Alessio Marra | IRCCS AOU San Martino-IST Genova (original) (raw)

Papers by Alessio Marra

European Journal of Emergency Medicine, 2021

Diagnostics, 2022

The diagnosis of acute myocarditis (AM) is based on a multi-parametric assessment including clini... more The diagnosis of acute myocarditis (AM) is based on a multi-parametric assessment including clinical presentation, ECG, imaging and biomarkers. Fragmented QRS (fQRS) might be an additional diagnostic sign in patients with proven AM. The main objective of this study was to assess the diagnostic yield of fQRS in patients with suspected AM presenting to the emergency department (ED). Patients admitted between January 2016 and March 2021 with a proven diagnosis of AM, according to clinical, cardiac magnetic resonance (CMR) and/or histologic criteria, were included in the analysis. In total, 51 patients were analyzed (41 men, 78%), with a median age of 36 (29–45) years. Thirty-three (65%) patients had prodromal flu-like symptoms. Patients presented to the ED mostly complaining of chest pain (68%) and palpitations (21%). Seven (14%) patients experienced cardiac arrest, one of whom died. At presentation, 40 patients (78%) displayed fQRS, and 10 (20%) presented ventricular arrhythmias. All ...

Italian Journal of Emergency Medicine, 2022

Acta Diabetologica, 2021

Aims The association between hyperglycemia at hospital admission and relevant short- and long-ter... more Aims The association between hyperglycemia at hospital admission and relevant short- and long-term outcomes in elderly population is known. We assessed the effects on mortality of hyperglycemia, disability, and multimorbidity at admission in internal medicine ward in patients aged ≥ 65 years. Methods Data were collected from an active register of 102 internal medicine and geriatric wards in Italy (RePoSi project). Patients were recruited during four index weeks of a year. Socio-demographic data, reason for hospitalization, diagnoses, treatment, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), renal function, functional (Barthel Index), and cognitive status (Short Blessed Test) and mood disorders (Geriatric Depression Scale) were recorded. Mortality rates were assessed in hospital 3 and 12 months after discharge. Results Of the 4714 elderly patients hospitalized, 361 had a glycemia level ≥ 250 mg/dL at admission. Compared to subjects with lower ...

Internal and Emergency Medicine, 2021

Coronavirus disease-19 (COVID-19) has spread worldwide, causing until now more than 65 million in... more Coronavirus disease-19 (COVID-19) has spread worldwide, causing until now more than 65 million infections and 1.5 million of deaths. COVID-19 may express in different clinical manifestations with possible multiorgan involvement [1, 2]. There are growing evidence of neurological manifestations in SARS-CoV-2 patients [3, 4]. Among these manifestations, peripheral involvement with anosmia and ageusia is the most frequent symptom, occurring in up to 80% of patients. Central involvement with headache, disturbed consciousness, and other brain dysfunction symptoms can be present in almost 40% of COVID-19 patients, and other less common symptoms may also be present (Table 1). In Lombardy, Italy, from late February to April 2020, COVID-19 caused thousands of infections, heavily engaging Emergency Departments (ED) and healthcare system. This unpredictable and unexpected scenario with a very high number of patients determined the emergence of several atypical manifestations of COVID-19, such as neurological ones. Among the patients evaluated in our hospital ED during the peak of epidemic, here we report two cases characterized by subtle neurological involvement of SARS-CoV-2 infection. An 82-year-old nonsmoker woman with arterial hypertension, diverticulosis, and hypothyroidism, presented in the ED for 5 days lasting altered mental status, worsened in the last 24 h with the development of aphasia. The patient

Academic Emergency Medicine, 2020

Word count 276) Background: There have been reports of pro-coagulant activity in patients with CO... more Word count 276) Background: There have been reports of pro-coagulant activity in patients with COVID-19. Whether there is an association between pulmonary embolism (PE) and COVID-19 in the emergency department (ED) is unknown. The aim of this study was to assess whether COVID-19 is associated with PE in ED patients that underwent a CTPA? Methods: A retrospective study in 26 EDs from 6 countries. ED patients in whom a computed tomographic pulmonary angiogram (CTPA) was performed for suspected PE during a 2-month period covering the pandemic peak. The primary endpoint was the occurrence of a pulmonary embolism on CTPA. COVID-19 was diagnosed in the ED either on CT or RT-PCR. A multivariable binary logistic regression was built to adjust with other variables known to be associated with PE. A sensitivity analysis was performed in patients included during the pandemic period. Results: A total of 3358 patients were included, of whom 105 were excluded because COVID-19 status was unknown, leaving 3253 for analysis. Among them, 974 (30%) were diagnosed with COVID-19. Mean age was 61 years (19) and 52% were women. A pulmonary embolism was diagnosed on CTPA in 500 patients (15%). The risk of PE was similar between COVID-19 patients and others (15% in both groups). In the multivariable binary logistic regression model, COVID-19 was not associated with higher risk of PE (adjusted odds ratio 0.98, 95% confidence interval 0.76 to 1.26). There was no association when limited to patients in the pandemic period. Conclusion: In ED patients that underwent CTPA for suspected PE, COVID-19 is not associated with an increased probability of PE diagnosis. These results were also valid when limited to the pandemic period. However, these results may not apply to patients with suspected COVID-19 in general.

Internal and Emergency Medicine, 2020

Currently, chronic obstructive pulmonary disease (COPD) represents the fourth cause of death worl... more Currently, chronic obstructive pulmonary disease (COPD) represents the fourth cause of death worldwide with significant economic burden. Comorbidities increase in number and severity with age and are identified as important determinants that influence the prognosis. In this observational study, we retrospectively analyzed data collected from the RePoSI register. We aimed to investigate comorbidities and outcomes in a cohort of hospitalized elderly patients with the clinical diagnosis of COPD. Socio-demographic, clinical characteristics and laboratory findings were considered. The association between variables and in-hospital, 3-month and 1-year follow-up were analyzed. Among 4696 in-patients, 932 (19.8%) had a diagnosis of COPD. Patients with COPD had more hospitalization, a significant overt cognitive impairment, a clinically significant disability and more depression in comparison with non-COPD subjects. COPD patients took more drugs, both at admission, in-hospital stay, discharge and 3-month and 1-year follow-up. 14 comorbidities were more frequent in COPD patients. Cerebrovascular disease was an independent predictor of in-hospital mortality. At 3-month follow-up, male sex and hepatic cirrhosis were independently associated with mortality. ICS-LABA therapy was predictor of mortality at in-hospital, 3-month and 1-year follow-up. This analysis showed the severity of impact of COPD and its comorbidities in the real life of internal medicine and geriatric wards.

European Journal of Internal Medicine, 2019

Internal and Emergency Medicine, 2019

British Journal of Clinical Pharmacology, 2018

Although oral anticoagulants (OACs) are effective in preventing stroke in older people with atria... more Although oral anticoagulants (OACs) are effective in preventing stroke in older people with atrial fibrillation (AF), they are often underused in this particularly high-risk population. The aim of the present study was to assess the appropriateness of OAC prescription and its associated factors in hospitalized patients aged 65 years or older. METHODS Data were obtained from the retrospective phase of Simulation-based Technologies to Improve the Appropriate Use of Oral Anticoagulants in Hospitalized Elderly Patients With Atrial Fibrillation (SIM-AF) study, held in 32 Italian internal medicine and geriatric wards. The appropriateness of OAC prescription was assessed, grouping patients in those who were and were not prescribed OACs at hospital discharge. Multivariable logistic regression was used to establish factors independently associated with the appropriateness of OAC prescription. RESULTS A total of 328 patients were included in the retrospective phase of the study. Of these, almost 44% (N = 143) were inappropriately prescribed OACs, being mainly underprescribed or prescribed an inappropriate antithrombotic drug (N = 88). Among the patients prescribed OACs (N = 221), errors in the prescribed doses were the most frequent cause of inappropriate use (N = 55). Factors associated with a higher degree of patient frailty were inversely associated with the appropriateness of OAC prescription.

Journal of the American Medical Directors Association, 2019

Objectives: We aimed to analyze the prevalence and impact of COPD in older patients hospitalized ... more Objectives: We aimed to analyze the prevalence and impact of COPD in older patients hospitalized in internal medicine or geriatric wards, and to investigate adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, associated clinical factors, and outcomes. Design: Data were obtained from REgistro POliterapie SIMI (REPOSI), a prospective multicenter observational registry that enrolls inpatients aged 65 years. Setting and Participants: Older hospitalized patients enrolled from 2008 to 2016 with a diagnosis of COPD. Measures: We evaluated adherence to the 2018 GOLD guidelines at admission and discharge, by examining the prescription of inhaled bronchodilators and corticosteroids in COPD patients. We also evaluated the occurrence of outcomes and its association with COPD and guideline adherence. Results: At hospital admission, COPD was diagnosed in 1302 (21.5%) of 6046 registered patients. COPD patients were older, with more impaired clinical and functional status and multiple comorbidities. Overall, 34.3% of COPD patients at admission and 35.6% at discharge were adherent to the GOLD guidelines. Polypharmacy (5 drugs) at admission [odds ratio (OR): 3.28, 95% confidence interval (CI): 2.24-4.81], a history of acute COPD exacerbation (OR: 2.65, 95% CI: 1.44-4.88) at admission, smoking habit (OR: 1.45, 95% CI: 1.08-1.94), and polypharmacy at discharge (OR: 6.76, 95% CI: 4.15-11.0) were associated with adherence to guidelines. COPD was independently associated with the risk of cardiovascular and respiratory death and rehospitalization occurrence compared to patients without COPD during follow-up. Adherence to guidelines was inversely associated with the occurrence of death from all causes (OR: 0.12, 95% CI: 0.02-0.90). Conclusions/Implications: COPD was common in older patients acutely hospitalized, showing an impaired functional and clinical status. Prescriptions for older COPD patients were often not adherent to GOLD guidelines. Poor adherence to guidelines was associated with a worse clinical status. There is a need to

European journal of internal medicine, Jun 1, 2018

Drugs & aging, Jan 21, 2018

Among rate-control or rhythm-control strategies, there is conflicting evidence as to which is the... more Among rate-control or rhythm-control strategies, there is conflicting evidence as to which is the best management approach for non-valvular atrial fibrillation (AF) in elderly patients. We performed an ancillary analysis from the 'Registro Politerapie SIMI' study, enrolling elderly inpatients from internal medicine and geriatric wards. We considered patients enrolled from 2008 to 2014 with an AF diagnosis at admission, treated with a rate-control-only or rhythm-control-only strategy. Among 1114 patients, 241 (21.6%) were managed with observation only and 122 (11%) were managed with both the rate- and rhythm-control approaches. Of the remaining 751 patients, 626 (83.4%) were managed with a rate-control-only strategy and 125 (16.6%) were managed with a rhythm-control-only strategy. Rate-control-managed patients were older (p = 0.002), had a higher Short Blessed Test (SBT; p = 0.022) and a lower Barthel Index (p = 0.047). Polypharmacy (p = 0.001), heart failure (p = 0.005) and ...

Drugs & aging, 2017

Older patients are prone to multimorbidity and polypharmacy, with an inherent risk of adverse eve... more Older patients are prone to multimorbidity and polypharmacy, with an inherent risk of adverse events and drug interactions. To the best of our knowledge, available information on the appropriateness of lipid-lowering treatment is extremely limited. The aim of the present study was to quantify and characterize lipid-lowering drug use in a population of complex in-hospital older patients. We analyzed data from 87 units of internal medicine or geriatric medicine in the REPOSI (Registro Politerapie della Società Italiana di Medicina Interna) study, with reference to the 2010 and 2012 patient cohorts. Lipid-lowering drug use was closely correlated with the clinical profiles, including multimorbidity markers and polypharmacy. 2171 patients aged >65 years were enrolled (1057 males, 1114 females, mean age 78.6 years). The patients treated with lipid-lowering drugs amounted to 508 subjects (23.4%), with no gender difference. Atorvastatin (39.3%) and simvastatin (34.0%) were the most widel...

BMJ, 2016

A 73 year old white man presented to the emergency department after unintentional ingestion of pa... more A 73 year old white man presented to the emergency department after unintentional ingestion of paraffin, which he had used as a paint remover two hours earlier. The episode was followed by cough, and the patient reported self induced vomiting. On admission he was eupnoeic and his respiratory rate, oxygen saturation, blood pressure, heart rate, and skin temperature were normal. The patient was a moderate smoker (15 cigarettes/day), and his history was notable only for a minor stroke two years previously without persistent sensory motor impairment. Physical examination, laboratory tests, and chest radiography were normal. No mucosal lesion was evident on an urgent gastroscopy. He was given vaseline oil and oral antacids. After 18 hours he developed hyperpyrexia (39°C), acute dyspnoea with desaturation (peripheral oxygen saturation 91% while breathing ambient air), and productive cough with blood streaks. A pulmonary examination identified fine crackles at the right lung base. White blood cell count and C reactive protein levels were increased (23×10 9 /L (reference values: 4.5-9.8×10 9 /L) and 216 mg/L (reference value: <5 mg/L) respectively). Contrast enhanced computed tomography (CT) of the chest was performed (fig 1).

Clinical Research in Cardiology, 2016

Background: Atrial fibrillation (AF) is associated with a substantial risk of thromboembolism and... more Background: Atrial fibrillation (AF) is associated with a substantial risk of thromboembolism and mortality, significantly reduced by oral anticoagulation. Adherence to guidelines may lower the risks for both all cause and cardiovascular (CV) deaths. Methods: Our objective was to evaluate if antithrombotic prophylaxis according to the European Society of Cardiology (ESC) guidelines are associated to a lower rate of adverse outcomes. Data were obtained from REPOSI, a prospective observational study enrolling inpatients aged ≥65 years. Patients enrolled in 2012 and 2014 discharged with an AF diagnosis were analysed. Results: Among 2,535 patients, 558 (22.0%) were discharged with a diagnosis of AF. Based on ESC guidelines, 40.9% of patients were on guideline-adherent thromboprophylaxis, 6.8% were overtreated and 52.3% undertreated. Logistic analysis showed that increasing age (p=0.01), heart failure (p=0.04), coronary artery disease (p=0.013), peripheral arterial disease (p=0.03) and concomitant cancer (p=0.003) were associated with non-adherence to guidelines. Specifically, undertreatment was significantly associated with increasing age (p=0.001) and cancer (p<0.001), and inversely associated with HF (p=0.023). AF patients who were guideline adherent had a lower rate of both all-cause death (p=0.007) and CV death (p=0.024) compared to those non-adherent. Kaplan-Meier analysis shows that guidelineadherent patients had a lower cumulative risk for both all-cause (p=0.002) and CV deaths (p=0.011). On Cox regression analysis, guideline adherence was independently associated with a lower risk of all-cause and CV deaths (p=0.019 and p=0.006). Conclusions: Non-adherence to guidelines is highly prevalent among elderly AF patients, despite guideline-adherent treatment being independently associated with lower risk of all-cause and CV 3 deaths. Efforts to improve guideline adherence would lead to better outcomes for elderly AF patients.

The Anatolian Journal of Cardiology, 2015

Annals of Emergency Medicine, 2018