Comparison of COVID-19 Severity and Mortality Rates in the First Four Epidemic Waves in Hungary in a Single-Center Study with Special Regard to Critically Ill Patients in an Intensive Care Unit.

Different variants of coronavirus 2 (SARS-CoV-2), a virus responsible for severe acute respiratory syndrome, caused several epidemic surges in Hungary. The severity of these surges varied due to the different virulences of the variants. In a single-center, retrospective, observational study, we aimed to assess and compare morbidities and mortality rates across the epidemic waves I to IV with special regard to hospitalized, critically ill patients. A significant difference was found between the surges with regard to morbidity (p < 0.001) and ICU mortality (p = 0.002), while in-hospital mortality rates (p = 0.503) did not differ significantly. Patients under invasive ventilation had a higher incidence of bloodstream infection (aOR: 8.91 [4.43-17.95] p < 0.001), which significantly increased mortality (OR: 3.32 [2.01-5.48]; p < 0.001). Our results suggest that Waves III and IV, caused by the alpha (B.1.1.7) and delta (B.1.617.2) variants, respectively, were more severe in terms of morbidity. The incidence of bloodstream infection was high in critically ill patients. Our results suggest that clinicians should be aware of the risk of bloodstream infection in critically ill ICU patients, especially when invasive ventilation is used.

The Impact of Comorbidities and Obesity on the Severity and Outcome of COVID-19 in Hospitalized Patients-A Retrospective Study in a Hungarian Hospital.

Patients with comorbidities and obesity are more likely to be hospitalized with coronavirus disease 2019 (COVID-19), to have a higher incidence of severe pneumonia and to also show higher mortality rates. Between 15 March 2020 and 31 December 2021, a retrospective, single-center, observational study was conducted among patients requiring hospitalization for COVID-19 infection. Our aim was to investigate the impact of comorbidities and lifestyle risk factors on mortality, the need for intensive care unit (ICU) admission and the severity of the disease among these patients. Our results demonstrated that comorbidities and obesity increased the risk for all investigated endpoints. Age over 65 years and male sex were identified as independent risk factors, and cardiovascular diseases, cancer, endocrine and metabolic diseases, chronic kidney disease and obesity were identified as significant risk factors. Obesity was found to be the most significant risk factor, associated with considerable odds of COVID-19 mortality and the need for ICU admission in the under-65 age group (aOR: 2.95; p < 0.001 and aOR: 3.49, p < 0.001). In our study, risk factors that increased mortality and morbidity among hospitalized patients were identified. Detailed information on such factors may support therapeutic decision making, the proper targeting of vaccination campaigns and the effective overall management of the COVID-19 epidemic, hence reducing the burden on the healthcare system.

Anti-cytokine therapy in novel coronavirus disease (COVID-19) ­ the first administration of tocilizumab in Hungary at a department of infectology / Citokinellenes terápia az új típusú koronavírus okozta megbetegedés (COVID-19) kezelésében - tocilizumab elsoként való alkalmazása egy hazai infektológiai osztályon.

During the past few months, a pandemic originating from China named new coronavirus disease (COVID-19) has shown how vulnerable the world is. To date, no medication supported by randomized clinical trials has been approved for the treatment of COVID-19. At the time of writing of this paper, severe acute respiratory syndrome caused by coronavirus-2 (SARS-CoV-2) has been responsible - according to modest estimations - for around 4 million of infections and 300 000 deaths. Unveiling details of patomechanism, in fatal cases the role of immune dysregulation, namely cytokine release syndrome (CRS) has been discovered. Based on the current knowledge, interleukin-6 (IL6) plays a pivotal role in COVID-19 associated CRS. Case reports and result of small case series suggest efficacy of an IL6 inhibitor monoclonal antibody (tocilizumab) in treating CRS. Authors describe a case and review recent knowledge on the treatment of COVID-19. To our knowledge, the first case of severe COVID-19-associated cytokine storm syndrome - treated succesfully with IL6 monoclocal antibody at a Hungarian department of infectology - is presented here. Orv Hetil. 2020; 161(26): 1070-1077.