ABSTRACT
Aim. To establish biomarkers for clinical, radiological, and laboratory severity of COVID-19 infection and to identify their relationships. Materials and methods. A retrospective study was carried out which included 155 patients undergoing treatment at the Hospital for War Veterans No. 3 with a confirmed diagnosis of novel coronavirus infection caused by nCoV from April 6 to June 10, 2020. All patients underwent clinical and laboratory examination. An intergroup statistical analysis of clinical and laboratory parameters was carried out depending on the criteria of clinical severity and severity of radiological signs of chest organ pathology according to computed tomography (CT). Results. Patients with mild COVID-19 showed a lower level of leukocytes, urea, creatinine, bilirubin, and aspartate dehydrogenase (AsAT), as opposed to the corresponding levels in patients with extremely severe course of the disease. A lower level of calcium in the peripheral blood was found in patients with severe COVID-19, along with an increase in blood glucose. Patients from the CT1 group as well as patients with a clinically mild course of the novel coronavirus infection had significantly lower levels of neutrophils, urea, creatinine, AsAT, and blood glucose and a higher level of blood calcium in comparison with patients with various CT patterns. In the group of patients with a fatal outcome, cardiovascular diseases were significantly more often detected, as opposed to the discharged patients. Conclusion. A number of biomarkers characterizing the severity of the novel coronavirus infection caused by the SARS-CoV-2 virus have been identified. However, the revealed differences in the laboratory markers of the clinical and radiological severity of the disease do not currently allow to give a clear answer about the nature of the relationship between the clinical severity of the disease, CT findings, and laboratory indicators of COVID-19 severity. © 2021 Siberian State Medical University. All rights reserved.
ABSTRACT
The objective: to evaluate the effect of high-flow oxygen and non-invasive ventilation on the mortality rate in adults with severe respiratory failure caused by the new coronavirus infection in the intensive care unit (ICU). Subjects and methods. A one-center retrospective study was conducted. Electronic medical files of patients treated in the ICU from April 1 to May 25, 2020, were analyzed. Totally, 101 medical files were selected, further, they were divided into two groups. Group 1 (n = 49) included patients who received oxygen insufflation, and should it fail, they received traditional artificial ventilation. No non-invasive respiratory therapy was used in this group. Group 2 (n = 52) included patients who received high-flow oxygen therapy and non-invasive ventilation. The mortality rate in the groups made a primary endpoint for assessing the impact of high-flow oxygen therapy and non-invasive ventilation. The following parameters were also analyzed: drug therapy, the number of patients in whom non-invasive techniques were used taking into account the frequency of cases when these techniques failed, and the number of patients in whom artificial ventilation was initiated. Results. In Group 2, non-invasive methods of respiratory therapy were used in 31 (60%) cases. High-flow oxygen therapy was used in 19 (36%) of them;in 13 cases this method allowed weaning them from the high flow. Non-invasive ventilation was used in 18 cases, in 12 patients it was used due to progressing severe respiratory failure during humidified oxygen insufflation, in 6 patients - after the failed high-flow oxygen therapy. In Group 1, 25 (51%) patients were intubated and transferred to artificial ventilation, in Group 2, 10 (19.2%) underwent the same. The lethal outcome was registered in 23 (47%) cases in Group 1, and in 10 (19.2%) in Group 2 (p = 0.004). Analysis of drug therapy in the groups revealed the difference in the prescription of pathogenetic therapy. Logistic regression demonstrated the effectiveness of the combination of tocilizumab + a glucocorticoid in reducing the frequency of lethal cases (p = 0.001). Conclusion. The use of non-invasive respiratory support in adults with severe respiratory failure caused by the new coronavirus infection combined with therapy by tocilizumab + a glucocorticoid can reduce the incidence of lethal cases. © 2021 New Terra Publishing House. All rights reserved.