When Outcomes Diverge: Age and Cardiovascular Risk as Determinants of Mortality and ICU Admission in COVID-19
Creators
- 1. Department of Cardiovascular Anesthesia and ICU, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
- 2. Department of Cardiovascular Neural and Metabolic Sciences, Department of Medicine and Surgery, IRCCS Istituto Auxologico Italiano, University of Milano-Bicocca, 20126 Milan, Italy;
- 3. Department of Cardiovascular Anesthesia and ICU, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy;
- 4. Department of Cardiac Rehabilitation, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milan, Italy;
- 5. Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, Vita-Salute University, IRCCS San Raffaele Hospital, 20132 Milan, Italy
- 6. Scientific Directorate, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy;
- 7. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy;IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- 8. Heart Failure Unit, Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, 20138 Milan, Italy;
- 9. Cardiovascular Disease Unit, Cardiac, Thoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
- 10. Biostatistics Unit, IRCCS Istituto Auxologico Italiano, 20126 Milan, Italy; Department of Statistics and Quantitative Methods, Università di Milano-Bicocca, 20126 Milan, Italy
- 11. Department of Cardiology, IRCCS Istituto Auxologico Italiano, Università di Milano-Bicocca, 20126 Milan, Italy
- 12. Department of Cardiac Rehabilitation, IRCCS Istituti Clinici Scientifici Maugeri, 28843 Montescano, Italy;
Description
Background: Hospital mortality and admission to the Intensive Care Unit (ICU) are markers of disease severity in COVID-19 patients. Cardiovascular co-morbidities are one of the Academic Editor: Atsushi Tanaka Received: 17 June 2022 Accepted: 12 July 2022 Published: 15 July 2022 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). main determinants of negative outcomes. In this study we investigated the impact of cardiovascular co-morbidities on mortality and admission to the ICU in first-wave COVID-19 patients. Methods: Amulticenter, retrospective, cohort study. A total of 1077 patients were analyzed for mortality and ICU admission. Cardiovascular risk factors were explored as determinants of the outcomes after correction for other confounders. Results: In the multivariable model, after correction for age, only a history of heart failure remained independently associated (p = 0.0013) with mortality (hazard ratio 2.22, 95% confidence interval 1.37 to 3.62). Age showed a mortality risk increase of 8% per year (hazard ratio 1.08, 95% confidence interval 1.05 to 1.10, p = 0.001). The transition from ward to the ICU had, as a single determinant, the age, but in a reversed fashion (hazard ratio 0.96, 95% confidence interval 0.94 to 0.98, p = 0.0002). Conclusions: Once adjusted for the main determinant of mortality (age) heart failure only remained independently associated with mortality. Admission to the ICU was less likely for elderly patients. This may reflect the catastrophic impact of the first wave of COVID-19 pandemic in terms of ICU bed availability in Lombardy, leading to a selection process for ICU admission.
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