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Survival of Hospitalized COVID-19 Patients in Northern Italy: A Population-Based Cohort Study by the ITA-COVID-19 Network

Authors Ferroni E, Giorgi Rossi P, Spila Alegiani S, Trifirò G, Pitter G, Leoni O, Cereda D, Marino M, Pellizzari M, Fabiani M, Riccardo F, Sultana J, Massari M

Received 14 July 2020

Accepted for publication 19 September 2020

Published 8 December 2020 Volume 2020:12 Pages 1337—1346


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Eyal Cohen

Eliana Ferroni,1 Paolo Giorgi Rossi,2 Stefania Spila Alegiani,3 Gianluca Trifirò,4 Gisella Pitter,1 Olivia Leoni,5 Danilo Cereda,5 Massimiliano Marino,2 Michele Pellizzari,1 Massimo Fabiani,6 Flavia Riccardo,6 Janet Sultana,4 Marco Massari3 On behalf of The ITA-COVID Working Group

1Azienda Zero of the Veneto Region, Padua, Italy; 2Azienda Unità Sanitaria Locale – IRCCS, Reggio Emilia, Italy; 3National Center for Drug Research and Evaluation, Istituto Superiore Di Sanità, Rome, Italy; 4Department of Biomedical and Dental Sciences and Morphofunctional Imaging – University of Messina, Messina, Italy; 5Department of Health of Lombardy Region, Milan, Italy; 6Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy

Correspondence: Stefania Spila Alegiani
Istituto Superiore Di Sanità, Viale Regina Elena, 299, Rome 00161, Italy
Tel +39 0649904249
Fax +39 0649904248
Email [email protected]
Paolo Giorgi Rossi
Azienda Unità Sanitaria Locale – IRCCS, Reggio Emilia, via Amendola 2, Reggio Emilia 42122, Italy
Tel +39 0522335490
Email [email protected]

Introduction: COVID-19 case fatality rate in hospitalized patients varies across countries and studies. Reliable estimates, specific for age, sex, and comorbidities, are needed to monitor the epidemic, to compare the outcome in different settings, and to correctly design trials for COVID-19 interventions. The aim of this study was to provide population-based survival curves of hospitalized COVID-19 patients.
Materials and Methods: A cohort study was conducted in three areas of Northern Italy, heavily affected by SARS-CoV-2 infection (Lombardy and Veneto Regions, and Reggio Emilia province), using a loco-regional COVID-19 surveillance system, linked to hospital discharge databases. We included all patients testing positive for SARS-CoV-2 RNA by RT-PCR on nasopharyngeal/throat swab samples who were hospitalized from 21 February to 21 April 2020. Kaplan–Meier survival estimates were calculated at 14 and 30 days for death in any setting, stratifying by age, sex, and the Charlson Index.
Results: Overall, 42,926 hospitalized COVID-19 patients were identified. Patients’ median age was 69 years (IQR: 57– 79), 62.6% were males, and 6.0% had a Charlson Index ≥ 3. Survival curves showed that 22.0% (95% CI 21.6– 22.4) of patients died within 14 days and 27.6% (95% CI 27.2– 28.1) within 30 days from hospitalization. Survival was higher in younger patients and in females. The negative impact of comorbidities on survival was more pronounced in younger age groups.
Conclusion: The high fatality rate observed in the study (28% at 30 days) suggests that studies should focus on death as primary endpoint during a follow-up of at least one month.

Keywords: COVID-19, survival, cohort study, hospitalized patients, Italy

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