Clinical Implications of Size of Cavities in Patients With Nontuberculous Mycobacterial Pulmonary Disease: A Single-Center Cohort Study

Abstract Background The presence of cavities is associated with unfavorable prognosis in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD). However, little is known about the characteristics of such cavities and their impact on clinical outcomes. The aim of this study was to investigate the size of cavities and their implications on treatment outcomes and mortality in patients with NTM-PD. Methods We included patients diagnosed with NTM-PD at Seoul National University Hospital between January 1, 2007, and December 31, 2018. We measured the size of cavities on chest computed tomography scans performed at the time of diagnosis and used multivariable logistic regression and Cox proportional hazards regression analysis to investigate the impact of these measurements on treatment outcomes and mortality. Results The study cohort comprised 421 patients (noncavitary, n = 329; cavitary, n = 92) with NTM-PD. During a median follow-up period of 49 months, 118 (35.9%) of the 329 patients with noncavitary and 64 (69.6%) of the 92 patients with cavitary NTM-PD received antibiotic treatment. Cavities >2 cm were associated with worse treatment outcomes (adjusted odds ratio, 0.41; 95% CI, 0.17–0.96) and higher mortality (adjusted hazard ratio, 2.52; 95% CI, 1.09–5.84), while there was no difference in treatment outcomes or mortality between patients with cavities ≤2 cm and patients with noncavitary NTM-PD. Conclusions Clinical outcomes are different according to the size of cavities in patients with cavitary NTM-PD; thus, the measurement of the size of cavities could help in making clinical decisions.

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Clinical Implications of Size of Cavities in Patients With Nontuberculous Mycobacterial Pulmonary Disease: A Single-Center Cohort Study

10.21203/rs.3.rs-124209/v1 ◽

2020 ◽

Author(s):

Hye-Rin Kang ◽

Eui Jin Hwang ◽

Sung A Kim ◽

Sun Mi Choi ◽

Jinwoo Lee ◽

...

Keyword(s):

Treatment Outcomes ◽

Pulmonary Disease ◽

Clinical Outcomes ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

University Hospital ◽

Study Cohort ◽

Poor Prognostic Factor ◽

National University ◽

The Impact

Abstract BackgroundThe presence of cavities is a poor prognostic factor in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD). However, little is known about the characteristics of such cavities and their impact on clinical outcomes. The aim of this study is to investigate the size of cavities and their implications on treatment outcomes and mortality in patients with NTM-PD.MethodsWe included patients diagnosed with NTM-PD at Seoul National University Hospital between 1 January 2007 and 31 December 2018. We measured the size of cavities on chest computed tomography scans performed at the time of diagnosis, and used multivariable logistic regression and Cox-proportional hazards regression analysis to investigate the impact of these measurements on treatment outcomes and mortality. ResultsThe study cohort comprised 421 patients (non-cavitary, n=329; cavitary, n=92) with NTM-PD. During a median follow-up period of 49 months, 118 (35.9%) of the 329 patients with non-cavitary and 64 (69.6%) of the 92 patients with cavitary NTM-PD received antibiotic treatment. Cavities >2 cm were associated with worse treatment outcomes (adjusted odds ratio, 0.38; 95% confidence interval [CI], 0.16–0.86) and higher mortality (adjusted hazard ratio, 2.50; 95% CI, 1.04–6.02), while there was no difference in treatment outcomes and mortality between patients with cavities <2 cm and patients with non-cavitary NTM-PD. ConclusionsClinical outcomes are different according to the size of cavities in patients with cavitary NTM-PD; thus the measurement of the size of cavities could help in making clinical decisions.

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Impact of Pathological Stratification on the Clinical Outcomes of Advanced Well-Differentiated/Dedifferentiated Liposarcoma Treated with Trabectedin

Cancers ◽

10.3390/cancers13061453 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1453

Author(s):

Chiara Fabbroni ◽

Giovanni Fucà ◽

Francesca Ligorio ◽

Elena Fumagalli ◽

Marta Barisella ◽

...

Keyword(s):

Clinical Outcomes ◽

Proportional Hazards ◽

Case Series ◽

Progression Free Survival ◽

Cox Proportional Hazards ◽

Low Grade ◽

High Grade ◽

Retrospective Case ◽

Well Differentiated ◽

The Impact

Background. We previously showed that grading can prognosticate the outcome of retroperitoneal liposarcoma (LPS). In the present study, we aimed to explore the impact of pathological stratification using grading on the clinical outcomes of patients with advanced well-differentiated LPS (WDLPS) and dedifferentiated LPS (DDLPS) treated with trabectedin. Patients: We included patients with advanced WDLPS and DDLPS treated with trabectedin at the Fondazione IRCCS Istituto Nazionale dei Tumori between April 2003 and November 2019. Tumors were categorized in WDLPS, low-grade DDLPS, and high-grade DDLPS according to the 2020 WHO classification. Patients were divided in two cohorts: Low-grade (WDLPS/low-grade DDLPS) and high-grade (high-grade DDLPS). Results: A total of 49 patients were included: 17 (35%) in the low-grade cohort and 32 (65%) in the high-grade cohort. Response rate was 47% in the low-grade cohort versus 9.4% in the high-grade cohort (logistic regression p = 0.006). Median progression-free survival (PFS) was 13.7 months in the low-grade cohort and 3.2 months in the high-grade cohort. Grading was confirmed as an independent predictor of PFS in the Cox proportional-hazards regression multivariable model (adjusted hazard ratio low-grade vs. high-grade: 0.45, 95% confidence interval: 0.22–0.94; adjusted p = 0.035). Conclusions: In this retrospective case series, sensitivity to trabectedin was higher in WDLPS/low-grade DDLPS than in high-grade DDLPS. If confirmed in larger series, grading could represent an effective tool to personalize the treatment with trabectedin in patients with advanced LPS.

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Clinical Outcomes of Patients with Combined Idiopathic Pulmonary Fibrosis and Emphysema in the IPF-PRO Registry

Lung ◽

10.1007/s00408-021-00506-x ◽

2022 ◽

Author(s):

Hyun J. Kim ◽

Laurie D. Snyder ◽

Megan L. Neely ◽

Anne S. Hellkamp ◽

David L. Hotchkin ◽

...

Keyword(s):

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Clinical Outcomes ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Models ◽

Baseline Variable ◽

Former Smokers ◽

The Impact ◽

Baseline Covariates

Abstract Purpose To assess the impact of concomitant emphysema on outcomes in patients with idiopathic pulmonary fibrosis (IPF). Methods The IPF-PRO Registry is a US registry of patients with IPF. The presence of combined pulmonary fibrosis and emphysema (CPFE) at enrollment was determined by investigators’ review of an HRCT scan. Associations between emphysema and clinical outcomes were analyzed using Cox proportional hazards models. Results Of 934 patients, 119 (12.7%) had CPFE. Compared with patients with IPF alone, patients with CPFE were older (median 72 vs 70 years); higher proportions were current/former smokers (88.2% vs 63.7%), used oxygen with activity (49.6% vs 31.9%) or at rest (30.8% vs 18.4%), had congestive heart failure (13.6% vs 4.8%) and had prior respiratory hospitalization (25.0% vs 16.7%); they had higher FVC (median 71.8 vs 69.4% predicted) and lower DLco (median 35.3 vs 43.6% predicted). In patients with CPFE and IPF alone, respectively, at 1 year, rates of death or lung transplant were 17.5% (95% CI: 11.7, 25.8) and 11.2% (9.2, 13.6) and rates of hospitalization were 21.6% (14.6, 29.6) and 20.6% (17.9, 23.5). There were no significant associations between emphysema and any outcome after adjustment for baseline variables. No baseline variable predicted outcomes better in IPF alone than in CPFE. Conclusion Approximately 13% of patients in the IPF-PRO Registry had CPFE. Physiologic characteristics and comorbidities of patients with CPFE differed from those of patients with IPF alone, but the presence of emphysema did not drive outcomes after adjustment for baseline covariates. Trial registration ClinicalTrials.gov, NCT01915511; registered August 5, 2013.

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Impact of chemoradiotherapy on PD1/PDL1 expression and clinical outcomes in gastroesophageal cancers.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.4031 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 4031-4031

Author(s):

Arsen Osipov ◽

Quanlin Li ◽

Shant Thomassian ◽

Lakshmanan Annamalai ◽

Jennifer Holmes Yearley ◽

...

Keyword(s):

Regression Analysis ◽

Clinical Outcomes ◽

Proportional Hazards ◽

Checkpoint Inhibitors ◽

Death Receptor ◽

Cox Proportional Hazards ◽

Gastrointestinal Malignancies ◽

Expression Levels ◽

Gastric Cancer Patients ◽

The Impact

4031 Background: Expression of the immune modulating proteins, programmed death receptor-1 (PD1) and its ligand (PDL1), in gastrointestinal malignancies is associated with poor prognosis. PD1/PDL1 expression levels have also been identified as predictors of response to checkpoint inhibition. Minimal data is available on how expression of PD1 and PDL1 is influenced by chemoradiotherapy (CRT). In this study, we investigated the relationship between PDL1/PD1 expression, CRT, and clinical outcomes in gastroesophageal (GE) cancer. Methods: With IRB approval, we identified 28 patients with gastric cardia or GE junction tumors who underwent neoadjuvant standard CRT followed by surgical resection. Pre-CRT biopsies and post-CRT surgical specimens were analyzed using quantitative immunohistochemistry for the expression of PDL1 and PD1. Samples were categorized as trace-low (TL) or moderate-high (MH) expressors of PDL1 and PD1. The impact of these and other clinical and pathologic variables on overall survival (OS) was assessed using multivariate cox proportional hazards modeling. Co-expression of PDL1 and PD1 in matched samples was determined by regression analysis. Results: Following CRT, PDL1 and PD1 expression increased in 54% and 32% of patients, respectively. On multivariate analysis, patients with MH expression of PD1 after CRT irrespective of pre-CRT expression levels had a significant decrease in OS compared to those with TL expression (median survival 23.1 vs 74.1 months; HR,3.31; CI,1.05-10.35; p = 0.039). In patients with gastric confined tumors, an increase in PD1 expression from TL to MH after CRT was associated with significantly lower OS rates (p = 0.003). Regression analysis of PD1 to PDL1 was significant (p < 0.01) both before and after CRT, with a correlation coefficient of 0.34 in pre-CRT and 0.49 in post-CRT specimens. Conclusions: Elevated expression of PD1 is associated with poor OS in patients with GE cancer. Neoadjuvant CRT upregulates both PDL1 and PD1. In gastric cancer patients, this led to significantly worse survival. These data identify potential mechanisms of resistance and suggest a role for checkpoint inhibitors in combination with CRT.

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Clinical outcomes and risk factors of hepatopulmonary syndrome in children

Scientific Reports ◽

10.1038/s41598-021-83785-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kwang Yeon Kim ◽

Tae Hyeong Kim ◽

Jeong-Moo Lee ◽

Nam-Joon Yi ◽

Hyun-Young Kim ◽

...

Keyword(s):

Risk Factors ◽

Liver Disease ◽

Portal Vein ◽

Clinical Outcomes ◽

Hepatopulmonary Syndrome ◽

University Hospital ◽

Vein Thrombosis ◽

National University ◽

Seoul National University ◽

End Stage

AbstractHepatopulmonary syndrome (HPS) is defined as three distinct features: liver disease, hypoxemia, and intrapulmonary vasodilation. The purpose of this study was to investigate the clinical outcomes of pediatric HPS and to identify the risk factors for HPS in children with biliary atresia (BA). We performed a retrospective cohort study of all children who were diagnosed with HPS between 2000 and 2018 at Seoul National University Hospital. The clinical features and outcomes of the 10 patients diagnosed with HPS were reviewed. To clarify the risk factors of HPS in patients with BA, we reviewed 120 patients diagnosed with BA. Underlying liver disease was BA in 8 patients, portal vein agenesis in 1 patient, and portal vein thrombosis in 1 patient. A total of 7 patients underwent liver transplantation (LT). Currently, all seven patients, including 3 patients with severe HPS, survived after LT. The prevalence of HPS in children with BA was 7%. Polysplenia/interrupted inferior vena was the only risk factor for HPS in BA patients in multivariate analysis. The Pediatric End-Stage Liver Disease score was not associated with the development of HPS. Children with severe HPS undergoing LT had excellent outcomes. Screening for HPS in children with BA is required regardless of the severity of liver diseases.

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Multicenter, Observational Cohort Study Evaluating Third-Generation Cephalosporin Therapy for Bloodstream Infections Secondary to Enterobacter, Serratia, and Citrobacter Species

Antibiotics ◽

10.3390/antibiotics9050254 ◽

2020 ◽

Vol 9 (5) ◽

pp. 254 ◽

Cited By ~ 2

Author(s):

Caroline Derrick ◽

P. Brandon Bookstaver ◽

Zhiqiang K. Lu ◽

Christopher M. Bland ◽

S. Travis King ◽

...

Keyword(s):

Cohort Study ◽

Clinical Outcomes ◽

Proportional Hazards ◽

Bloodstream Infections ◽

Cox Proportional Hazards ◽

Third Generation ◽

Cox Proportional Hazards Regression ◽

Proportional Hazards Regression ◽

Definitive Therapy ◽

The Impact

Objectives: There is debate on whether the use of third-generation cephalosporins (3GC) increases the risk of clinical failure in bloodstream infections (BSIs) caused by chromosomally-mediated AmpC-producing Enterobacterales (CAE). This study evaluates the impact of definitive 3GC therapy versus other antibiotics on clinical outcomes in BSIs due to Enterobacter, Serratia, or Citrobacter species. Methods: This multicenter, retrospective cohort study evaluated adult hospitalized patients with BSIs secondary to Enterobacter, Serratia, or Citrobacter species from 1 January 2006 to 1 September 2014. Definitive 3GC therapy was compared to definitive therapy with other non-3GC antibiotics. Multivariable Cox proportional hazards regression evaluated the impact of definitive 3GC on overall treatment failure (OTF) as a composite of in-hospital mortality, 30-day hospital readmission, or 90-day reinfection. Results: A total of 381 patients from 18 institutions in the southeastern United States were enrolled. Common sources of BSIs were the urinary tract and central venous catheters (78 (20.5%) patients each). Definitive 3GC therapy was utilized in 65 (17.1%) patients. OTF occurred in 22/65 patients (33.9%) in the definitive 3GC group vs. 94/316 (29.8%) in the non-3GC group (p = 0.51). Individual components of OTF were comparable between groups. Risk of OTF was comparable with definitive 3GC therapy vs. definitive non-3GC therapy (aHR 0.93, 95% CI 0.51–1.72) in multivariable Cox proportional hazards regression analysis. Conclusions: These outcomes suggest definitive 3GC therapy does not significantly alter the risk of poor clinical outcomes in the treatment of BSIs secondary to Enterobacter, Serratia, or Citrobacter species compared to other antimicrobial agents.

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Adjuvant treatment patterns and clinical outcomes in patients with curative resected ampulla of Vater cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.415 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 415-415

Author(s):

Hyerim Ha ◽

Do-Youn Oh ◽

Tae-Yong Kim ◽

KyoungBun Lee ◽

Kyubo Kim ◽

...

Keyword(s):

Clinical Outcomes ◽

Adjuvant Treatment ◽

Curative Resection ◽

Disease Free Survival ◽

Ampulla Of Vater ◽

University Hospital ◽

Maintenance Chemotherapy ◽

National University ◽

N Stage ◽

Seoul National University

415 Background: Ampulla of Vater cancer (AoV ca) is rare tumor, and its adjuvant treatment after curative resection has not been well established. The purpose of this study is to see the clinical outcomes of curatively resected AoV ca patients and to figure out the role of adjuvant treatment. Methods: We reviewed 227 AoV ca patients who underwent curative resection at the Seoul National University Hospital between 1997 and 2012. Clinical factors, pathologic findings, adjuvant treatment pattern, disease-free survival (DFS) and overall survival (OS) were analyzed. Results: Median age was 61.5 year old (range, 33.8-88.2) and 125 patients were male. T1/T2 stage was found in 63.9% of patients and T3/4 stage was in 36.1%. Seventy-seven patients (33.9%) had node positive disease (N+) and seventy-three patients (32.1%) had well-differentiated histology. OS of all patients was 90.9 months (95% CI: 58.4-128.09). 5-Year OS- and DFS- rate were 58.2% and 62.5%, respectively. On multivariate analysis, adverse prognostic factors for OS included poorly differentiated histology (HR 1.35, 95% CI: 1.01-1.81, p=0.045), elevated CEA (HR 2.55, 95% CI: 1.29-5.04, p=0.007), elevated CA 19-9(HR 1.86, 95% CI: 1.08-3.21, p=0.027), and stage (HR 2.34, 95% CI: 1.43-3.82, p=0.001). A total of 104 patients (46.3%) received adjuvant treatment (concurrent chemoradiotherapy (CCRT) 32, CCRT with maintenance chemotherapy 58, chemotherapy alone 9, radiotherapy alone 5). Most of the chemotherapies were 5-FU-based ones. Among patients with T1/T2 & N (-) (n=111), only 25 patients (22.5%) received adjuvant treatment. In contrast, among patients with T3/T4 or N (+) (n=116), 79 patients (68.1%) received adjuvant treatment. 5Y-OS rate was 74.1% in patients with T1/T2 and N (-) and that of patients with T3/T4 or N (+) was 43.0% (p<0.001). In T1/T2 and N (-) stage, OS was not different according to adjuvant treatment. In T3/T4 or N (+) stage, adjuvant CCRT with maintenance chemotherapy conferred the longest OS, which was not statistically significant. (5Y-OSR: 47.0% vs 41.4% in no adjuvant treatment.) Conclusions: Adjuvant treatment should be further defined in AoV ca, especially in T3/T4 or N (+) stage.

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New-onset nontuberculous mycobacterial pulmonary disease in bronchiectasis: tracking the clinical and radiographic changes

BMC Pulmonary Medicine ◽

10.1186/s12890-020-01331-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Nakwon Kwak ◽

Jong Hyuk Lee ◽

Hyung-Jun Kim ◽

Sung A. Kim ◽

Jae-Joon Yim

Keyword(s):

Pulmonary Disease ◽

Close Association ◽

Severity Index ◽

University Hospital ◽

Radiographic Findings ◽

National University ◽

Seoul National University ◽

Radiographic Changes ◽

Observation Period ◽

New Onset

Abstract Background The close association between bronchiectasis and nontuberculous mycobacterial pulmonary disease (NTM-PD) is well-known. However, the clinical impact of subsequent new-onset NTM-PD in bronchiectasis patients has not been elucidated. The aim of this study is to investigate the clinical courses and radiographic changes of patients with bronchiectasis in whom NTM-PD subsequently developed. Methods A total of 221 patients with bronchiectasis who had participated in a non-NTM bronchiectasis cohort between July 1st 2011 and August 31st 2019 at Seoul National University Hospital were included in this study. The data of patients in whom NTM-PD developed during this observation period were analyzed; specifically, changes in the Bronchiectasis Severity Index (BSI) and lesions on computerized tomography (CT) scan of the chest arising during the observation period. Results During the observation period, NTM was isolated from 35 patients. A total of 31 patients (14.0%) satisfied the diagnostic criteria of NTM-PD. The median time from enrollment in the cohort to the development of subsequent NTM-PD was 37 months (Interquartile range [IQR], 18–78 months). Mycobacterium avium complex was the most common pathogen (80.6%). Twelve patients underwent antibiotic treatment for NTM-PD with a median interval of 20 months (IQR, 13–30) from the time of NTM-PD diagnosis. When NTM-PD developed, the severity and extent of bronchiectasis, cellular bronchiolitis, and the extent of nodules worsened on CT scans, while BSI did not change. Conclusions NTM-PD can develop in previously negative bronchiectasis patients. It is associated with worsening radiographic lesions. Active screening of non-NTM bronchiectasis patients for new-onset NTM infection should be considered, especially if radiographic findings worsen. The BSI is not a reliable predictor of new-onset NTM-PD. Trial registration This study was performed at Seoul National University Hospital (NCT01616745).

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Associations of mutation profiles with clinical outcomes among metastatic colorectal cancer patients at the United States-Mexico border.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e15519 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e15519-e15519

Author(s):

Reshad Ghafouri ◽

Alexander Philipovskiy ◽

Javier Chavez Corral ◽

Sumit Gaur ◽

Nawar Hakim ◽

...

Keyword(s):

Colon Cancer ◽

Clinical Outcomes ◽

Proportional Hazards ◽

Brca Mutation ◽

The United States ◽

Genetic Alterations ◽

Cox Proportional Hazards ◽

Rank Test ◽

Study Cohort ◽

Female Ratio

e15519 Background: The incidence of CRC among Hispanics living in the USA varies according to their country of origin, supports the idea that differences in ancestry may contribute to the differences in the incidence of CRC. Moreover, Hispanics-Latino(HL) patients usually present with a more advanced stage and have a higher mortality rate compared to other ethnic cohorts. Although it is unknown, the incidence of CRC has been substantially increasing among younger Hispanics. We sought to characterize the tumor mutation profile of mCRC patients and associate with clinical outcomes among Hispanic population. Methods: We retrospectively collected the data from next generation sequencing of 49 patients with metastatic CRC (treated at TTUHSC from 2012 to 2020. We identified the most frequent alterations in our study sample and associated with the clinical outcomes. Association analyses were performed using chi square test, unpaired t-test, log rank test and the Cox proportional hazards regressions. Results: Of 49 patients with mCRC, the average age of patients at the time of diagnosis was 57 years with 98% Hispanic, and 32(65%) male. Most of the patients had stage IV disease (98%) and left side CRC (31, 67%). In our study cohort, the most commonly mutated genes identified as APC (37/11, 77.08%), TP53 (29/19, 60.42%), KRAS (23/25, 47.92%), NOTCH 12/36 (25.00%), BRCA 1&2 11/37 (22.92%) and FLT1 11/37 (22.92%). None of the identified mutations were found to be associated with overall survival. However, the presence of the FLT1 mutation was associated with a reduced risk of progression to additional chemotherapy (P=0.031). Compared to the left side CRC, the BRCA mutation appeared slightly higher on the right side of the CRC (p=0.057). In compare to data from larger national and international colon cancer databases ( COSMIC and METABRICS); HL patients showed a significantly higher proportion of frequent mutations. Compared to other ethnic cohorts, HL patients were relatively younger (57 vs. 63 years) and the male to female ratio was observed to be remarkably higher as well (1.77:1 vs. 1.32:1). In our study, the combination of mutations (TP53, APC, and KRAS) was associated with worse clinical outcomes. Our study demonstrated that worse clinical outcomes were correlated with. Conclusions: Our study is the first to characterize the most common genetic alterations among HL patients with mCRC. The most frequent identified mutations including TP53, APC, KRAS, NOTCH, and BRCA were even higher in HL cohort than the national and international databases ( COSMIC and METABRICS). Our data support the motion that molecular drivers of colon cancer might be different in HL patients.

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Impact of an Intermediate Respiratory Care Unit on Clinical Outcomes of COVID-19 Patients

10.21203/rs.3.rs-124213/v1 ◽

2020 ◽

Author(s):

Guillermo Suarez-Cuartin ◽

Merce Gasa ◽

Guadalupe Bermudo ◽

Yolanda Ruiz-Albert ◽

Marta Hernandez-Argudo ◽

...

Keyword(s):

Clinical Outcomes ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Respiratory Support ◽

Respiratory Care ◽

High Dose ◽

Risk Of Death ◽

Systemic Corticosteroids ◽

The Impact

Abstract Background: Many severe COVID-19 patients require respiratory support and monitoring. An intermediate respiratory care unit (IMCU) may be a valuable element for optimizing patient care and limited health-care resources management. We aim to assess the impact of an IMCU in the management of severe COVID-19.Methods: Observational, retrospective study including patients admitted to the IMCU due to COVID-19 pneumonia during the months of March and April 2020. Patients were stratified based on their requirement of transfer to the intensive care unit (ICU) and on survival status at the end of follow-up. A multivariable Cox proportional hazards method was used to assess risk factors associated with mortality.Results: A total of 253 patients were included. Of them, 68% were male and median age was 65 years (IQR 18 years). Ninety-two patients (36.4%) required ICU transfer. Patients transferred to the ICU had a higher mortality rate (44.6% Vs 24.2%; p<0.001). Multivariable proportional hazards model showed that age ³65 years (HR 4.14; 95%CI 2.31-7.42; p<0.001); chronic respiratory conditions (HR 2.34; 95%CI 1.38-3.99; p=0.002) and chronic kidney disease (HR 2.96; 95%CI 1.61-5.43; p<0.001) were independently associated with mortality. High-dose systemic corticosteroids followed by progressive dose tapering showed a lower risk of death (HR 0.15; 95%CI 0.06-0.40; p<0.001). Conclusions: IMCU allow to safely and effectively manage severe COVID-19 patients requiring respiratory support and non-invasive monitoring, therefore reducing ICU burden. Older age and chronic respiratory or renal conditions are associated with worse clinical outcomes, while treatment with systemic corticosteroids may have a protective effect on mortality.

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