Browsing by Author "Nikolić, Nataša (58288723700)"

Introduction: Bilateral facial nerve palsy (FNP) is a rare condition that is idiopathic in only 20%. FNP is the most common cranial neuropathy in West Nile neuroinvasive disease (WNND) but is usually unilateral and only a few cases of bilateral FNP have been reported. Case: We present a case of a 65-year-old woman with confirmed WNND and simultaneous bilateral FNP. Results: In August 2022, the patient presented with ataxia, gait instability, tremor, fever, and vomiting. Following admission, due to her cerebrospinal fluid analyses she was diagnosed with WNV encephalitis. Her initial symptoms subsided, but on the 17th day of the disease, right FNP was observed. Three days later bilateral FNP developed, predominantly on the right side, with bilateral otalgia. Further diagnostic was performed but no other aetiology that could contribute to FNP was found. The patient was treated with a 3-day metilprednisolone course, followed by 60 mg of prednisone with dose tapering for 12 days. One month later she was discharged with significant regression of the left and slight regression of the right FNP. Subsequent physical therapy was conducted. The patient’s neurological status gradually improved and 4 months after the first symptoms onset, her neurological examination was normal. Conclusions: WNND should be included in the differential diagnosis of acquired bilateral FNP. It can result in full recovery, but unfavorable course is also possible. © 2024 Nikolić et al.

Introduction: Bilateral facial nerve palsy (FNP) is a rare condition that is idiopathic in only 20%. FNP is the most common cranial neuropathy in West Nile neuroinvasive disease (WNND) but is usually unilateral and only a few cases of bilateral FNP have been reported. Case: We present a case of a 65-year-old woman with confirmed WNND and simultaneous bilateral FNP. Results: In August 2022, the patient presented with ataxia, gait instability, tremor, fever, and vomiting. Following admission, due to her cerebrospinal fluid analyses she was diagnosed with WNV encephalitis. Her initial symptoms subsided, but on the 17th day of the disease, right FNP was observed. Three days later bilateral FNP developed, predominantly on the right side, with bilateral otalgia. Further diagnostic was performed but no other aetiology that could contribute to FNP was found. The patient was treated with a 3-day metilprednisolone course, followed by 60 mg of prednisone with dose tapering for 12 days. One month later she was discharged with significant regression of the left and slight regression of the right FNP. Subsequent physical therapy was conducted. The patient’s neurological status gradually improved and 4 months after the first symptoms onset, her neurological examination was normal. Conclusions: WNND should be included in the differential diagnosis of acquired bilateral FNP. It can result in full recovery, but unfavorable course is also possible. © 2024 Nikolić et al.

Background: The global epidemic of nosocomial diarrhea caused by Clostridioides (Clostridium) difficile started in 2000, with high mortality rates and emergence of a new hypervirulent strain NAP1/BI/027. The aim of this study was to assess the presence of ribotype 027 and other C. difficile ribotypes in a Serbian University Hospital, compare the temporal variability of ribotypes 3 years apart, as well as to compare clinical, demographic and laboratory characteristics and disease outcome among patients infected with 027 and non-027 ribotype. This was a prospective observational cohort study addressing 4-month intervals during 2014/2015 and 2017/2018. Results: Ribotyping was performed in 64 non-duplicate C. difficile strains. Ribotype 027 was the most prevalent, and was detected in 53 (82.8%) patients (43/45 and 10/19 patients in 2014-2015 and 2017/2018, respectively). Other detected ribotypes were 001/072 in 4 (6.3%), 002 in 4 (6.3%), 014/020 in 2 (3.1%) and 176 in 1 (1.5%) patient. The percentage of the patients infected with ribotype 027 significantly decreased during the 3-year period, from 95.6 to 52.6% (p < 0.001). Ribotype 027 infection was associated with fluoroquinolone treatment more frequently than infection with other ribotypes [33 (62.3%) vs. 2 (18.2%), p = 0.010)]. A severe C. difficile infection was diagnosed more often in patients with the detected ribotype 027 compared to those infected with non-027 ribotypes (p = 0.006). No significant difference in the mortality and recurrence rates was found between the patients infected with ribotype 027 and those infected with other ribotypes [10/53 (18.8%) vs. 2/11 (18.2%), p = 0.708, and 10/35 (28.6%) vs. 0/2 (0%), p = 1.000, respectively]. Conclusion: Clostridium difficile ribotype 027 was the most prevalent ribotype among patients in a large Serbian hospital, but there is a clear decreasing trend. © 2020 The Author(s).

Background: The global epidemic of nosocomial diarrhea caused by Clostridioides (Clostridium) difficile started in 2000, with high mortality rates and emergence of a new hypervirulent strain NAP1/BI/027. The aim of this study was to assess the presence of ribotype 027 and other C. difficile ribotypes in a Serbian University Hospital, compare the temporal variability of ribotypes 3 years apart, as well as to compare clinical, demographic and laboratory characteristics and disease outcome among patients infected with 027 and non-027 ribotype. This was a prospective observational cohort study addressing 4-month intervals during 2014/2015 and 2017/2018. Results: Ribotyping was performed in 64 non-duplicate C. difficile strains. Ribotype 027 was the most prevalent, and was detected in 53 (82.8%) patients (43/45 and 10/19 patients in 2014-2015 and 2017/2018, respectively). Other detected ribotypes were 001/072 in 4 (6.3%), 002 in 4 (6.3%), 014/020 in 2 (3.1%) and 176 in 1 (1.5%) patient. The percentage of the patients infected with ribotype 027 significantly decreased during the 3-year period, from 95.6 to 52.6% (p < 0.001). Ribotype 027 infection was associated with fluoroquinolone treatment more frequently than infection with other ribotypes [33 (62.3%) vs. 2 (18.2%), p = 0.010)]. A severe C. difficile infection was diagnosed more often in patients with the detected ribotype 027 compared to those infected with non-027 ribotypes (p = 0.006). No significant difference in the mortality and recurrence rates was found between the patients infected with ribotype 027 and those infected with other ribotypes [10/53 (18.8%) vs. 2/11 (18.2%), p = 0.708, and 10/35 (28.6%) vs. 0/2 (0%), p = 1.000, respectively]. Conclusion: Clostridium difficile ribotype 027 was the most prevalent ribotype among patients in a large Serbian hospital, but there is a clear decreasing trend. © 2020 The Author(s).

Introduction: Chronic Hepatitis C Virus (HCV) infection leads to progressive fibrosis making fibrosis staging necessary in the evaluation of such patients. Different fibrosis scores are emerging as possible non-invasive alternatives for liver biopsy. The Fibrosis-4 Index (FIB-4) and AST to Platelet Ratio Index (APRI) scores are the most widely used and the most extensively tested. This study aims to determine if it was possible to accurately use these to identify patients that are unlikely to have severe fibrosis. Methodology: One hundred and forty-two patients with chronic hepatitis C infection who underwent liver biopsy since January 1st 2014 until May 31st 2017 at the Hospital for Infectious and Tropical Diseases in Belgrade were analyzed. The FIB-4 and APRI scores were calculated for each patient and compared to histologically determined fibrosis stage. Results: A comprehensive statistical analysis was conducted in order to compare patients with and without severe fibrosis and to evaluate the accuracy of the fibrosis scores. Patients with non-severe fibrosis were younger, had higher platelet counts and lower transaminase levels. FIB-4 had an AUC of 0.875 and the APRI score had an AUC of 0.861. No patients with severe fibrosis or cirrhosis had a FIB-4 lower than 1.08. FIB-4 was superior to APRI in identifying patients with severe fibrosis in the study cohort. Conclusion: FIB-4 was superior to APRI in the recognition of severe fibrosis. FIB-4 may prove very useful in identifying patients without advanced liver disease, especially if other non-invasive methods are inaccessible. © 2018 Karić et al.

Introduction: Chronic Hepatitis C Virus (HCV) infection leads to progressive fibrosis making fibrosis staging necessary in the evaluation of such patients. Different fibrosis scores are emerging as possible non-invasive alternatives for liver biopsy. The Fibrosis-4 Index (FIB-4) and AST to Platelet Ratio Index (APRI) scores are the most widely used and the most extensively tested. This study aims to determine if it was possible to accurately use these to identify patients that are unlikely to have severe fibrosis. Methodology: One hundred and forty-two patients with chronic hepatitis C infection who underwent liver biopsy since January 1st 2014 until May 31st 2017 at the Hospital for Infectious and Tropical Diseases in Belgrade were analyzed. The FIB-4 and APRI scores were calculated for each patient and compared to histologically determined fibrosis stage. Results: A comprehensive statistical analysis was conducted in order to compare patients with and without severe fibrosis and to evaluate the accuracy of the fibrosis scores. Patients with non-severe fibrosis were younger, had higher platelet counts and lower transaminase levels. FIB-4 had an AUC of 0.875 and the APRI score had an AUC of 0.861. No patients with severe fibrosis or cirrhosis had a FIB-4 lower than 1.08. FIB-4 was superior to APRI in identifying patients with severe fibrosis in the study cohort. Conclusion: FIB-4 was superior to APRI in the recognition of severe fibrosis. FIB-4 may prove very useful in identifying patients without advanced liver disease, especially if other non-invasive methods are inaccessible. © 2018 Karić et al.

People who inject drugs (PWIDs) experience high rates of hepatitis C virus (HCV) infection, primarily due to needle sharing and limited healthcare access, resulting in a disproportionate disease burden within this population. This prospective study evaluated treatment outcomes in 432 adult patients with chronic hepatitis C (CHC) treated with direct-acting antivirals (DAAs) at the University Clinical Center of Serbia. Patients were categorized into two groups based on a history of drug addiction: PWIDs (163, 37.7%) and non-PWIDs (269, 62.3%). The PWID group was further categorized into subpopulations of problematic PWIDs (39, 23.9%), ex-PWIDs (124, 76.1%), and PWIDs on OST (96, 58.9%). The PWID group demonstrated significantly lower treatment adherence, with an intention-to-treat (ITT) rate of 82.8%, compared to 96.3% in the control group (p < 0.001). In contrast, no significant differences were observed in per-protocol (PP) outcomes between the two groups. Additionally, PWIDs were significantly younger (p < 0.001) and had higher rates of psychiatric disorders (p < 0.001), alcohol abuse (p < 0.001), and HCV genotype 1a (p < 0.001). Advanced fibrosis was predictor of PP treatment failure among PWIDs, while mood disorders and alcohol use disorder were associated with interruptions before the scheduled completion time. For non-PWIDs, older age and advanced fibrosis emerged as key predictors of PP treatment failure. The loss to follow-up was most commonly observed in the problematic PWID subgroup (p = 0.001). These findings highlight the importance of addressing barriers in PWIDs through integrated care strategies that concurrently manage addiction and HCV. © 2024 by the authors.

People who inject drugs (PWIDs) experience high rates of hepatitis C virus (HCV) infection, primarily due to needle sharing and limited healthcare access, resulting in a disproportionate disease burden within this population. This prospective study evaluated treatment outcomes in 432 adult patients with chronic hepatitis C (CHC) treated with direct-acting antivirals (DAAs) at the University Clinical Center of Serbia. Patients were categorized into two groups based on a history of drug addiction: PWIDs (163, 37.7%) and non-PWIDs (269, 62.3%). The PWID group was further categorized into subpopulations of problematic PWIDs (39, 23.9%), ex-PWIDs (124, 76.1%), and PWIDs on OST (96, 58.9%). The PWID group demonstrated significantly lower treatment adherence, with an intention-to-treat (ITT) rate of 82.8%, compared to 96.3% in the control group (p < 0.001). In contrast, no significant differences were observed in per-protocol (PP) outcomes between the two groups. Additionally, PWIDs were significantly younger (p < 0.001) and had higher rates of psychiatric disorders (p < 0.001), alcohol abuse (p < 0.001), and HCV genotype 1a (p < 0.001). Advanced fibrosis was predictor of PP treatment failure among PWIDs, while mood disorders and alcohol use disorder were associated with interruptions before the scheduled completion time. For non-PWIDs, older age and advanced fibrosis emerged as key predictors of PP treatment failure. The loss to follow-up was most commonly observed in the problematic PWID subgroup (p = 0.001). These findings highlight the importance of addressing barriers in PWIDs through integrated care strategies that concurrently manage addiction and HCV. © 2024 by the authors.

Background/Aim. The reactivation of the varicella zoster virus results in herpes zoster. Acyclovir is currently recommended over 7 to 10 days for herpes zoster treatment and should be started within 72 hours of rash eruption. This study analyses whether a therapy delay and/or shorter courses of treatment are associated with adverse outcomes. Methods. We identified 292 patients treated at the Clinic for Infectious and Tropical Diseases in Belgrade for herpes zoster in a five-years period. The data on these patients were analyzed using the descriptive statistics, the χ2 test, the Mann-Whitney U-test and the multiple logistic regression analysis. Results. The average time from rash eruption to the first dose of acyclovir was 4.07 ± 2.64 days. The patients received acyclovir for 6.83 ± 2.45 days. Seventy-one patients had disseminated herpes zoster, 100 had cranial nerve involvement, 86 had complications other than postherpetic neuralgia and one patient died. In cases where therapy was delayed there was no significant association with complications (χ2 = 0.031; p = 0.86). Our logistic regression model was not able to predict who was treated less than 7 days. An association between the HZ complications and abbreviated acyclovir regimens was not demonstrated (χ2 = 1.109; p = 0.326). We conducted the PubMed search on February 1st, 2017 and found no proof for the need to apply at least 7 days of acyclovir therapy for herpes zoster in the studies that have been published so far. Conclusion. We were unable to prove an association between therapy delay and unfavorable outcomes. The same was true for shorter than recommended acyclovir courses. © 2019 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Introduction. Multifocal cerebritis is a rare and severe disease and just a several cases caused by Listeria monocytogenes were described in the literature. Case report. A 64 year old man was admitted to the hospital with disturbed consciounsness (Glasgow Coma Scale score: 9) after being febrile for 16 days with history of fever, headache and middle ear pain. He did not have any other comorbidities neither he was immunocompromised. Penicillin allergy was noted for him. On neurologic exam, meningeal or focal neurologic signs were not evident, but computed tomography (CT) brain scan with contrast injection showed 3 hypodense zones in the occipital and 1 in the right temporal lobe. Laboratory findings in blood and cerebrospinal fluid (CSF) were indicative for the infectious nature of changes in the endocranium (multifocal cerebritis). Initial therapy was the combination of cefotaxime, amikacin and metronidazole, but after the isolation of L. monocytogenes from CSF and blood culture, therapy was switched to co-trimoxazole. Recovery of consciouscness with establisment of alert state occurred after 6 days of co-trimoxazole administration. Total therapy took 36 days. During that period all clinical and laboratory parameters normalized. The patient was discharged as recovered, with sequelas of amnesia and slurring of speech. Conclusion. In the treatment of multifocal cerebritis caused by L. monocytogenes, adequate choice and long-term therapy with antibiotics are necessary. The drug of choice is ampicillin but in the case of allergy to it, co-trimoxazole is a good replacement. © 2020 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Introduction: We aimed to describe neurological manifestations and functional outcome at discharge in patients with West Nile neuroinvasive disease. Methods: This retrospective study enrolled inpatients treated in the University Clinic for Infectious and Tropical Diseases in Belgrade, Serbia, from 1 June until 31 October 2022. Functional outcome at discharge was assessed using modified Rankin scale. Results: Among the 135 analyzed patients, encephalitis, meningitis and acute flaccid paralysis (AFP) were present in 114 (84.6%), 20 (14.8%), and 21 (15.6%), respectively. Quadriparesis/quadriplegia and monoparesis were the most frequent forms of AFP, present in 9 (6.7%) and 6 (4.4%) patients, respectively. Fourty-five (33.3%) patients had cerebellitis, 80 (59.3%) had rhombencephalitis, and 5 (3.7%) exhibited Parkinsonism. Ataxia and wide-based gait were present in 79 (58.5%) patients each. Fifty-one (37.8%) patients had tremor (41 (30.3%) had postural and/or kinetic tremor, 10 (7.4%) had resting tremor). Glasgow coma score (GCS) ≤ 8 and respiratory failure requiring mechanical ventilation developed in 39 (28.9%), and 33 (24.4%) patients, respectively. Quadriparesis was a risk factor for prolonged ventilator support (29.5 ± 16.8 vs. 12.4 ± 8.7 days, p = 0.001). At discharge, one patient with monoparesis recovered full muscle strength, whereas 8 patients with AFP were functionally dependent. Twenty-nine (21.5%) patients died. All of the succumbed had encephalitis, and 7 had quadriparesis. Ataxia, tremor and cognitive deficit persisted in 18 (16.9%), 15 (14.2%), and 22 (16.3%) patients at discharge, respectively. Age, malignancy, coronary disease, quadriparesis, mechanical ventilation, GCS ≤ 8 and healthcare-associated infections were risk factors for death (p = 0.001; p = 0.019; p = 0.004; p = 0.001; p < 0.001; p < 0.001, and p < 0.001, respectively). © 2023, Fondazione Società Italiana di Neurologia.

This study, conducted at two university-based infectious disease clinics, included 216 patients with chronic hepatitis C. The primary objective was to assess the positive and negative predictive values, sensitivity, and specificity of achieving a sustained virological response (SVR) at 4 weeks compared to 12 weeks post-therapy. The results demonstrated a maximum sensitivity of 100% for achieving SVR at 12 weeks after reaching SVR at 4 weeks for all analyzed genotypes, except for genotype 1b treated with EBR/GZR therapy, where the specificity was 75%. Additionally, younger age and less advanced liver fibrosis were identified as independent predictors of achieving a sustained virological response at both 4 and 12 weeks. The significant normalization of various biochemical parameters was observed after treatment, indicating an overall improvement in liver function. This study suggests that shortening the monitoring period to 4 weeks might be effective for younger patients without significant fibrosis, potentially reducing loss to follow-up, which is a critical issue in HCV treatment. These findings align with the “test and treat” approach. Further research is needed to confirm these findings and incorporate them into official guidelines, which could simplify and enhance the effectiveness of HCV treatment protocols, aiding global efforts to eliminate HCV as a public health issue by 2030. © 2024 by the authors.

This study, conducted at two university-based infectious disease clinics, included 216 patients with chronic hepatitis C. The primary objective was to assess the positive and negative predictive values, sensitivity, and specificity of achieving a sustained virological response (SVR) at 4 weeks compared to 12 weeks post-therapy. The results demonstrated a maximum sensitivity of 100% for achieving SVR at 12 weeks after reaching SVR at 4 weeks for all analyzed genotypes, except for genotype 1b treated with EBR/GZR therapy, where the specificity was 75%. Additionally, younger age and less advanced liver fibrosis were identified as independent predictors of achieving a sustained virological response at both 4 and 12 weeks. The significant normalization of various biochemical parameters was observed after treatment, indicating an overall improvement in liver function. This study suggests that shortening the monitoring period to 4 weeks might be effective for younger patients without significant fibrosis, potentially reducing loss to follow-up, which is a critical issue in HCV treatment. These findings align with the “test and treat” approach. Further research is needed to confirm these findings and incorporate them into official guidelines, which could simplify and enhance the effectiveness of HCV treatment protocols, aiding global efforts to eliminate HCV as a public health issue by 2030. © 2024 by the authors.

Introduction: In addition to known systemic manifestations, coronavirus disease (COVID-19) can cause serious neurological manifestations as a result of damage to the central and peripheral nervous system. Case report: A 62-year-old male with medical history of arterial hypertension and type 2 diabetes mellitus was admitted to the hospital, complaining of high fever, fatigue, cough, and disturbed mental state. He was diagnosed with COVID-19, had fever of up to 38 °C 7 days before admission, dry cough, and became disoriented and psychotic after 5 days. The chest X-ray and computed tomography (CT) of the head were normal. Following a lumbar puncture, the patient was diagnosed with encephalitis based on clinical and laboratory findings (pleocytosis and hyperproteinorachia in cerebrospinal fluid (CSF)). CSF was checked with the polymerase chain reaction meningitis-encephalitis panel which excludes the more common viral or bacterial causes of encephalitis. Anti-edematous, anti-inflammatory, anticoagulant, gastroprotective, and other symptomatic medications were administered. Ataxic gait was the only focal neurological abnormality identified during neurological assessment. The chest CT did not reveal COVID-19 pneumonia and brain magnetic resonance imaging revealed only cortical reductive brain alterations. The COVID-19 swab test after 10 days was negative. The patient was recovered and released from hospital treatment with normal physical findings and without neurological abnormalities. Conclusions: The diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) encephalitis can be challenging, and it is usually based on the exclusion of other etiological agents of brain infections. Copyright © 2025 Poluga et al.

Background/Aim. The World Health Organization estimates that 3.2 billion people are at a risk of being infected with malaria. Thus, the adequate diagnostic protocols for malaria, especially those aimed at determining disease severity, are paramount both in endemic and non-endemic setting. The aim of this study was to identify the demographic, parositological, clinical and laboratory characteristics associated with severe malaria in a non-endemic settings. Methods. We analyzed 22 patients with severe malaria and compared their clinical and laboratory findings with those of the patients with non-severe malaria in a search of predictors of disease severity. All patients were treated at the Infectious and Tropical Diseases University Hospital, Clinical Centre of Serbia in Belgrade, Serbia from 2000 to 2010. Results. The average age of patients with with severe malaria was 44.86 ± 12.33 years and men predominated (95.45%). The patients with severe malaria were infected Plasmodium falciparum (P. falciparum) significantly more frequently compared with those with non-severe disease (p =0.047). Jaundice was the most commonly observed feature of severe malaria, followed by anemia and renal failure. The multifactor analysis of variance showed that thrombocytopenia (p = 0.05) and high serum tumor necrosis factor-alpha levels (p = 0.02) were significantly associated with the disease severity. Conclusion. A high index of suspicion for malaria should be maintained when evaluating febrile patients returning from the malaria endemic regions. The elevated serum tumor necrosis factor-alpha levels and thrombocytopenia are associated with severe malaria in non-endemic settings. © 2019, Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Introduction Toxic liver injury is becoming greater problem in today´s hepatology. Until today more than 900 drugs, toxins and herbs have been identified that can cause different liver injury. There was no significant research of this problem in Serbia so far. The aim of this study is to present the patient with severe form of acute hepatitis, whose etiology is exclusively toxic. Case outline A 23-year-old male, from Belgrade, previously healthy, got sick with signs and symptoms that correlated with acute hepatitis. Biochemical analyses pointed to severe form of acute hepatitis with impending hepatocellular failure. The diagnosis of toxic liver injury was set. It was caused by the use of number substances and supplements: Ecstasy, whey protein, branched-chain amino acid (BCAA), creatine, high doses of vitamin D, glutamine, and multivitamin complex. He was treated with infusion, gastroprotective, and substitution therapy. During hospitalization, the patient’s symptoms disappeared with gradual normalization of biochemical analyses of the liver. When the patient’s condition was satisfying, blind percutaneous liver biopsy was performed, with the following pathohistological findings: Lobular hepatitis, with no fibrosis, etiology correlates to toxic. After a month and a half since the disease had begun, the patient fully recovered. Conclusion Increased number of persons with toxic liver injury is being registered in developed countries worldwide. Similar trend can be noted in Serbia as well. By presenting young previously healthy man with the severe form of toxic acute hepatitis and impending liver failure, we are pointing out the significance of this problem. Multidisciplinary approach is needed to reach the most effective solutions. © 2019, Serbia Medical Society. All rights reserved.

Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, low- and middle- income countries had less access to monoclonal antibodies, such as tocilizumab (TCZ), compared to high-income countries. This retrospective cohort study aimed at evaluating the impact of a delayed TCZ administration on patient outcomes, and at determining the optimum timing of TCZ initiation for COVID-19 pneumonia in Serbia. Methodology: The study included 150 patients who received TCZ at a tertiary referral center. The outcomes analyzed in this study were the need for an intensive care unit (ICU) treatment and mortality. Results: The multiple Cox proportional hazard model suggested that the delay in TCZ administration was an independent predictor of needing ICU treatment and mortality. The receiver operating characteristic (ROC) curve showed that patients who received TCZ after 7.5 days since the onset of symptoms had 74.4% higher chances of needing ICU treatment. Receiving TCZ after 9.5 days since the onset of symptoms, increased the chances of mortality by 78.9%. The multiple Cox proportional hazard model suggested that TCZ administration after 7.5 days since the onset of symptoms increased the hazard for ICU admission by 24.5%; and the hazard of mortality increased by 46.1% after 9.5 days since the onset of symptoms. Conclusions: This study emphasizes the importance of timely administration of TCZ in COVID-19 pneumonia. Better outcomes were observed when TCZ was administered up to 7.5 days since the onset of symptoms. Copyright © 2025 Beronja et al.

Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, low- and middle- income countries had less access to monoclonal antibodies, such as tocilizumab (TCZ), compared to high-income countries. This retrospective cohort study aimed at evaluating the impact of a delayed TCZ administration on patient outcomes, and at determining the optimum timing of TCZ initiation for COVID-19 pneumonia in Serbia. Methodology: The study included 150 patients who received TCZ at a tertiary referral center. The outcomes analyzed in this study were the need for an intensive care unit (ICU) treatment and mortality. Results: The multiple Cox proportional hazard model suggested that the delay in TCZ administration was an independent predictor of needing ICU treatment and mortality. The receiver operating characteristic (ROC) curve showed that patients who received TCZ after 7.5 days since the onset of symptoms had 74.4% higher chances of needing ICU treatment. Receiving TCZ after 9.5 days since the onset of symptoms, increased the chances of mortality by 78.9%. The multiple Cox proportional hazard model suggested that TCZ administration after 7.5 days since the onset of symptoms increased the hazard for ICU admission by 24.5%; and the hazard of mortality increased by 46.1% after 9.5 days since the onset of symptoms. Conclusions: This study emphasizes the importance of timely administration of TCZ in COVID-19 pneumonia. Better outcomes were observed when TCZ was administered up to 7.5 days since the onset of symptoms. Copyright © 2025 Beronja et al.