi.org/10.1016/j.amjcard.2020.12.073
Wang L, Li H, Gu X, et al. Effect of antiplatelet therapy on acute respiratory distress syndrome and mortality in critically ill patients: a meta-analysis. PLoS One 2016;11:e0154754.
DOI: https://doi.org/10.1371/journal.pone.0154754
Camous L, Pommier J-D, Martino F, et al. Very late intubation in COVID-19 patients: a forgotten prognosis factor? Crit Care 2022;26:89.
DOI: https://doi.org/10.1186/s13054-022-03966-6
How to Cite
Vallelonga, F., Diella, F. A., Converso, M., De Filippi, G., Bosco, F., Panero, F., Aprà, F., & Elia, F. (2022). COVID-19 in sub-intensive care unit: An italian single-center experience along the three epidemic waves. Emergency Care Journal, 18(3). https://doi.org/10.4081/ecj.2022.10648
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
