Outcome of Covid-19 disease in vaccinated patients

Uvod: Koronavirusi su česti patogeni koji primarno zahvaćaju ljudski respiratorni sustav. Novi koronavirus SARS-CoV-2 uzrokovao je globalnu pandemiju od početka 2020. godine. Dosada je COVID-19 potvrđen u 543 milijuna slučajeva od kojih je 6.33 milijuna završilo smrtnim ishodom ----- Cilj: Svrha istraživanje je usporediti ishode bolesti u hospitaliziranih bolesnika s COVID-19 u odnosu na cijepni status. Dodatni cilj je utvrditi koji su faktori bitni za ishod u oboljelih od COVID-19, poput komorbiditeta, dobi i spola. ----- Ispitanici i metode: Radi se o retrospektivnom kohortnom istraživanju. Kohorta se sastoji od 180 pacijenata koji su liječeni od COVID-19 na Odjelu za virusni hepatitis Klinike za infektivne bolesti „Fran Mihaljević“ u periodu od 1.8.2021. do 28.2. 2022. U istraživanju smo koristili odjelnu prospektivno dizajniranu bazu podataka s osnovnim podacima o hospitaliziranim pacijentima. ----- Rezultati: Ukupno je u istraživanje uključeno 180 pacijenata koji su bolnički liječeni od COVID-19. Prosječna dob ove populacije je bila 62,08 ± 16,52 godina, 108 ih je bilo muškog spola, dok je ženskog spola bilo 72. Populacija se u svrhu istraživanja podijelila na necijepljenu i cijepljenu. Necijepljena populacija obuhvaćala je 128 pacijenata, 67 muškaraca i 61 ženu, prosječne dobi 58.27 ± 16.91 godina. Cijepljena populacija je dalje podijeljena u 3 grupe ovisno o broju primljenih doza. 46 pacijenata su primili dvije doze cjepiva, prosječne dobi 71.22 ±11.29. godina. Cijepljena populacija je starija i ima veći udio muškaraca u odnosu na necijepljenu populaciju, ima veći udio bolesnika s komorbiditetima, posebno arterijske hipertenzije (78.26% vs 45.31%), šećerne bolesti (26.09% vs 16.41%) i ostalih kardiovaskularnih bolesti (34.78% vs 11.72%). Sveukupno gledano mortalitet je bio viši u cijepljenoj populaciji (17.39%) naspram necijepljene (13.28%). Incidencija tromboze plućne arterije je bila viša među necijepljenima (17.97%) u usporedbi s cijepljenima (6.52%). Mortalitet u najstarijim dobnim skupinama (više od 80 godina) bio je 54% niži u cijepljenoj populaciji (40%) u usporedbi s necijepljenom populacijom (61.54%). Populacija svih umrlih je imala značajno veću prevalenciju kardiovaskularnih komorbiditeta (50%) u odnosu na preživjele (12.34%). ----- Zaključak: Starija životna dob i komorbiditeti prepoznati su kao najvažniji faktori rizika za razvitak teškog i/ili letalnog oblika COVID-19. Prisutnost kardiovaskularnih komorbiditeta negativno utječe na ishod. Necijepljena populacija ima dugoročno lošiji ishod i kasnije komplikacije vezane uz respiratorni sustav. Cjepivo ima povoljniji utjecaj na ishod, posebno ako je vrijeme proteklo od cijepljenja kraće, što opravdava potrebu za booster dozama. To se posebice odnosi na starije dobne skupine koje su ujedno i najugroženije.Introduction: Coronavirus are common pathogens that primarily affect the human respiratory system. New coronavirus SARS-CoV-2 has caused a global pandemic since the beginning of 2020. So far, COVID-19 has been confirmed in 543 million cases of which 6.33 million have been fatal. ----- Objective: The purpose of the research is to compare disease outcomes in hospitalized patients with COVID-19 in relation to vaccination status. An additional goal is to determine which factors are important for the outcome in patients with COVID-19, such as comorbidities, age and gender. ------ Subjects and methods: This is a retrospective cohort study. The cohort consists of 180 patients who were treated for COVID-19 at the Viral Hepatitis Department of the "Fran Mihaljević" Infectious Diseases Clinic in the period from August 1, 2021. until 28.2. 2022. In the research, we used a departmental prospectively designed database with basic data on hospitalized patients. ----- Results: In total, 180 patients who were treated for COVID-19 in the hospital were included in the study. The average age of this population was 62.08 ± 16.52 years, 108 of them were male, while 72 were female. For research purposes, the population was divided into unvaccinated and vaccinated. The unvaccinated population included 128 patients, 67 men and 61 women, average age 58.27 ± 16.91 years. The vaccinated population was further divided into 3 groups depending on the number of doses received. 46 patients received two doses of the vaccine, average age 71.22 ±11.29. year. The vaccinated population is older and has a higher proportion of men compared to the unvaccinated population, has a higher proportion of patients with comorbidities, especially arterial hypertension (78.26% vs 45.31%), diabetes (26.09% vs 16.41%) and other cardiovascular diseases (34.78% vs 11.72%). Overall, mortality was higher in the vaccinated population (17.39%) compared to the unvaccinated (13.28%). The incidence of pulmonary artery thrombosis was higher among the unvaccinated (17.97%) compared to the vaccinated (6.52%). Mortality in the oldest age groups (over 80 years) was 54% lower in the vaccinated population (40%) compared to the unvaccinated population (61.54%). The population of all the deceased had a significantly higher prevalence of cardiovascular comorbidities (50%) compared to the survivors (12.34%). -----Conclusion: Older age and comorbidities are recognized as the most important risk factors for the development of a severe and/or lethal form of COVID-19. The presence of cardiovascular comorbidities negatively affects the outcome. The unvaccinated population has a worse long-term outcome and later complications related to the respiratory system. The vaccine has a more favorable effect on the outcome, especially if the time elapsed since vaccination is shorter, which justifies the need for booster doses. This especially applies to older age groups, which are also the most vulnerable