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Clinical Characteristics and Outcomes of COVID-19 in Patients Hospitalized at the University Hospital for Infectious Diseases „Dr. Fran Mihaljević“, Zagreb, Croatia, During the First Wave of the Epidemic

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in December 2019 in China, and spread across the world by the beginning of 2020, causing the World Health Organization to declare a pandemic in March 2020. The first documented case in Croatia was recorded on February 25th, 2020 with over 373 330 people infected so far. The goal of this paper was to describe the clinical characteristics and outcomes of COVID-19 in patients hospitalized at the University Hospital for Infectious Diseases „Dr. Fran Mihaljevic“, Zagreb, Croatia during the first wave of the epidemic. A retrospective study was conducted on the cohort of patients hospitalized at our Hospital with documented COVID-19, confirmed with a positive RT- PCR test for SARS- CoV-2. All hospitalized patients during the first wave of the epidemic, between February 25 and June 18, were included in the study. The demographic, epidemiologic and clinical data were obtained from the patients' medical charts. During the study period, a total of 175 patients with COVID-19 were hospitalized. All patients were over 18 years of age, with a median age of 59 (range 22–99) years of whom 110 (62.9%) were male. Regarding disease severity, 24 (13.7%) had a mild form, 33 (18.9%) moderate form, 54 (30.9%) severe form and 63 (36.0%) critical form of the disease. A total of 110 (62.9%) patients had one or more comorbidities with cardiovascular disease and diabetes as most frequent. Oxygen therapy was used in 104 (59.4%) patients, admission to ICU in 33 (18.9%) patients, 29 (16.6%) patients required mechanical ventilation and 11 (6.3%) renal replacement therapy. We found a significant correlation between patients’ fatal outcome and vital parameters at admission, such as higher respiratory frequency (p=0.026), MEWS (Modified Early Warning Score) (p<0.001), as well as lower oxygen saturation (p=0.001). Furthermore, we identified a significant correlation between patients’ fatal outcome and several laboratory findings at patients’ admission, such as higher leukocyte counts (p=0.004) and percentage of lymphocytes in the peripheral blood (p=0.040), as well as higher levels of serum ALT (p=0.001), creatinine (p=0.027), CK (p=0.006), troponin (p=0.003), LDH (p<0.001) and CRP (p<0.001) were correlated with poor outcomes. Chest X-ray imaging showed interstitial pneumonia in 122 (69.7%) patients, pulmonary consolidation in 8 (4.6%), pleural effusion in 13 (7.4%) and no pulmonary changes in 35 (20.0%) patients. Regarding treatment, 59 (22.3%) patients received hydroxychloroquine, 11 (6.3%) glucocorticoids, 12 (6.9%) lopinavir/ritonavir and 8 (4.6%) azithromycin. Overall, 21 (12.0%) of the hospitalized patients died. COVID-19 has become a major respiratory threat during 2020 with a case fatality ratio of 12% among hospitalized patients with confirmed SARS- CoV-2 infection. Poor outcome is associated with several clinical and laboratory parameters. Further investigation is needed to clarify the pathogenesis, outcomes and treatment options for COVID-19 in the future.

COVID-19 ; SARS-CoV-2 ; clinical characteristics ; outcome ; treatment

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