Original scientific paper
CLINICAL CHARACTERISTICS AND OUTCOMES OF COVID-19 IN PATIENTS HOSPITALIZED AT THE UNIVERSITY HOSPITAL FOR INFECTIOUS DISEASES „DR. FRAN MIHALJEVIĆ“, ZAGREB, DURING THE FIRST WAVE OF THE EPIDEMIC
EVA SMILJANIĆ
; Dom zdravlja Zagrebačke županije, Ljudevita Gaja 37, Samobor, Hrvatska
IVAN KREŠIMIR LIZATOVIĆ
; Zagreb County Health Centre, Ljudevita Gaja 37, Samobor, Croatia
MARTA PEROVIĆ MIHANOVIĆ
; University Hospital for Infectious Diseases „Dr. Fran Mihaljević“, Zagreb, Croatia
EVA HULJEV
; University Hospital for Infectious Diseases „Dr. Fran Mihaljević“, Zagreb, Croatia
NINOSLAVA VICKOVIĆ
; University Hospital for Infectious Diseases „Dr. Fran Mihaljević“, Zagreb, Croatia
VANJA ROMIH PINTAR
; University Hospital for Infectious Diseases „Dr. Fran Mihaljević“, Zagreb, Croatia
ANTONIA ČIVLJAK
; Dr. Ljiljana Lipovac-Francuz, Family Medicine Clinic, Zagreb, Croatia
ANDREA RACETIN
; University of Zagreb School of Medicine, Zagreb, Croatia
KRISTIAN BODULIĆ
; University Hospital for Infectious Diseases „Dr. Fran Mihaljević“, Zagreb, Croatia
IVAN-CHRISTIAN KUROLT
; University Hospital for Infectious Diseases „Dr. Fran Mihaljević“, Zagreb, Croatia
ALEMKA MARKOTIĆ
; University Hospital for Infectious Diseases „Dr. Fran Mihaljević“; Catholic University of Croatia, Zagreb, Croatia
ROK ČIVLJAK
; University Hospital for Infectious Diseases „Dr. Fran Mihaljević“; University of Zagreb School of Medicine, Zagreb, Croatia
Abstract
Aim: The aim of this study was to examine the clinical characteristics and patient outcomes of patients hospitalized for COVID-19 in the University Hospital for Infectious Diseases „Dr. Fran Mihaljevic“ (UHID) in Zagreb during the fi rst wave of the epidemic. Methods: A retrospective analysis was conducted using medical records of a cohort of patients hospitalized due to COVID-19 in the UHID in which infection with the SARS-CoV-2 virus was etiologically confi rmed by a positive result of the RT-PCR test. Included were all the patients hospitalized during the fi rst wave of the epidemic, between February 25th and June 18th, 2020. Results: During the study period, 175 patients with COVID-19 were hospitalized in the UHID of which 110 (62.9%) were men. All patients were over 18 years old (median age 59, range 22–99 years). A total of 110 (62.9%) patients had one or more comorbidities, the most common of which were cardiovascular disease including hypertension (49.1%), diabetes (16.6%) and COPD/asthma (6.9%). The most common symptoms of the disease were: fever (89.7%), cough (73.7%), dyspnoea (45.7%), diarrhoea (45.3%) and fatigue (33.1%). Of the total number of patients, 24 (13.7%) had a mild disease, 54 (30.9%) moderate, 64 (36.6%) severe and 33 (18.9%) critical. 104 (59.4%) patients required oxygen therapy, while 33 (18.9%) patients required ICU care. 29 (16.6%) patients required mechanical ventilationand 11 (6.3%) patients required haemodialysis. Among patients hospitalized due to COVID-19, the higher chance of fatal outcomes had patients aged > 65 years, those with more than one comorbidity or with concurrent cardiovascular diseases, those with peripheral oxygen saturation (SpO2) ≤ 90% on admission, respiratory frequency ≥ 22/min, MEWS score ≥ 3, pathological changes on the chest X-ray, those with longer hospitalization duration and patients in need of oxygen replacement treatment, dialysis or ICU care. 59 (22.3%) patients were treated with hydroxychloroquine, 11 (6.3%) glucocorticoids, 12 (6.9%) lopinavir/ritonavir and 8 (4.6%) azithromycin. 21 (12%) of hospitalized patients died. Discussion: Results show that during the fi rst wave of the COVID-19 epidemic only adult patients were hospitalized in the UHID in Zagreb, more often men, with one or more comorbidities, often with mild disease, without respiratory insuffi ciency and need for oxygen treatment. The bivariate analysis found differences in clinical characteristics and laboratory fi ndings between surviving and deceased patients, while signifi cant predictors of fatal outcome proved to be age > 65 years, presence of comorbidities (especially cardiovascular diseases), absence of febrility, presence of dyspnoea, disease severity (higher MEWS and respiratory frequency, lower peripheral oxygen saturation on admission and need for oxygen replacement treatment, dialysis and treatment in ICU) and elevated values of leukocytes, lymphocytes, CRP, urea, ALT, creatinine, CK and LDH. Multivariate analysis showed that the set of predictors that most accurately predicts thefatal outcome includes the patient's age, presence of cardiovascular diseases, and values of CRP, urea and AST, since these differed between surviving and deceased patients regardless of the values of other predictors. Conclusion: The COVID-19 disease became a great danger during 2020 with many ill and deceased patients and a fatality rate of 12% among our hospitalized patients. Unfavourable disease outcome was associated with several clinical and laboratory parameters. In the fi rst wave of the epidemic, mainly adult patients with moderate to critical COVID-19 disease were hospitalized, and those with one or more risk factors had worse disease outcomes. In the future, it will be necessary to invest additional efforts in active search and timely recognition of patients with potential risk factors that require timely antiviral and immunomodulating treatment. Ultimately, the COVID-19 disease is a multisystem disease with many unknowns, which we are still getting to know each day.
Keywords
COVID-19; outcomes; clinical characteristics; treatment; SARS-CoV-2
Hrčak ID:
294423
URI
Publication date:
27.2.2023.
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