• Elena Corradini, Paolo Ventura, Walter Ageno, Chiara Beatrice Cogliati, Maria Lorenza Muiesan, Domenico Girelli, Mario Pirisi, Antonio Gasbarrini, Paolo Angeli, QueriniPatrizia RoverePRUnit of Internal Medicine, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy., Emanuele Bosi, Moreno Tresoldi, Roberto Vettor, Marco Cattaneo, Fabio Piscaglia, Antonio Luca Brucato, Stefano Perlini, Paolo Martelletti, Roberto Pontremoli, Massimo Porta, Pietro Minuz, Oliviero Olivieri, Giorgio Sesti, Gianni Biolo, Damiano Rizzoni, Gaetano Serviddio, Francesco Cipollone, Davide Grassi, Roberto Manfredini, Guido Luigi Moreo, Antonello Pietrangelo, and SIMI-COVID-19 Collaborators.
• Unit of Internal Medicine, University Hospital Policlinico di Modena, Modena, Italy.
• Intern Emerg Med. 2021 Jun 1; 16 (4): 1005-1015.

AbstractDuring the COVID-19 2020 outbreak, a large body of data has been provided on general management and outcomes of hospitalized COVID-19 patients. Yet, relatively little is known on characteristics and outcome of patients managed in Internal Medicine Units (IMU). To address this gap, the Italian Society of Internal Medicine has conducted a nationwide cohort multicentre study on death outcome in adult COVID-19 patients admitted and managed in IMU. This study assessed 3044 COVID-19 patients at 41 referral hospitals across Italy from February 3rd to May 8th 2020. Demographics, comorbidities, organ dysfunction, treatment, and outcomes including death were assessed. During the study period, 697 patients (22.9%) were transferred to intensive care units, and 351 died in IMU (death rate 14.9%). At admission, factors independently associated with in-hospital mortality were age (OR 2.46, p = 0.000), productive cough (OR 2.04, p = 0.000), pre-existing chronic heart failure (OR 1.58, p = 0.017) and chronic obstructive pulmonary disease (OR 1.17, p = 0.048), the number of comorbidities (OR 1.34, p = 0.000) and polypharmacy (OR 1.20, p = 0.000). Of note, up to 40% of elderly patients did not report fever at admission. Decreasing PaO2/FiO2 ratio at admission was strongly inversely associated with survival. The use of conventional oxygen supplementation increased with the number of pre-existing comorbidities, but it did not associate with better survival in patients with PaO2/FiO2 ratio < 100. The latter, significantly benefited by the early use of non-invasive mechanical ventilation. Our study identified PaO2/FiO2 ratio at admission and comorbidity as the main alert signs to inform clinical decisions and resource allocation in non-critically ill COVID-19 patients admitted to IMU.

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