Impact of COVID-19 vaccine on clinical characteristics and outcome of hospitalized COVID-19 patients during the fourth wave of the pandemic in Tuzla Canton, Bosnia and Herzegovina
Aim To evaluate clinical and epidemiological characteristics and outcome of patients with COVID-19, and impact of vaccine against COVID-19 on them. Methods This retrospective study included 225 patients treated from COVID-19 in the period from 1 to 30 September 2021 at the Clinic for Infectious Diseases, University Clinical Centre Tuzla (UCC Tuzla). For the diagnosis confirmation of Covid-19, RTPCR was used. Patients were divided in two groups: fully vaccinated with two doses of vaccine, and non-vaccinated or partially vaccinated. Results Of 225 patients, 120 (53.3%) were females, and 105 (46.7%) males. Mean age was 65.6 years. There were 26 (11.6%) fully vaccinated patients. Most common symptoms in unvaccinated patients were fatigue (70.9%), cough (70.4%) and fever (69.8%), and in vaccinated fever (76.9%), fatigue (69.2%) and cough (46.2%). Cough was more common in unvaccinated patients (p=0.013). Fatal outcome happened in 84 (37.3%) patients. Transfer to the Intensive Care Unit (ICU) and older age had a higher risk of death (p<0.001). Older age patients were more likely to have comorbidities like atrial fibrillation (p=0.017), hypertension (p<001) and diabetes mellitus (p=0.002). Atrial fibrillation (p<0.001), hypertension (p<0.001), diabetes mellitus (p=0.009) and history of stroke (p=0.026), were related to fatal outcome in unvaccinated patients, also did a shorter duration of illness prior to hospitalization (p<0.001) and shorter length of hospitalization (p=0.002). Conclusion Older patients with comorbidities, as well as those who were not vaccinated against COVID-19, were at higher risk for severe form of the disease and poor outcome.
Boston M, Center. Guidelines for hospital admission from the emergency department for patients with presumed or confirmed COVID 2AD:19.
3
Polack F, Thomas S, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. mRNA Covid-19 Vaccine. N Engl J Med 2020;(2):2603–15.
4
Baden L, Sahly E, Essink H, Kotloff B, Frey K, Novak S, et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 Vaccine. N Engl J Med 2021:403–16.
5
Sadoff J, Gray G, Vandebosch A, Cárdenas V, Shukarev G, Grinsztejn B, et al. Safety and efficacy of single-dose Ad26.COV2. S vaccine against Covid-19. N Engl J Med 2021:2187–201.
6
Tenforde M, Self W, Adams K, Gaglani M, Ginde A, Mcneal T, et al. Influenza and other viruses in the acutely Ill (IVY) Network. Association between mRNA vaccination and COVID-19 hospitalization and disease severity. JAMA 2021:2043–54.
7
Pritchard M. COVID-19 symptoms at hospital admission vary with age and sex: ISARIC multinational study 2020.
8
Epaulard O, Abgrall S, Lefebvre M, Faucher J-F, Michon J, Frentiu E, et al. Pierre Casez, Aba Mahamat, Guillaume Béraud the Groupe Vaccination-Prévention, Société de Pathologie Infectieuse de Langue Française. Symptoms and severity in vaccinated and unvaccinated patients hospitalized with SARS-CoV-2 delta (B.1.617.2) variant infection 9AD. doi: 10.1101/2022020822270506v1fullpdf.
9
Yavuz S, Tunçer G, Altuntaş-Aydın Ö, Aydın M, Pehlivanoğlu F, Tok Y, et al. Comparison of the clinical and laboratory findings and outcomes of hospitalized COVID-19 patients who were either fully vaccinated with CoronaVac or not: An analytical, cross-sectional study. Vaccines (Basel) 2022:733.
10
Pérez M, F, Del Pino L, J, García J, N, et al. Comorbidity and prognostic factors on admission in a COVID-19 cohort of a general hospital. Rev Clin Esp (Barc) n.d.:529–35.
11
Cascella M, Rajnik M, Aleem A, Dulebohn S, Napoli D, R. Treasure Island (FL): StatPearls Publishing; 2021. StatPearls 2021.
12
Klok F, Kruip M, Van Der Meer N, Arbous M, Gommers D, Kant K, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020:145–7.
13
Bilaloglu S, Aphinyanaphongs Y, Jones S, Iturrate E, Hochman J, Berger J. Thrombosis in hospitalized patients with COVID-19 in a New York City health system. JAMA 2020:799–801.
14
Alwafi H, Naser A, Qanash S, Brinji A, Ghazawi M, Alotaibi B, et al. Predictors of length of hospital stay, mortality, and outcomes among hospitalised COVID-19 patients in Saudi Arabia: A cross-sectional study. J Multidiscip Healthc 2021:839–52.
15
Li J, Chen Z, Nie Y, Ma Y, Guo Q, Dai X. Identification of Symptoms Prognostic of COVID-19 Severity: Multivariate data analysis of a case series n.d.
16
The World Factbook. Bosnia and Herzegovina 31AD.
17
Sarfaraz S, Shaikh Q, Saleem S, Rahim A, Herekar F, Junejo S, et al. Determinants of in-hospital mortality in COVID-19; a prospective cohort study from Pakistan. PLoS One 2021:251754.
18
Cummings M, Baldwin M, Abrams D, Jacobson S, Meyer B, Balough E, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet 2020:1763–70.
19
Botta M, Tsonas A, Pillay J, Boers L, Algera A, Bos L, et al. PRo-VENT-COVID Collaborative Group. Ventilation management and clinical outcomes in invasively ventilated patients with COVID-19 (PRoVENT-COVID): a national, multicentre, observational cohort study. Lancet Respir Med 2021:139–48.
20
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 Novel Coronavirus-infected pneumonia in Wuhan. JAMA 2020:1061–9.
21
Lu J, Hu S, Fan R, Liu Z, Yin X, Wang Q, et al. ACP risk grade: a simple mortality index for patients with confirmed or suspected severe acute respiratory syndrome coronavirus 2 disease (COVID-19) during the early stage of outbreak in Wuhan 2002551. doi: 10.1101/2020022020025510v1.
22
Xie J, Hungerford D, Chen H, Abrams S, Li S, Wang G, et al. Development and external validation of a prognostic multivariable model on admission for hospitalized patients with 30AD. doi: 10.1101/2020032820045997v2.
23
Brosh-Nissimov T, Orenbuch-Harroch E, Chowers M, Elbaz M, Nesher L, Stein M, et al. vaccine breakthrough: clinical characteristics of 152 fully vaccinated hospitalized COVID-19 patients in Israel. Clin Microbiol Infect 2021;(2):1652–7.
24
Roth G, Emmons-Bell S, Alger H, Bradley S, Das S, De Lemos J, et al. Trends in patient characteristics and COVID-19 in-hospital mortality in the United States during the COVID-19 pandemic. JAMA Netw Open 2021:218828.
25
Guillon A, Laurent E, Godillon L, Kimmoun A. Grammatico-Guillon L. In-hospital mortality rates of critically ill COVID-19 patients in France: a nationwide cross-sectional study of 45 409 ICU patients. Br J Anaesth 2021:180-e182.
26
Sarfaraz S, Shaikh Q, Saleem S, Rahim A, Herekar F, Junejo S, et al. Determinants of in-hospital mortality in COVID-19; a prospective cohort study from Pakistan. PLoS One 2021:251754.
27
Underlying medical conditions associated with high risk for severe COVID-19: Information for healthcare providers 8AD.
28
Evidence used to update the list of underlying medical conditions that increase a person’s risk of severe illness from COVID 8AD:19.
29
Aggarwal G, Lippi G, Henry M, B. Cerebrovascular disease is associated with an increased disease severity in patients with coronavirus disease 2019 (COVID-19): a pooled analysis of published literature. Int J Stroke 2020:385–9.
30
Dagan N, Barda N, Kepten E, Miron O, Perchik S, Katz M, et al. mRNA Covid-19 vaccine in a nationwide mass vaccination setting. N Engl J Med 2021;(2):1412–23.
31
WHO Director-General’s opening remarks at the media briefing on COVID-19 -21 n.d.
32
WHO Director-General’s opening remarks at the media briefing on COVID-19 -11 2020.
33
Li X, Zai J, Wang X, Li Y. Potential of large “first generation” human-to-human transmission of 2019-nCoV. J Med Virol 2020:448–54.
34
Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020:1708–20.
35
Livingston E, Bucher K. Coronavirus disease 2019 (COVID-19) in Italy. JAMA 2020:1335.
36
Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol 2020:531–8.
37
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020:1054–62.
38
Gruszecka J, Filip. Preliminary information on prevention of infections caused by SARS-COV-2 virus in endoscopic laboratories. Ann Agric Environ Med 2020:171–4.
39
Sun H, Ning R, Tao Y, Yu C, Deng X, Zhao C, et al. Risk factors for mortality in 244 older adults with COVID-19 in Wuhan, China: a retrospective study. J Am Geriatr Soc 2020:19–23.
40
Garg S, Kim L, Whitaker M, ’halloran O, Cummings A, Holstein C, et al. Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019 -COVID-NET, 14 states. MMWR Morb Mortal Wkly Rep n.d.:458–64.
41
Bernheim A, Mei X, Huang M, Yang Y, Fayad Z, Zhang N, et al. Chest CT findings in coronavirus disease-19 (COVID-19): Relationship to duration of infection. Radiology 2020.
42
Wang Y, Kang H, Liu X, Tong Z. Combination of RT-qPCR testing and clinical features for diagnosis of COVID-19 facilitates management of SARS-CoV-2 outbreak. J Med Virol 2020:538–9.
43
Statista. Number of coronavirus (COVID-19) cases worldwide as of December 16 2021.
44
Puca E, Čivljak R, Arapović J, Popescu C, Christova I, Raka L, et al. Short epidemiological overview of the current situation on COVID-19 pandemic in Southeast European (SEE) countries. J Infect Dev Ctries 2020:433–7.
45
Trnacevic A, Mujkanovic A, Al-Salloum N, Sakusic A, Trnacevic E, Jusufovic E, et al. COVID-19 in Northeast Bosnia and Herzegovina and patient’s length of hospitalization. BMC Infect Dis 2021:367.
46
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan. Lancet 2020:497–506.
47
Li Y, Chi W, Su J, Ferrall L, Hung C, Wu T. Coronavirus vaccine development: from SARS and MERS to COVID-19. J Biomed Sci 2020:104.
48
Tregoning J, Flight K, Higham S, Wang Z, Pierce B. Progress of the COVID-19 vaccine effort: viruses, vaccines and variants versus efficacy, effectiveness and escape. Nat Rev Immunol 202AD:626–36.
Naganathan S, Paiva M, Soliman L, Amanullah S, Aluisio A, Genisca A. Epidemiology and clinical characteristics of emergency department patients with COVID-19 in a Rhode Island healthcare system. R I Med J 2021:24–9.
51
Allameh S, Nemati S, Ghalehtaki R, Mohammadnejad E, Aghili S, Khajavirad N, et al. Clinical characteristics and outcomes of 905 COVID-19 patients admitted to Imam Khomeini Hospital Complex in the capital city of Tehran. Iran Arch Iran Med 2020:766–75.
52
Jiang N, Liu Y, Bao J, Li R, Ni W, Tan X, et al. Clinical features and risk factors associated with severe COVID-19 patients in China. Chin Med J (Engl) n.d.:944–53.
53
Cao Y, Li L, Feng Z, Wan S, Huang P, Sun X, et al. Comparative genetic analysis of the novel coronavirus (2019-nCoV/ SARS-CoV-2) receptor ACE2 in different populations. Cell Discov 2020:11.
54
Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterization and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020:565–74.
55
Sama I, Ravera A, Santema B, Van Goor H, Maaten T, Cleland J, et al. Circulating plasma concentrations of angiotensin-converting enzyme 2 in men and women with heart failure and effects of renin-angiotensin-aldosterone inhibitors. Eur Heart J 2020:1810–7.
56
Zhao Y, Zhao Z, Wang Y, Zhou Y, Ma Y, Zuo W. Single-Cell RNA expression profiling of ACE2, the receptor of SARS-CoV-2. Am J Respir Crit Care Med 2020:756–9.
57
Ghazeeri G, Abdullah L, Abbas O. Immunological differences in women compared with men: overview and contributing factors. Am J Reprod Immunol 2011:163–9.
58
Conway J, Gould A, Westley R, Raju S, Oklopcic A, Broadbent A, et al. Clinical characteristics and progression of COVID-19 confirmed cases admitted to a single British clinical centre-A brief case series report. Int J Clin Pract 2021:13807.
59
Popov G, Baymakova M, Vaseva V, Kundurzhiev T, Mutafchiyski V. Clinical characteristics of hospitalized patients with COVID-19 in Sofia. Bulgaria Vector Borne Zoonotic Dis 2020:910–5.
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