Viral pathogens associated with acute respiratory illness in hospitalized adults and elderly from Zagreb, Croatia, 2016 to 2018

AIMS: To investigate the viral etiology of acute respiratory infection (ARI) in hospitalized adults and elderly patients in Croatia, compare the prevalence of detected viruses, and to determine clinical characteristics and seasonal occurrence of investigated infections. METHODS: From January 2016 to June 2018, a total of 182 adult patients presented with symptoms of ARI and admitted to the hospital were tested for 15 respiratory viruses by multiplex reverse-transcription polymerase chain reaction. Clinical data were collected by retrospective analysis of the patient\u27s chart. RESULTS: A virus was identified in 106 (58.5%) of the patients. The most commonly detected virus was influenza virus (41.5%), followed by respiratory syncytial virus (13.8%), human metapneumovirus (13.0%), parainfluenza viruses (12.2%), rhinoviruses (11.4%), adenovirus and coronaviruses with equal frequencies (3.3%), and enterovirus (1.6%). The serum level of C-reactive protein and white blood cell count were significantly lower in patients with respiratory viruses identified when compared with those in whom no virus was detected (P \u3c 0.001 and P = 0.007, respectively). There were no differences in clinical symptoms according to the type of the detected virus, except for more frequent illness exposure recall for influenza infection ( P = 0.010). Influenza, parainfluenza, and pneumoviruses were detected mostly in winter months, while rhinoviruses in autumn and spring. CONCLUSIONS: In addition to influenza, pneumoviruses, rhinoviruses, and parainfluenza viruses play an important role in etiology of ARIs in adults. Fast and accurate laboratory diagnosis for respiratory viruses in routine practice is needed for clinicians optimally manage patients with ARI and potentially avoid the unnecessary use of antimicrobial drugs

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

Cilj: Cilj ovog rada bio je ispitati klinička obilježja i ishode u bolesnika hospitaliziranih zbog bolesti COVID-19 u Klinici za infektivne bolesti „Dr. Fran Mihaljević“ (KZIB) u Zagrebu tijekom prvog vala epidemije. Metode: Provedena je retrospektivna analiza medicinske dokumentacije kohorte bolesnika hospitaliziranih u KZIB zbog COVID-19 u kojih je infekcija virusom SARS-CoV-2 bila etiološki potvrđena pozitivnim nalazom RT-PCR testa. U istraživanje su uključeni svi bolesnici hospitalizirani tijekom prvog vala epidemije, između 25. veljače i 18. lipnja 2020. godine. Rezultati: Tijekom promatranog razdoblja, u KZIB je zbog COVID-19 bilo hospitalizirano ukupno 175 bolesnika, od čega 110 (62,9 %) muškaraca. Svi su bolesnici bili stariji od 18 godina (medijan 59 godina, raspon dobi 22–99 godina). Ukupno 110 (62,9 %) bolesnika imalo je jedan ili više komorbiditeta od kojih su najčešći bili kardiovaskularna bolest, uključujući hipertenziju (49,1 %), dijabetes (16,6 %) i KOPB/astma (6,9 %). Najčešći simptomi bolesti bili su: febrilitet (89,7 %), kašalj (73,7 %), dispneja (45,7 %), proljev (45,3 %) i malaksalost (33,1 %). Blagi oblik bolesti imalo je 24 (13,7 %) bolesnika, srednje teški oblik 54 (30,9 %), teški oblik 64 (36,6 %), a kritični oblik 33 (18,9 %) bolesnika. Potrebu za liječenje kisikom imalo je 104 (59,4 %) bolesnika, a za liječenjem u jedinici intenzivnog liječenja (JIL) 33 (18,9 %) bolesnika. Mehanički je ventilirano 29 (16,6 %) dok je 11 (6,3 %) bolesnika zahtijevalo liječenje hemodijalizom. Među bolesnicima hospitaliziranima zbog COVID-19 veći izgled smrtnog ishoda imali su bolesnici u dobi > 65 godina, oni s više od jednog komorbiditeta ili s istovremenim kardiovaskularnim bolestima, oni koji su pri prijmu imali perifernu saturaciju kisikom (SpO2) ≤ 90 %, respiratornu frekvenciju ≥ 22/min, MEWS zbroj ≥ 3, patološke promjene na rendgenogramu pluća, oni s duljim trajanjem hospitalizacije te bolesnici s potrebom za nadomjesnim liječenjem kisikom, dijalizom ili liječenjem u JIL-u. Terapiju hidroksiklorokinom primilo je 59 (22,3 %) bolesnika, lopinavir/ritonavirom 12 (6,9 %), azitromicinom 8 (4,6 %), a glukokortikoidima svega 11 (6,3 %) bolesnika. Preminuo je 21 hospitalizirani bolesnik (12 %). Rasprava: Rezultati našeg istraživanja pokazuju da su tijekom prvog vala epidemije bolesti COVID-19 u KZIB u Zagrebu hospitalizirani isključivo odrasli bolesnici, češće muškarci, s jednim ili više komorbiditeta, nerijetko s blagim oblikom bolesti i bez respiratorne insufi cijencije te potrebe za liječenjem kisikom. Bivarijatnom analizom nađene su razlike u kliničkim obilježjima i laboratorijskim nalazima između preživjelih i umrlih bolesnika, a značajnim prediktorima smrtnog ishoda pokazali su se dob > 65 godina, prisutnost komorbiditeta (osobito kardiovaskularnih bolesti), odsutnost febriliteta, prisutnost dispneje, težina bolesti (viši MEWS i respiratorna frekvencija, niža periferna saturacija kisikom pri prijmu te potreba za nadomjesnim liječenjem kisikom, dijalizom i liječenjem u JIL-u) te povišene vrijednosti leukocita, limfocita, CRP, ureje, ALT, kreatinina, CK i LDH. Multivarijatna analiza pokazala je da skup prediktora koji najtočnije predviđa smrtni ishod bolesnika uključuje dob bolesnika, prisutnost kardiovaskularnih bolesti te vrijednosti CRP-a, ureje i AST-a, budući da su ove vrijednosti bile različite između skupina preživjelih i umrlih bolesnika neovisno o vrijednostima drugih prediktora. Zaključak: Bolest COVID-19 je postala velika opasnost tijekom 2020. godine s velikim brojem oboljelih i umrlih bolesnika uz letalitet od 12 % među našim hospitaliziranim bolesnicima. Nepovoljan ishod bolesti bio je povezan s više kliničkih i laboratorijskih parametara. U prvom valu epidemije zbog COVID-19 bili su hospitalizirani uglavnom odrasli bolesnici sa srednje teškim do kritičnim oblikom bolesti, a lošije ishode bolesti imali su bolesnici s jednim ili više čimbenika rizika. U budućnosti će biti potrebno uložiti dodatne napore u aktivno traženje i pravovremeno prepoznavanje bolesnika s potencijalnim rizičnim čimbenicima koji zahtijevaju pravovremeno antivirusno i imunomodulacijsko liječenje. U konačnici, bolest COVID-19 je multisistemska bolest s još puno nepoznanica, a koju još uvijek svakodnevno upoznajemo.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\u27s 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

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

Cilj: Cilj ovog rada bio je ispitati klinička obilježja i ishode u bolesnika hospitaliziranih zbog bolesti COVID-19 u Klinici za infektivne bolesti „Dr. Fran Mihaljević“ (KZIB) u Zagrebu tijekom prvog vala epidemije. Metode: Provedena je retrospektivna analiza medicinske dokumentacije kohorte bolesnika hospitaliziranih u KZIB zbog COVID-19 u kojih je infekcija virusom SARS-CoV-2 bila etiološki potvrđena pozitivnim nalazom RT-PCR testa. U istraživanje su uključeni svi bolesnici hospitalizirani tijekom prvog vala epidemije, između 25. veljače i 18. lipnja 2020. godine. Rezultati: Tijekom promatranog razdoblja, u KZIB je zbog COVID-19 bilo hospitalizirano ukupno 175 bolesnika, od čega 110 (62,9 %) muškaraca. Svi su bolesnici bili stariji od 18 godina (medijan 59 godina, raspon dobi 22–99 godina). Ukupno 110 (62,9 %) bolesnika imalo je jedan ili više komorbiditeta od kojih su najčešći bili kardiovaskularna bolest, uključujući hipertenziju (49,1 %), dijabetes (16,6 %) i KOPB/astma (6,9 %). Najčešći simptomi bolesti bili su: febrilitet (89,7 %), kašalj (73,7 %), dispneja (45,7 %), proljev (45,3 %) i malaksalost (33,1 %). Blagi oblik bolesti imalo je 24 (13,7 %) bolesnika, srednje teški oblik 54 (30,9 %), teški oblik 64 (36,6 %), a kritični oblik 33 (18,9 %) bolesnika. Potrebu za liječenje kisikom imalo je 104 (59,4 %) bolesnika, a za liječenjem u jedinici intenzivnog liječenja (JIL) 33 (18,9 %) bolesnika. Mehanički je ventilirano 29 (16,6 %) dok je 11 (6,3 %) bolesnika zahtijevalo liječenje hemodijalizom. Među bolesnicima hospitaliziranima zbog COVID-19 veći izgled smrtnog ishoda imali su bolesnici u dobi > 65 godina, oni s više od jednog komorbiditeta ili s istovremenim kardiovaskularnim bolestima, oni koji su pri prijmu imali perifernu saturaciju kisikom (SpO2) ≤ 90 %, respiratornu frekvenciju ≥ 22/min, MEWS zbroj ≥ 3, patološke promjene na rendgenogramu pluća, oni s duljim trajanjem hospitalizacije te bolesnici s potrebom za nadomjesnim liječenjem kisikom, dijalizom ili liječenjem u JIL-u. Terapiju hidroksiklorokinom primilo je 59 (22,3 %) bolesnika, lopinavir/ritonavirom 12 (6,9 %), azitromicinom 8 (4,6 %), a glukokortikoidima svega 11 (6,3 %) bolesnika. Preminuo je 21 hospitalizirani bolesnik (12 %). Rasprava: Rezultati našeg istraživanja pokazuju da su tijekom prvog vala epidemije bolesti COVID-19 u KZIB u Zagrebu hospitalizirani isključivo odrasli bolesnici, češće muškarci, s jednim ili više komorbiditeta, nerijetko s blagim oblikom bolesti i bez respiratorne insufi cijencije te potrebe za liječenjem kisikom. Bivarijatnom analizom nađene su razlike u kliničkim obilježjima i laboratorijskim nalazima između preživjelih i umrlih bolesnika, a značajnim prediktorima smrtnog ishoda pokazali su se dob > 65 godina, prisutnost komorbiditeta (osobito kardiovaskularnih bolesti), odsutnost febriliteta, prisutnost dispneje, težina bolesti (viši MEWS i respiratorna frekvencija, niža periferna saturacija kisikom pri prijmu te potreba za nadomjesnim liječenjem kisikom, dijalizom i liječenjem u JIL-u) te povišene vrijednosti leukocita, limfocita, CRP, ureje, ALT, kreatinina, CK i LDH. Multivarijatna analiza pokazala je da skup prediktora koji najtočnije predviđa smrtni ishod bolesnika uključuje dob bolesnika, prisutnost kardiovaskularnih bolesti te vrijednosti CRP-a, ureje i AST-a, budući da su ove vrijednosti bile različite između skupina preživjelih i umrlih bolesnika neovisno o vrijednostima drugih prediktora. Zaključak: Bolest COVID-19 je postala velika opasnost tijekom 2020. godine s velikim brojem oboljelih i umrlih bolesnika uz letalitet od 12 % među našim hospitaliziranim bolesnicima. Nepovoljan ishod bolesti bio je povezan s više kliničkih i laboratorijskih parametara. U prvom valu epidemije zbog COVID-19 bili su hospitalizirani uglavnom odrasli bolesnici sa srednje teškim do kritičnim oblikom bolesti, a lošije ishode bolesti imali su bolesnici s jednim ili više čimbenika rizika. U budućnosti će biti potrebno uložiti dodatne napore u aktivno traženje i pravovremeno prepoznavanje bolesnika s potencijalnim rizičnim čimbenicima koji zahtijevaju pravovremeno antivirusno i imunomodulacijsko liječenje. U konačnici, bolest COVID-19 je multisistemska bolest s još puno nepoznanica, a koju još uvijek svakodnevno upoznajemo.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

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

Cilj: Cilj ovog rada bio je ispitati klinička obilježja i ishode u bolesnika hospitaliziranih zbog bolesti COVID-19 u Klinici za infektivne bolesti „Dr. Fran Mihaljević“ (KZIB) u Zagrebu tijekom prvog vala epidemije. Metode: Provedena je retrospektivna analiza medicinske dokumentacije kohorte bolesnika hospitaliziranih u KZIB zbog COVID-19 u kojih je infekcija virusom SARS-CoV-2 bila etiološki potvrđena pozitivnim nalazom RT-PCR testa. U istraživanje su uključeni svi bolesnici hospitalizirani tijekom prvog vala epidemije, između 25. veljače i 18. lipnja 2020. godine. Rezultati: Tijekom promatranog razdoblja, u KZIB je zbog COVID-19 bilo hospitalizirano ukupno 175 bolesnika, od čega 110 (62,9 %) muškaraca. Svi su bolesnici bili stariji od 18 godina (medijan 59 godina, raspon dobi 22–99 godina). Ukupno 110 (62,9 %) bolesnika imalo je jedan ili više komorbiditeta od kojih su najčešći bili kardiovaskularna bolest, uključujući hipertenziju (49,1 %), dijabetes (16,6 %) i KOPB/astma (6,9 %). Najčešći simptomi bolesti bili su: febrilitet (89,7 %), kašalj (73,7 %), dispneja (45,7 %), proljev (45,3 %) i malaksalost (33,1 %). Blagi oblik bolesti imalo je 24 (13,7 %) bolesnika, srednje teški oblik 54 (30,9 %), teški oblik 64 (36,6 %), a kritični oblik 33 (18,9 %) bolesnika. Potrebu za liječenje kisikom imalo je 104 (59,4 %) bolesnika, a za liječenjem u jedinici intenzivnog liječenja (JIL) 33 (18,9 %) bolesnika. Mehanički je ventilirano 29 (16,6 %) dok je 11 (6,3 %) bolesnika zahtijevalo liječenje hemodijalizom. Među bolesnicima hospitaliziranima zbog COVID-19 veći izgled smrtnog ishoda imali su bolesnici u dobi > 65 godina, oni s više od jednog komorbiditeta ili s istovremenim kardiovaskularnim bolestima, oni koji su pri prijmu imali perifernu saturaciju kisikom (SpO2) ≤ 90 %, respiratornu frekvenciju ≥ 22/min, MEWS zbroj ≥ 3, patološke promjene na rendgenogramu pluća, oni s duljim trajanjem hospitalizacije te bolesnici s potrebom za nadomjesnim liječenjem kisikom, dijalizom ili liječenjem u JIL-u. Terapiju hidroksiklorokinom primilo je 59 (22,3 %) bolesnika, lopinavir/ritonavirom 12 (6,9 %), azitromicinom 8 (4,6 %), a glukokortikoidima svega 11 (6,3 %) bolesnika. Preminuo je 21 hospitalizirani bolesnik (12 %). Rasprava: Rezultati našeg istraživanja pokazuju da su tijekom prvog vala epidemije bolesti COVID-19 u KZIB u Zagrebu hospitalizirani isključivo odrasli bolesnici, češće muškarci, s jednim ili više komorbiditeta, nerijetko s blagim oblikom bolesti i bez respiratorne insufi cijencije te potrebe za liječenjem kisikom. Bivarijatnom analizom nađene su razlike u kliničkim obilježjima i laboratorijskim nalazima između preživjelih i umrlih bolesnika, a značajnim prediktorima smrtnog ishoda pokazali su se dob > 65 godina, prisutnost komorbiditeta (osobito kardiovaskularnih bolesti), odsutnost febriliteta, prisutnost dispneje, težina bolesti (viši MEWS i respiratorna frekvencija, niža periferna saturacija kisikom pri prijmu te potreba za nadomjesnim liječenjem kisikom, dijalizom i liječenjem u JIL-u) te povišene vrijednosti leukocita, limfocita, CRP, ureje, ALT, kreatinina, CK i LDH. Multivarijatna analiza pokazala je da skup prediktora koji najtočnije predviđa smrtni ishod bolesnika uključuje dob bolesnika, prisutnost kardiovaskularnih bolesti te vrijednosti CRP-a, ureje i AST-a, budući da su ove vrijednosti bile različite između skupina preživjelih i umrlih bolesnika neovisno o vrijednostima drugih prediktora. Zaključak: Bolest COVID-19 je postala velika opasnost tijekom 2020. godine s velikim brojem oboljelih i umrlih bolesnika uz letalitet od 12 % među našim hospitaliziranim bolesnicima. Nepovoljan ishod bolesti bio je povezan s više kliničkih i laboratorijskih parametara. U prvom valu epidemije zbog COVID-19 bili su hospitalizirani uglavnom odrasli bolesnici sa srednje teškim do kritičnim oblikom bolesti, a lošije ishode bolesti imali su bolesnici s jednim ili više čimbenika rizika. U budućnosti će biti potrebno uložiti dodatne napore u aktivno traženje i pravovremeno prepoznavanje bolesnika s potencijalnim rizičnim čimbenicima koji zahtijevaju pravovremeno antivirusno i imunomodulacijsko liječenje. U konačnici, bolest COVID-19 je multisistemska bolest s još puno nepoznanica, a koju još uvijek svakodnevno upoznajemo.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

Differences in Immunoglobulin G Glycosylation Between Influenza and COVID-19 Patients

The essential role of immunoglobulin G (IgG) in immune system regulation and combatting infectious diseases cannot be fully recognized without an understanding of the changes in its N-glycans attached to the asparagine 297 of the Fc domain that occur under such circumstances. These glycans impact the antibody stability, half-life, secretion, immunogenicity, and effector functions. Therefore, in this study, we analyzed and compared the total IgG glycome—at the level of individual glycan structures and derived glycosylation traits (sialylation, galactosylation, fucosylation, and bisecting N-acetylglucosamine (GlcNAc))—of 64 patients with influenza, 77 patients with coronavirus disease 2019 (COVID- 19), and 56 healthy controls. Our study revealed a significant decrease in IgG galactosylation, sialylation, and bisecting GlcNAc (where the latter shows the most significant decrease) in deceased COVID-19 patients, whereas IgG fucosylation was increased. On the other hand, IgG galactosylation remained stable in influenza patients and COVID-19 survivors. IgG glycosylation in influenza patients was more time-dependent: In the first seven days of the disease, sialylation increased and fucosylation and bisecting GlcNAc decreased ; in the next 21 days, sialylation decreased and fucosylation increased (while bisecting GlcNAc remained stable). The similarity of IgG glycosylation changes in COVID-19 survivors and influenza patients may be the consequence of an adequate immune response to enveloped viruses, while the observed changes in deceased COVID-19 patients may indicate its deviation

Vaccine hesitancy and refusal among parents: An international ID-IRI survey

Introduction: Although vaccines are the safest and most effective means to prevent and control infectious diseases, the increasing rate of vaccine hesitancy and refusal (VHR) has become a worldwide concern. We aimed to find opinions of parents on vaccinating their children and contribute to available literature in order to support the fight against vaccine refusal by investigating the reasons for VHR on a global scale. Methodology: In this international cross-sectional multicenter study conducted by the Infectious Diseases International Research Initiative (ID-IRI), a questionnaire consisting of 20 questions was used to determine parents' attitudes towards vaccination of their children. Results: Four thousand and twenty-nine (4,029) parents were included in the study and 2,863 (78.1%) were females. The overall VHR rate of the parents was found to be 13.7%. Nineteen-point three percent (19.3%) of the parents did not fully comply with the vaccination programs. The VHR rate was higher in high-income (HI) countries. Our study has shown that parents with disabled children and immunocompromised children, with low education levels, and those who use social media networks as sources of information for childhood immunizations had higher VHR rates (p < 0.05 for all). Conclusions: Seemingly all factors leading to VHR are related to training of the community and the sources of training. Thus, it is necessary to develop strategies at a global level and provide reliable knowledge to combat VHR