Data from the first wave of Covid-19 from the Central Military Hospital, Prague, Czech Republic
Authors:
Z. Bartovská 1; F. Andrle 2; O. Beran 1; M. Zlámal 1; D. Řezáč 1; I. Murinova 3,4; M. Holub 1
Authors‘ workplace:
Klinika infekčních nemocí, 1. lékařská fakulta Univerzity Karlovy a Ústřední vojenská nemocnice – Vojenská fakultní nemocnice Praha
1; Interní klinika, 1. lékařská fakulta Univerzity Karlovy a Ústřední vojenská nemocnice – Vojenská fakultní nemocnice Praha
2; Oddělení klinické farmacie, Ústřední vojenská nemocnice – Vojenská fakultní nemocnice Praha
3; Ústav aplikované farmacie, Farmaceutická fakulta, Veterinární a farmaceutická univerzita Brno
4
Published in:
Epidemiol. Mikrobiol. Imunol. 69, 2020, č. 4, s. 164-171
Category:
Original Papers
Overview
Aims: To process data from the first wave of Covid-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) collected in the Infectious Diseases Clinic (IDC) of the First Faculty of Medicine and Central Military Hospital, Prague. To analyse some clinical, diagnostic and therapeutic aspects of Covid-19 in the context of the Czech Republic and to compare them with the data from the most recent literature.
Patients and methods: This retrospective study analysed data on patients admitted to the IDC between 12 March 2020 and 5 May 2020. The study cohort included 53 patients with Covid-19, 25 females and 28 males, with an average age of 57 years. The parameters analysed were clinical symptoms, average length of hospital stay, complications, and death. Additional data concerned the age, weight, smoking habits, history of comorbidities, and selected laboratory results. These data were compared between groups of patients differing in severity of the course of Covid-19. Finally, imaging findings, serology results, and therapy outcomes were studied. Statistical analysis was performed using the SigmaStat software.
Results: Eleven (20.8%) patients had a mild course of the disease, 16 (30.2%) patients had a moderate course, 22 (41.5%) patients had a severe course, and four (7.5%) patients had a critical course. The study patients presented with the following clinical symptoms: fever in 88.5% of cases, cough in 84.6% of cases, difficulty breathing in 77.4% of cases, diarrhoea in 23.1% of cases, chest pain in 17.3% of cases, and anosmia in 11.5% of cases. The average length of hospital stay was eight days. The most common complication was a bacterial superinfection, reported in 17 (32.1%) study patients. The overall case fatality rate for Covid-19 in our study was 5.7%.
The average age of the study cohort was 57 years, and patients with a severe course of the disease were of older average age than those with a less severe course of the disease (p < 0.05). The predominant comorbidities were hypertension and diabetes mellitus. The analysis of the baseline laboratory data showed significant differences between the groups of patients differing in severity of the course of Covid-19 in CRP, procalcitonin, and d-dimers but not in lymphocyte count. High resolution computed tomography (HRCT) scan of the lungs was performed in 22 patients, and 21 of them had typical findings for Covid-19. The average MuLBSTA score for Covid-19 pneumonia severity in our study cohort was 11.5 points and was not associated with the severity of the course of the disease. Serology tests were performed in 43 study patients, with 29 (67.4%) of them turning out positive in the first test and other five (11.6%) testing positive when retested.
Hydroxychloroquine (HCQ) was given experimentally as monotherapy or in combination with azithromycin (AZI) to 24 (45.3%) patients. Two patients on HCQ therapy also received inosinum pranobexum (isoprinosine) for severe lymphopenia, one patient received convalescent plasma, six patients were given AZI alone, and one patient was treated with inosinum pranobexum alone. Altogether 37.7% of study patients were prescribed other antibiotics for confirmed or suspected bacterial superinfection. Standard clinical and pharmaceutical care was provided to patients with particular focus on the safety of off-label drug use. HCQ was with drawn in three patients due to a prolonged corrected QT interval (QTc).
Conclusions: In the first wave of the SARS-CoV-2 epidemic, our study patients showed comorbidities and risk factors which are consistent with the international literature, but the course of the disease was mostly moderate to severe, with a low proportion of critically ill patients and fatal outcomes. As soon as new information became available, new diagnostic and therapeutic options were introduced into routine practice. Based on our experience, we are well prepared for a possible second wave of SARS-CoV-2 in terms of the diagnostics, but the therapeutic options still remain very limited.
Keywords:
COVID-19 – severe acute respiratory syndrome coronavirus 2 – hydroxychloroquine – plasma – inosine pranobex
Sources
1. COVID-19 situation update worldwide, as of 31 May 2020 [online]. 2020 [cit. 2020-05-31]. Dostupné na www: https://www.ecdc.europa.eu/en/geographical-distribution-2019-ncov-cases.
2. COVID19: Přehled aktuální situace v ČR [online]. 2020 [cit. 2020-05-31] Dostupné na www: https://onemocneni-aktualne.mzcr.cz/covid-19.
3. Hamiel U, Kozer E, Youngster I. SARS-CoV-2 Rates in BG-Vaccinated and Unvaccinated Young Adults. JAMA [online]. 2020;323(22) [cit. 2020-06-15]. DOI: 10.1001/jama.2020.8189. ISSN 0098-7484. Dostupné na www: https://jamanetwork.com/journals/jama/fullarticle/2766182.
4. Riphagen S, Gomez X, Gonzalez-Martinez C, et al. Hyperinflammatory shock in children during COVID-19 pandemic. The Lancet [online], 2020; 395(10237):1607–1608 [cit. 2020-06-15]. DOI: 10.1016/S0140-6736(20)31094-1. ISSN 01406736. Dostupné na www: https://linkinghub.elsevier.com/retrieve/pii/S0140673620310941.
5. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China. JAMA [online, 2020; 323(13) [cit. 2020-06-15]. DOI: 10.1001/jama.2020.2648. ISSN 0098-7484. Dostupné na www: https://jamanetwork.com/journals/jama/fullarticle/2762130.
6. COVID-19 surveillance report [online]. 2020 [cit. 2020-06-15]. Dostupné na www: https://covid19-surveillance-report.ecdc.europa.eu/
7. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet [online], 2020; 395(10229):1054–1062 [cit. 2020-06-15]. DOI: 10.1016/S0140-6736(20)30566-3. ISSN 01406736. Dostupné na www: https://linkinghub.elsevier.com/retrieve/pii/S0140673620305663.
8. Simpson S, Kay FU, Abbara S, et al. Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA. Journal of Thoracic Imaging [online], 2020;Publish Ahead of Print [cit. 2020-06-15]. DOI: 10.1097/RTI.0000000000000524. ISSN 0883-5993. Dostupné na www: https://journals.lww.com/10.1097/RTI.0000000000000524.
9. Sanders JM, Monogue ML, Jodlowski TZ et al. Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19). JAMA [online]. [cit. 2020-06-15]. DOI: 10.1001/jama.2020.6019. ISSN 0098-7484. Dostupné z: https://jamanetwork.com/journals/jama/fullarticle/2764727
10. Guo L, Wei D, Zhang X, et al. Clinical Features Predicting Mortality Risk in Patients With Viral Pneumonia: The MuLBSTA Score. Frontiers in Microbiology [online], 2019; 10 [cit. 2020-06-15]. DOI: 10.3389/fmicb.2019.02752. ISSN 1664-302X. Dostupné na www: https://www.frontiersin.org/article/10.3389/fmicb.2019.02752/full.
11. Kümpel P, Holub M, Roháčová H, Plíšek S. Doporučený postup SIL ČLS JEP léčby pacientů s prokázanou infekcí COVID-19. [online] 2020-04-11 [cit. 2020-06-15]. Dostupné na www: https://www.infekce.cz/zprava20-47.htm.
12. Gregorová J, Rychlíčková J, Šaloun J. Standardization of clinical pharmacist’s activities: Methodology. Saudi Pharmaceutical Journal [online]. 2017; 25(6):927–933 [cit. 2020-06-15]. DOI: 10.1016/j.jsps.2017.02.005. ISSN 13190164. Dostupné na www: https://linkinghub.elsevier.com/retrieve/pii/S1319016417300269.
13. Gregorová J, Murínová I, Linhartová A. Management prodloužení intervalu QTc u pacientů s farmakoterapií COVID-19 [online], 2020 [cit. 2020-06-15]. Dostupné na www: https://www.coskf.cz/media/files/covid-19-coskf-qtc-v_1_02042020.pdf.
14. IFCC Information Guide on COVID-19 [online]. 2020 [cit. 2020-06-15]. Dostupné na www: https://www.ifcc.org/ifcc-news/2020-03-26-ifcc-information-guide-on-covid-19/.
15. Gautret P, Lagier JC, Parola P, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. International Journal of Antimicrobial Agents [online]. 2020 [cit. 2020-06-15]. DOI: 10.1016/j.ijantimicag.2020.105949. ISSN 09248579. Dostupné na www: https://linkinghub.elsevier.com/retrieve/pii/S0924857920300996.
16. Rosenberg ES, Dufort EM, Udo T, et al. Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State. JAMA [online]. [cit. 2020-06-15]. DOI: 10.1001/jama.2020.8630. ISSN 0098-7484. Dostupné na www: https://jamanetwork.com/journals/jama/fullarticle/2766117.
17. Duan K, Liu B, Li C, et al. Effectiveness of convalescent plasma therapy in severe COVID-19 patients. Proceedings of the National Academy of Sciences [online], 2020; 117(17):9490–9496 [cit. 2020-06-15]. DOI: 10.1073/pnas.2004168117. ISSN 0027-8424. Dostupné na www: http://www.pnas.org/lookup/doi/10.1073/pnas.2004168117.
18. Cunningham AC, Goh HP, Koh D. Treatment of COVID-19: old tricks for new challenges. Critical Care [online], 2020;24(1) [cit. 2020-06-15]. DOI: 10.1186/s13054-020-2818-6. ISSN 1364-8535. Dostupné na www: https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-2818-6.
19. Doporučený postup pro použití rekonvalescentní plazmy v léčbě dospělých pacientů s covid-19 [online]. 2020-04-30 [cit. 2020-06-15]. Dostupné na www: https://www.infekce.cz/Covid2019/DPtrf-covid050520.pdf.
Labels
Hygiene and epidemiology Medical virology Clinical microbiologyArticle was published in
Epidemiology, Microbiology, Immunology
2020 Issue 4
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