Prognostic value of clinical and microbiological parameters in COVID-19: the COMEPA study

From Top Italian Scientists Journal
January 12, 2024
Prognostic value of clinical and microbiological parameters in COVID-19: the COMEPA study
Nicola Veronese, Marianna Noale, Anna La Carrubba, Luca Carruba, Stefano Ciriminna, Francesco Pollicino, Dario Saguto, Simona De Grazia, Federica Cacioppo, Giovanni M. Giammanco, Claudio Costantino, Francesco Vitale, Marco Affronti, Maria Chiara Morgante, Giusi Randazzo, Ligia J. Dominguez, Stefania Maggi, Mario Barbagallo and the COMEPA study authors
COVID-19; clusters; long COVID; prognosis
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Nicola Veronese(a), Marianna Noale(b), Anna La Carrubba(a), Luca Carruba(a), Stefano Ciriminna(a), Francesco Pollicino(a), Dario Saguto(a), Simona De Grazia(a), Federica Cacioppo(a), Giovanni M. Giammanco(a), Claudio Costantino(a), Francesco Vitale(a), Marco Affronti(c), Maria Chiara Morgante(c), Giusi Randazzo(c), Ligia J. Dominguez(a,d), Stefania Maggi(b), Mario Barbagallo(a), and the COMEPA study authors

(a) Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, 90127 Palermo, Italy.

(b) Consiglio Nazionale delle Ricerche, Neuroscience Institute, Padova, 35100, Italy.

(c) Geriatric Unit, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy.

(d) School of Medicine and Surgery, University of Enna "Kore", 94100, Enna, Italy;

Correspondence to: Nicola Veronese. Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro, 141, 90127 Palermo, Italy. Email:



Clusters’ analysis may indicate distinct phenotypes and symptom profiles potentially due to differing pathophysiology and needing different clinical approaches in COVID-19. However, the research about clusters combining clinical and microbiological information is still limited. The purpose of our study was to examine the prognostic role of clusters, including clinical and microbiological parameters in terms of severity of lung involvement, in-hospital mortality, and the occurrence of long COVID.


Information regarding COVID-19, mortality, severity of lung involvement derived from medical records; long COVID symptomatology was ascertained using phone calls. A k-means clustering method was considered to partition data into clusters considering typical symptoms of COVID-19 present at hospital admission and SarsCov2 variants.


Our analysis identified among 414 patients (mean age: 65 years; males: 59.9%) four different clusters. Cluster 1: higher prevalence of respiratory COVID symptoms at hospital admission; Cluster 2: higher frequency of non-respiratory COVID symptoms and a higher prevalence of the Alpha variant; Cluster 3: older subjects and more frequently men, reporting more severe medical conditions and with a higher prevalence of Wild type variant; Cluster 4: patients that more often reported general and gastrointestinal COVID symptoms at the admission. From a prognostic point of view, patients in cluster 3 more frequently died and were admitted in a nursing home, with significantly lower presence of long COVID symptomatology.


Clusters combining clinical and microbiological information in individuals hospitalized with COVID-19 that had different not only different profiles, but also different prognostic values, also in terms of long COVID.



The COMEPA group includes (alphabetical order): Affronti Marco, Amodeo Simona, Barbagallo Mario, Briganò Vincenza Maria, Cacioppo Federica, Capitano Walter M., Carruba Luca, Cavaleri Francesco, Catanese Giuseppina, Citarrella Roberto, Di Bella Giovanna, Di Franco Giuseppina, Di Prazza Agnese, Dominguez Ligia Juliana, Giannitrapani Lydia, Grasso Giulia, Immordino Federico, Licata Anna, La Carruba Anna, Mansueto Pasquale, Mirarchi Luigi, Morgante Maria Chiara, Parinello Alessandra, Pecoraro Emanuela, Peralta Marco, Polizzotto Carla, Pollicino Francesco, Quartetti Federico, Randazzo Giusi, Rizzo Angelo, Rizzo Giuseppina, Sanfilippo Valeria, Soresi Maurizio, Malerba Valentina, Vernuccio Laura, Veronese Nicola, Zerbo Maddalena.

Conflict of interest

The Authors declare that there is no conflict of interest.



Data Availability

The datasets analysed during the current study are available from the corresponding author on reasonable request.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. The study was approved by the Local Ethical Committee during the session of the 28th of April 2021 (protocol number 04/2021).

Consent to participate

Informed consent was obtained from all individual participants included in the study.


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