OBJECTIVE:A definition of refractory septic shock is necessary to guide diagnosis, management, prognostication, research, and future guidelines for this most severe form of the disease. We sought to achieve consensus on clinical criteria that would be used to define refractory septic shock. DESIGN:Review of literature, expert panel position statements, and Delphi rounds with an international expert group. SETTING:Consensus was defined as having at least 75% of panellists in agreement or disagreement on the three highest or lowest levels of a 7-point Likert scale or based on responses to single- or multiple-choice questions, respectively. SUBJECTS:A panel of multinational, multiprofessional and multidisciplinary critical care experts assembled by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine (57 invitations and 56 participants). MEASUREMENTS AND MAIN RESULTS:A five-round Delphi process was conducted for consensus and stability. The steering committee proposed 34 statements, and five of them were rejected by panel experts after round 2. Among 29 statements selected from eight domains, consensus was reached for 13. The panel agreed on the need for a comprehensive consensus set of clinical criteria for refractory septic shock. Markers of organ dysfunction (75%, 2 rounds), tissue perfusion (91.1%, 2 rounds) including lactate (94.6%, 2 rounds) and capillary refill time (76.8%, 2 rounds), assessment of fluid-responsiveness after initial resuscitation (92.9%, 5 rounds), and use of vasoactive drugs at norepinephrine equivalents greater than 0.5 µg/kg/min (75.0%, 3 rounds), were selected as clinical criteria of refractory septic shock. The use of critical care ultrasound (CCUS) (92.9%, 3 rounds) was the single diagnostic modality that reached a consensus-based agreement. CONCLUSIONS:A consensus for 13 criteria to frame the definition of refractory septic shock was reached. Refractory septic shock is characterised by persistently elevated lactate concentrations and or prolonged capillary refill time in patients with septic shock who are fluid unresponsive, require a norepinephrine base equivalent dose greater than 0.5 micrograms per kilogram per minute, and undergo CCUS assessment when mixed shock is suspected.

Background/aim: Parenteral feeding is used in critically ill patients when enteral nutrition is inadequate or intolerable, and the gastrointestinal tract is not functioning properly. Lipid emulsions play a major role in parenteral nutrition because they supply necessary fatty acids and a high-calorie density. We investigated the effects of parenteral lipid emulsions on mesenteric perfusion, inflammation-induced oxidation, and organ damage in lipopolysaccharide-induced mice endotoxemia model. Materials and methods: In septic mice, organ damage induced by lipopolysaccharide was assessed by histopathology and biochemical examination. Additionally, an ultrasonic blood flowmeter was used to measure the impact of lipid emulsions on mesenteric blood flow. Results: When compared to control animals, mesenteric blood flow was reduced by parenteral lipid emulsions containing fish oil, soybean oil, and olive oil; however, when compared to the lipopolysaccharide group, the decrease in mesenteric blood flow was avoided by fish oil therapy. Lipid emulsions could not hinder the increase in liver and spleen weight caused by lipopolysaccharide injection. In septic mice, fish oil reduced liver damage, whereas in control animals, specific dosages of olive and soybean oils resulted in histopathologically significant liver and spleen damage. Parenteral lipid emulsions have shown an organ-specific impact on compromised oxidative equilibrium. Conclusion: Fish oil emulsions containing high omega-3 fatty acids abrogate the decrease in mesenteric blood flow and prevent liver damage in this experimental endotoxemia model.

Background/aim:Parenteral feeding is used in critically ill patients when enteral nutrition is inadequate or intolerable, or when the gastrointestinal tract is nonfunctional. Lipid emulsions play a major role in parenteral nutrition, supplying the necessary fatty acids and providing high-caloric density. We investigated the effects of various parenteral lipid emulsions on mesenteric perfusion, inflammation-induced oxidation, and organ damage in a lipopolysaccharide-induced mouse endotoxemia model. Materials and methods:Organ damage induced by lipopolysaccharide in septic mice was assessed histopathologically and biochemically, and an ultrasonic blood flowmeter was used to measure the impact of lipid emulsions on mesenteric blood flow. Results:Lipopolysaccharide injection significantly reduced mesenteric blood flow when compared to saline controls (3.02 ± 0.10 mL/min vs 1.44 ± 0.10 mL/min, p < 0.05). Only fish oil emulsion treatment significantly abrogated this decrease (2.84 ± 0.39 mL/min, p < 0.05). None of the tested lipid emulsions prevented lipopolysaccharide-induced increases in liver and spleen weights. Fish oil reduced liver damage in septic mice, whereas specific dosages of olive and soybean oils caused significant histopathological liver and spleen damage even in the control animals. Furthermore, soybean and olive oil also significantly increased serum oxidative stress in the healthy control mice (2.55 ± 0.06 vs 4.93 ± 0.38 and 4.28 ± 0.12, p <0.05). Conclusion:Fish oil emulsions with high omega-3 fatty acid content abrogated the decrease in mesenteric blood flow and prevented liver damage in this experimental endotoxemia model.

RATIONALE:Neuromuscular blocking agents (NMBAs) show potential benefits on mortality and other complications of acute respiratory distress syndrome (ARDS) in adult patients. Evidence-based decisions and processes ensure appropriate use of neuromuscular blockade in adult patients with ARDS. OBJECTIVES:The objective of these guidelines was to develop evidence-based recommendations for the administration of NMBAs in critically ill adult patients with ARDS. DESIGN:The American College of Critical Care Medicine Board convened a 21-member multidisciplinary panel of experts in critical care medicine, nursing, respiratory therapy, pharmacology, surgery, neurology, and anesthesiology. The panel included two expert methodologists specialized in developing evidence-based recommendations in alignment with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Conflict-of-interest policies were strictly followed during all phases of guidelines development including task force selection and voting. METHODS:The panel members identified and formulated five Population, Intervention, Comparison, and Outcome questions. We conducted a systematic review for each question to identify the best available evidence, statistically analyzed the evidence, and assessed the certainty of the evidence using the GRADE methodology. We used the GRADE evidence-to-decision framework to formulate the recommendations. RESULTS:The panel generated two conditional recommendations. One recommendation is to use NMBAs in adults with ARDS with Pao2/Fio2 less than 150. For the other recommendations, there was equipoise in the recommendation for and against using titratable vs. fixed-dose NMBA dosing, a monitoring-based strategy for assessing depth of sedation and analgesia in adults with ARDS before initiating or while receiving neuromuscular blockade, and administration of NMBAs for patients who are proned, due to overall lack of evidence in critically ill patients and due to considerations of patient safety and experience concerns. CONCLUSIONS:These guidelines provide additional perspectives on the use of NMBA in patients with ARDS, recognizing that institutional and patient-specific considerations must help to guide the decision-making process.

Background Diversity in intensive care medicine (ICM) contributes to equity, team performance, and innovation. However, international data highlight persistent gender disparities in leadership, authorship, and specialty composition. While Türkiye appears to have balanced gender representation in critical care, a national analysis has been lacking. Methods This descriptive study evaluated gender and specialty diversity among ICM professionals in Türkiye across five domains: (1)national society leadership, (2)congress speaker rosters, (3)fellowship program directors, (4)ICM specialists, and (5)Türkiye-based PubMed-indexed ICM publications between 2015 and 2025. Data were collected from public records, institutional websites, and structured database searches. Results One of the two national societies demonstrated strong female leadership, with 55.6 % female presidents since 2005. Congress speaker data from 2004 to 2024 (n = 1567) showed increasing female representation (n = 635, 40.5 %), reaching near parity in recent years. Among 53 fellowship programs, 45.3 % of directors were female. ICM specialists (n = 571) had a near-equal gender distribution (50.6 % female). Anesthesiology was the dominant primary specialty (54.6 %) among ICM specialists. In ICM publications from Türkiye indexed in PubMed, women represented 41.6 % of all authors (n = 7073) across 1107 ICM publications, with 59.0 % led by a female first or last author. Conclusion Türkiye shows encouraging trends in gender equity across clinical and academic ICM. These gains may reflect equitable public policies, gender-balanced specialty pipelines, and visible female role models. While challenges remain—particularly in senior authorship and society leadership—Türkiye's experience may offer valuable lessons for global equity in ICM. Further research should explore other dimensions, including race/ethnicity and socioeconomic background, which are underreported in current systems.

One of the most challenging factors for clinicians in managing COVID-19 has been differences in the clinical course. To investigate the parameters associated with severe disease in detail, along with examining known risk factors such as advanced age and comorbidities, understanding personal genetic factors is necessary, as the clinical course may change due to differences in the host genome. Human genetic variants reported to be associated with severe disease were genotyped in 68 patients in COVID-19 medical wards and 52 in COVID-19 intensive care units at Hacettepe University Adult Hospital. The rs17860115 variant was significantly more prevalent in our cohort than in the European (non-Finish) population, whereas the rs2298659, rs2298661, rs4290734, and rs9271609 variants were significantly less common, which may reflect genetic differentiation, selective pressures, or protective factors within this population. While no significant association was found between variants and disease severity, notably, the ACE2 rs1548474 allele frequency was 38.0

ObjectiveTo document the occurrence of post-intensive care syndrome (PICS) in intensive care unit (ICU) survivors with coronavirus disease-2019 (COVID-19) up to one year.MethodsRetrospective observational study at a university hospital post-ICU outpatient clinic. Patients were followed up in-person at 1 month, 3 months, 6 months and one-year after hospital discharge. Cognitive, physical and psychological domains of PICS were evaluated. PICS was defined as at least one dysfunction in the assessment tools in each domain.ResultsSixty-four patients were evaluated during the study period. Median age was 62.5 (55.0-71.0). Fifty-eight percent of them were male. Median APACHE II and admission SOFA scores were 13 (10-16) and 3 (3-4), respectively. Sixty-four, 54, 44, 20 patients were evaluated during the 1 -month, 3-month, 6-month and one-year visits. 94% of patients had PICS at the 1st visit and this declined to 75% in one-year. The ratio of patients who fulfilled all PICS domains were 15%, 10%, 13% and 13%, respectively at 4 follow-up visits. Physical impairment was the most commonly observed dysfunction during all visits.DiscussionThis study showed that at least one domain of PICS persisted in 75% of patients at one-year in COVID-19 ICU survivors.

BACKGROUND:Platelet transfusions are frequent in the Intensive Care Unit (ICU), either as prophylaxis against bleeding complications or as treatment for bleeding. The European Society of Intensive Care Medicine guidelines for ICU patients generally recommend not using prophylactic platelet transfusions unless the platelet count falls below 10 × 109 cells/L in non-bleeding patients and make no recommendation for platelet transfusion threshold in non-massively bleeding patients with thrombocytopenia. Therefore, the decision to transfuse platelets is often left to clinical assessment by the treating physician. This study aims to describe current platelet transfusion preferences among ICU physicians. METHODS:An online, anonymous survey consisting of 43 items was produced in two languages (French and English) and distributed by investigators in the Nine-I research network to ICU physicians in Europe and the United States of America. The survey evaluated platelet transfusion practices in ICU patients with and without bleeding, the presence of local guidelines, and factors influencing the decisions to transfuse platelets. Only completed surveys were analysed. RESULTS:We received 997 surveys completed by ICU physicians. Overall, there was large heterogeneity in platelet transfusion practices between and within countries. In non-bleeding, thrombocytopenic medical ICU patients, most would transfuse prophylactic platelets at a platelet count threshold of 10 × 109 cells/L. Thirty percent would change their strategy in patients with bone marrow failure and either be more liberal (60%; 95% Confidence Limits 0.54, 0.66), more restrictive (31%; 0.26,0.36) or seek assistance. Higher thresholds were preferred in surgical patients, prior to procedures and in patients with bleeding. Only 173 (17%; 0.15,0.19) responded that they were confident about the clinical indications every time they prescribed a platelet transfusion. As for existing guidelines, only 123 (12%; 0.10,0.15) responded that they always read them. Colleagues' attitudes and departmental culture were important influencers on transfusion practice. CONCLUSION:Platelet transfusion practice in the ICU is heterogeneous, both between and within countries; guidelines are often not used, and there is often uncertainty about the clinical indication.

ABSTRACT BACKGROUND: Oxygen is widely used to treat hypoxemia. OBJECTIVE: To determine the frequency of inappropriate oxygen administration in patients admitted to Internal Medicine (IM) wards and intensive care units (ICU). DESIGN AND SETTING: Single-center prospective, observational study in a tertiary university hospital in Ankara, Türkiye. METHODS: Patients who were hospitalized in the IM wards and ICU and were receiving oxygen were recruited. Every 6 hours, the oxygenation parameters were noted, and the averages over the first 24 hours of oxygen usage were recorded. Inappropriate usage was defined as oxygen flow rates > 6 L/min in the nasal cannula and < 5 L/min and > 10 L/min in the simple face mask, application of the simple face mask in chronic obstructive lung disease (COPD) exacerbation, SpO2 > 98% in general, or SpO2 > 92% in COPD exacerbation. RESULTS: Of the 397 patients, 20% in the IM wards and 50% of 124 in the ICU received oxygen. The oxygen method used was nasal cannula in 51%, simple face mask in 21%, and high-flow nasal cannula in 4% of the patients. Among the simple face mask applications, 46% were < 5 L/min and 5% were > 10 L/min. Among the 62% of patients with COPD exacerbations, the SpO2 was > 92%. CONCLUSION: The frequency of oxygen use was 20% among patients hospitalized in IM wards and 50% among patients in the ICU. Almost half of the simple face mask applications were inappropriate.

Introduction:Intravenous fluids are commonly used to resuscitate cardiac surgery patients in the operating room and ICU, assuming they expand the intravascular compartment. However, the quantitative information for their distribution and shift between the tissue compartments is still lacking. This study aimed to assess how administered fluids distribute across compartments and their effects on micro- and macrocirculation during the long term of cardiac surgery. Materials and Methods:Thirty-three consecutive patients undergoing major cardiac surgery were prospectively enrolled. Information regarding the body fluid distribution [total body water (TBW), extracellular water (ECW), intracellular water (ICW)], sublingual microcirculation total vessel density (TVD), per-fused vessel density (PVD), and proportion of perfused vessel (PPV)], and hemodynamics were collected before surgery (T0), on the day of discharge from the intensive care unit (T1), and on the third day at the ward (T3). Correlations of the changes in microcirculatory and macrocircula-tory parameters were determined by linear regression. Result:Twenty-four patients were included in the analysis with available data. Body weight significantly increased from 86.0 ± 13.6 kg to 91.6 ± 13.3 kg at T1 and decreased to 87.8 ± 12.9 kg at T3 (p< 0.001). While TBW and ECW varied in parallel with body weight, ICW showed a continuous decrease throughout the study process. TVD, PVD, and PPV significantly decreased at T1, then increased at T3, but all remained lower than baseline (p< 0.001 for TVD and PVD, p= 0.034 for PPV). A cut-off point of a 5% increase in body weight predicted a 10% decrease in TVD with a sensitivity of 0.833 and specificity of 0.666. Besides, a cut-off point of a 4% increase in body weight predicted a 10% decrease in PVD with a sensitivity of 0.94 and specificity of 0.75. Conclusions:Administering fluid during operation and intensive care stay significantly reduces ICW and causes microcirculatory disturbances in cardiac surgery patients. Long-term microcirculation disturbances correlate with ECW and TBW in these patients.

Levels of C-reactive protein (CRP), an acute-phase protein, and procalcitonin (PCT) in serum and certain body fluids increase during inflammatory conditions, particularly bacterial infections, and decrease following treatment or resolution of the triggering cause. Therefore, both biomarkers can be effectively utilized for diagnosing infectious diseases, differentiating between viral and bacterial infections, monitoring antibiotic treatment response, and making decisions regarding the cessation of therapy. In recent years, with the significant global and national increase in antimicrobial resistance, these biomarkers have become increasingly important as part of antimicrobial stewardship practices promoting rational antimicrobial use. This consensus report aims to guide the optimal utilization of CRP and PCT in managing infectious diseases in adult patients across various clinical settings and patient groups based on a review of the current literature and collaboration among seven relevant medical societies. We hope this report will benefit all physicians involved in diagnosing and treating adult infectious diseases.

Midodrine is an orally approved alpha-agonist increasingly utilized in intensive care units for the treatment of refractory hypotension with peripheral effects. The current case report presents the clinical manifestation of midodrine utilization in a female patient experiencing refractory hypotension. She was admitted to the intensive care unit of a university hospital due to confusion and suspicion of intoxication. Due to the patient's hypotensive condition, vasopressor support (norepinephrine) was initiated to address shock of unidentified cause. Midodrine was recommended by the clinical pharmacist to the patient due to the persisting need for norepinephrine. This case report highlights that, based on the clinical judgement of the clinician, midodrine can be used during vasopressor weaning when no other specific cause of hypotension has been identified.

Scarce evidence is available on the epidemiology of microbiologically proven clinical infections in patients admitted to the intensive care unit (ICU) after a great earthquake. The main aim of this study was to assess clinical infections and microbiological features in patients admitted to the ICU following the 2023 earthquake in the southeastern region of Türkiye with a focus on the timing of culture positivity during their ICU stay. The secondary objectives included determining antibiotic susceptibility patterns, identifying the types of antibiotics administered upon ICU admission, evaluating the appropriateness of antibiotic usage, assessing patient outcomes, and identifying factors that influence microbiologically confirmed clinical infections. A retrospective, multicenter, observational study was conducted on adult earthquake victims admitted to the ICU after the 2023 earthquake in southeastern Türkiye. Patients were categorized into four groups on the basis of culture positivity timing at the 72-hour breakpoint and clinical characteristics were compared among these groups. Factors influencing microbiologically proven clinical infections were also analysed. A total of 107 earthquake-affected adults (58 females and 49 males, median [IQR] age: 37 [27–57] years) were analysed. Infection was present in 50.5

IntroductionThe outcomes of patients admitted to intensive care units (ICUs) after earthquakes that occurred on the 6th of February 2023 in Türkiye are unknown. Our objective was to delineate the demographic and clinical characteristics, therapeutic approaches, and ICU outcomes of earthquake victims who were hospitalized in Turkish ICUs.MethodsThis was a retrospective multicenter study of adult patients admitted to 12 ICUs across eight tertiary hospitals located in five different cities within 2 weeks after consecutive earthquakes. Clinical and laboratory data were documented at four specific time intervals: upon hospital admission and during the first, second, and third days of ICU admission. To identify independent predictors of ICU mortality, a binary logistic regression model was used for variables identified from the univariate analysis.ResultsA total of 201 patients were admitted to ICUs. The median age of the entire cohort was 36 [26–54] years. 87 patients were male (43.3%), and 114 were female (56.7%). The majority of patients (79.1%) were initially admitted to the emergency department. The median duration of being trapped under the rubble was 12 [5–31] hours. The primary reason (63.7%) for ICU admission was crush syndrome. Acute kidney injury (AKI) was identified in 61.5% of patients. Of 201 patients, 184 had information regarding ICU survival. The ICU mortality rate was 10%. A five-year increase in age, the presence of crush syndrome, and the requirement for vasopressor therapy during ICU care were independently associated with increased ICU mortality rates, while an increase of one point in the Glasgow Coma Scale (GCS) score was favorable for ICU mortality.ConclusionThis study demonstrated that crush syndrome accounted for 63.7% of the reasons for ICU admissions. The ICU mortality rate was recorded as 10%. Noteworthy independent risk factors for mortality were the presence of crush syndrome, increased age, vasopressor treatment and lower GCS score.

Background: Despite a lack of sufficient knowledge about the prevalence and impact of hypophosphatemia in critically ill COVID-19 patients, organ dysfunction, adverse clinical outcomes, and increased mortality have been consistently associated with hypophosphatemia across diverse patient populations. This retrospective, observational study aimed to investigate hypophosphatemia (HypoP) frequency and establish the correlation between variations in serum phosphorus levels and outcomes in critically ill patients with SARS-CoV-2. Methods: The research comprised 205 patients diagnosed with COVID-19 confirmed via RT-PCR. The study included COVID-19 patients who experienced respiratory failure and were in intensive care for more than 24 hours, and their phosphorus values were accurately documented. Clinical para meters, comorbidities, respiratory support requirements, and laboratory findings were analysed. Results: The study participants had a median age of 64 (IQR: 54-75 years), with hypertension being the most pre - valent chronic disease (46%). During the first three days of intensive care, 33% of the participants received conventional oxygen support, whereas 54% required intubation and mechanical ventilation (MV). During this period, hypophosphatemia was noted in 25% of patients, with an ICU admission median serum phosphorus level of 1.02 (0.87-1.25) mmol/L. The median duration of stay in the intensive care unit (ICU) was 7 days, significantly extended in patients with hypophosphatemia (p=0.046). Phosphorus levels on the third day of ICU stay were an independent predictor of ICU mortality. (COX, HR=1.48, 95% CI=1.11-1.98, p=0.006) Conclusions: During the first three days of ICU admission, 25% of SARS-CoV-2 critically ill adult patients presented with hypophosphatemia. This condition was found to increase ICU mortality rates and prolong ICU stays. Therefore, it is crucial to monitor serum phosphorus levels in the care of critically ill COVID-19 patients.

Objectives: Critically ill COVID-19 patients are at high risk of malnutrition; however, no study has directly compared the prognostic accuracy of different nutritional assessment tools. This study aimed to determine the optimal cutoff values for the Modified Nutrition Risk in the Critically Ill (mNUTRIC) score, Nutritional Risk Screening 2002 (NRS 2002), and Malnutrition Universal Screening Tool (MUST) and to evaluate their predictive value for ICU mortality. Method: A retrospective analysis was conducted on patients with laboratory-confirmed COVID-19 admitted to our ICU between 20 March 2020 and 15 June 2021. Clinical and laboratory data, as well as patient outcomes, were retrieved from electronic medical records and patient charts. The mNUTRIC, NRS 2002, and MUST scores were calculated at ICU admission. Results: The study included 397 patients, with 273 survivors and 124 non-survivors. The median age was 65 (55-76) years, and the median BMI was 26.1 (24.0-29.4). Non-survivors had significantly higher median scores in all three nutritional assessment tools compared to survivors (mNUTRIC: 5 vs. 3, NRS 2002: 4 vs. 3, MUST: 2 vs. 2; p < 0.01). At the optimal cutoff values, mNUTRIC ≥ 4 demonstrated the highest prognostic accuracy (sensitivity: 0.77, specificity: 0.74; AUC = 0.75, CI = 0.70-0.81), followed by NRS 2002 ≥ 4 (sensitivity: 0.63, specificity: 0.60; AUC = 0.62, CI = 0.56-0.67) and MUST ≥ 3 (sensitivity: 0.21, specificity: 0.91; AUC = 0.56, CI = 0.50-0.68). Higher scores were associated with increased disease severity, poorer patient performance, prolonged hospital stays, and elevated ICU, 28-day, and overall hospital mortality rates. Among the three assessment tools, only an mNUTRIC score of ≥ 4 was independently associated with ICU mortality (OR = 1.54, CI = 1.21-1.96, p < 0.01). Conclusions: At ICU admission, mNUTRIC ≥ 4, NRS 2002 ≥ 4, and MUST ≥ 3 were identified as the most accurate predictors of mortality in critically ill COVID-19 patients. However, only the mNUTRIC score was an independent predictor of ICU mortality.

COVID-19 has worse clinical outcomes in inborn errors of immunity (IEI) patients. We aimed to determine COVID-19-related hospitalization/ICU admission/mortality risk in patients with IEI. We included 62 COVID-19 (29 children and 33 adults) in a referral center. F/M ratio was 0.94 with median age, 19 (8 months-64 years) years. 53.2% had primary antibody deficiency. Hospitalization rate was 11/29 in children, 21/33 in adults and 7/11 in patients with combined immunodeficiency diseases. Myalgia was more common in adults compared to children (p = 0.013). Inpatients have more cough compared to outpatients (p = 0.002). D-dimer and ferritin levels were higher in inpatients (p = 0.033 and p = 0.046, respectively). Cough (OR: 6.05; [95% CI: 1.76-20.74], p = 0.004) and immunoglobulin replacement therapy use in IEI (OR: 5.15; [95% CI: 1.46-18.11], p = 0.010) were related to hospitalization risk. Inpatients with intensive care unit (ICU) admission had higher ferritin levels (p = 0.02). 77.4% had at least one comorbidity like pulmonary (45.2%), autoimmune (38.7%), and gastrointestinal diseases (32.3%). ICU admission was high in agammaglobulinemia (40%) and immune dyseregulation (ID) (16.6%). An LRBA deficiency patient experienced MIS-C (Multisystem Inflammatory Syndrome in Children) and another died. Eight patients, four in the present center, received convalescent plasma (X-linked agammaglobulinemia [XLA] [n = 3], autosomal recessive agammaglobulinemia [n = 1], LRBA deficiency [n = 1], and CTLA4 deficiency [n = 1], CVID [n = 1], and STAT1 deficiency [n = 1]). Overall mortality was 6.5%, high in ID (16.6%), none in children. Higher D-dimer and ferritin levels is associated with a higher hospitalization ratio- twice in adults compared to children. Overall mortality (6.5%) was about six times the general population with no mortality in children. A high ICU ratio in agammaglobulinemia, suggesting the importance of mucosal IgA in COVID-19 defense. Convalescent plasma helps shorten hospitalization period in agammaglobulinemia.