Anest. intenziv. Med. 2024;35(3):142-154 | DOI: 10.36290/aim.2024.034

Analysis of risk factors and the effect of specific treatments on the clinical outcome of patients hospitalized for COVID-19 at a university hospital in the Czech RepublicOriginal Article

Černá Pařízková R.^{1, 2}, Astapenko D.^{1, 2, 3}, Balík M.⁴, Blažek M.^{2, 5}, Dostál P.^{1, 2}, Dušek L.⁶, Fajfr M.^{2, 7}, Jarkovský J.^{6, 16}, Jurišínová I.⁴, Svobodová E.⁴, Szanyi J.^{2, 8}, Šmahel P.^{2, 9}, Černý V.^2,10-15

¹ Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Hradec Králové

² Lékařská fakulta v Hradci Králové, Univerzita Karlova

³ Fakulta zdravotnických studií, Technická univerzita v Liberci

⁴ Klinika anesteziologie, resuscitace a intenzivní medicíny, 1. LF UK a VFN Praha

⁵ Plicní klinika, Fakultní nemocnice Hradec Králové

⁶ Ústav zdravotnických informací a statistiky, Praha

⁷ Ústav klinické mikrobiologie, Fakultní nemocnice Hradec Králové

⁸ Klinika infekčních nemocí, Fakultní nemocnice Hradec Králové

⁹ Chirurgická klinika, Fakultní nemocnice Hradec Králové

¹⁰ Klinika anesteziologie, perioperační a intenzivní medicíny, Masarykova nemocnice v Ústí nad Labem, Univerzita J. E. Purkyně v Ústí nad Labem

¹¹ Národní institut kvality a excelence zdravotnictví, Praha

¹² Klinika anesteziologie a resuscitace, Fakultní nemocnice Královské Vinohrady, Univerzita Karlova v Praze, 3. LF UK, Praha

¹³ Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada

¹⁴ Ústav klinických oborů a biomedicíny, Technická univerzita Liberec

¹⁵ Constantine th Philospher University in Nitra, Faculty of Social Sciences and Health Care, Nitra, Slovak Republic

¹⁶ Institut Biostatistiky a Analýz, Lékařská fakulta, Masarykova univerzita, Brno

Objective: The study aimed to evaluate the clinical outcome of patients hospitalized for COVID-19 in two university hospitals in 2021-2022, define risk factors, and evaluate the effect of specific treatment procedures.

Design: A multicentric retrospective study. Setting: Intensive care units.

Material and methods: The study included all adult patients hospitalized for COVID-19. The demographic data, comorbidities, degree of vaccination, ventilatory support, and pharmacotherapy were recorded. The study aimed to determine the impacts of selected risk factors, pharmacotherapy, and vaccination against SARS-CoV-2 on the clinical outcome.

Results: A total of 3,835 patients were included in the study; the median age was 71 years. 523 (13.6 %) patients died during hospitalization and 930 (24.3 %) patients died until 90 days after admission. Of patients treated with mechanical ventilation or ECMO, 53.4 % died until 90 days. Males had a higher mortality rate than women; 64.3 % died in the group with ventilatory support older than 65 years. Most patients (76.2 %) were not vaccinated against SARS-CoV-2; these patients accounted for 87.4 % of the deceased. Obesity, arterial hypertension, diabetes mellitus, coronary heart disease, and atrial fibrillation were the main risk factors for death, the risk increased with several comorbidities. The analyses showed a significant protective effect of vaccination against the risk of death, especially in the group of elderly patients with multiple comorbidities. The inconclusive impact of vaccination was apparent in the group of younger patients. Chronic pharmacotherapy with heparin, warfarin, antithrombotic agents, and corticoids increased the risk of death. Treatment with remdesivir and casivirimab/imdevimab reduced the risk of death in contrast to therapy with convalescent plasma and corticoids.

Conclusion: The study demonstrated a significant protective effect of vaccination against severe course and death in hospitalized patients with COVID-19. In patients who developed a severe course of disease requiring mechanical ventilation and/or ECMO, the protective effect of vaccination is inconclusive. The main risk factors for an unfavourable clinical outcome were older age, male sex, and comorbidities (overweight, diabetes mellitus, hypertension, coronary artery diseases).

Keywords: COVID-19, risk factors, mortality, vaccination.

Received: April 29, 2024; Revised: July 26, 2024; Accepted: August 5, 2024; Published: October 7, 2024  Show citation