ABSTRACT
INTRODUCTION: Despite the progress in understanding the pathophysiology of coagulopathy in COVID-19, data about the association and phasing of pathological changes in various parts of the hemostatic system with the development of acute respiratory distress syndrome (ARDS) are insufficient. OBJECTIVE: To determine association between the severity of respiratory failure and pathological changes in the hemostatic system in COVID-19 patients. MATERIALS AND METHODS: A prospective observational study included 204 patients with a confirmed diagnosis of severe and extremely severe COVID-19. Two groups were identified according to disease outcome: Fatal (n = 106) and survived (n = 98) groups. To assess dynamics of the clinical picture of the disease and to study the hemostatic profile, time points were determined: I point — the first day — admission to intensive care unit;II point — 3-5 days, III point — 7-10 days after ICU admission. The respiratory index was calculated to assess the severity of respiratory distress syndrome. Statistical data processing was carried out using the statistical software package MedCalc Version 20.110 (MedCalc Software Ltd, Belgium). RESULTS: A 2.15-fold decrease in the respiratory index was determined for fatal outcome in patients with severe and extremely severe COVID-19. The most important hemostatic parameters affecting the severity of respiratory failure are increased Willebrand factor concentration at I point of the study (21% contribution and inverse correlation), increased plasminogen activator inhibitor type 1 (PAI-1) level on 3-5 days (35% contribution and direct correlation), and activation of the coagulative component of hemostasis on 7-10 days (78% contribution and direct correlation). CONCLUSIONS: The severity of respiratory failure in patients with a confirmed diagnosis of severe and extremely severe COVID-19 is gradually associated with endotheliopathy (1 day), inhibition of parietal fibrinolysis (3-5 days) and activation of the coagulative component of hemostasis by 7-10 days of ICU stay. © 2023, Practical Medicine Publishing House LLC. All rights reserved.
ABSTRACT
The objective: to study the relationship between markers of imbalance in the platelet-vascular hemostasis system and lung damage and disease outcome in patients with COVID-19. Subjects and Methods: the study included 225 patients with the confirmed diagnosis of moderate, severe and extremely severe COVID-19. In all patients, lung damage was confirmed using computed and X-ray diagnostic methods. We studied the concentration of von Willebrand factor (vWF), activity of metalloproteinase ADAMTS-13, concentration of homocysteine, endothelin-1, thrombomodulin and the number of platelets and changes in these parameters on the 1st, 3-5th and 7-10th days from the admission to the intensive care unit (ICU). In deceased patients (n = 106), lung specimens were collected to assess the nature of morphological changes. Results. It was determined that by the 7-10th days with a lethal outcome of the disease, there was a statistically significant increase in the concentration of vWF by 22.2% (p = 0.0225), the vWF/ADAMTS-13 ratio by 2 times (p = 0.0408) and decrease in the platelet count by 52% (p = 0.0008) versus the initial stage of the study. In all the deceased, the morphological picture of lung tissue damage was characterized by destruction of alveolocytes, proliferation of connective tissue, cellular infiltration, plethora of capillaries, parietal erythrocyte thrombi in the lumen of capillaries, arterioles and venules, and obstructive erythrocyte thrombi in the lumen of vessels of lung microcirculation. Conclusion. The study showed that a possible cause of thrombosis in the lumen of vessels of lung microcirculation in the case of a lethal outcome of COVID-19 might be a primary imbalance in the vascular-platelet hemostasis characterized by a significant increase in the concentration of the vWF factor, the vWF/ADAMTS-13 ratio and a decrease in the number (consumption) of platelets by the 7-10th day of the disease versus the initial stage of the study. © 2022 Messenger of Anesthesiology and Resuscitation. All rights reserved.
ABSTRACT
In November-December 2020, the Federation of Anesthesiologists and Reanimatologists has conducted a survey of intensive care units (ICU) in 100 hospitals re-profiled for the treatment of COVID-19. There were regional (n=44), city (n=31), district (n=13), inter-district (n=8) and federal (n=4) hospitals from 27 constituent entities of the Russian Federation. Capacity of 59 hospitals was less than 300 beds, 23 hospitals — over 500 beds, 18 hospitals — 300—500 beds. The number of ICU beds exceeded 10% of repurposed beds in 35 hospitals, 5—10% of ICU beds — in 51 hospitals, less than 5% — in 14 hospitals. There were 6—12 patients per one physician in 68 ICUs, less than 6 patients — in 12 ICUs, over 12 patients — in 20 ICUs. Also, there were 3-6 patients per a nurse in 69 ICUs, less than 3 patients — in 2 ICUs, over 6 patients — in 29 ICUs. Over 70% of the repurposed beds were provided with a networked oxygen supply in 61 hospitals, 50—70% — in 25 hospitals, less than 50% — in 14 hospitals. Oxygen flow rate over 10 l/min was provided in 70 hospitals, 5—10 l/min — in 28 hospitals, less than 5 l/min — in 2 hospitals. Over 80% of ICU beds are equipped with ventilators in 78 hospitals, 50—80% — in 15 hospitals, less than 50% — in 7 hospitals. Less than 5% of ventilators have been out of order throughout the pandemic in 62 ICUs, 5—10% — in 20 departments, over 10% — in 18 ICUs. High-flow oxygen therapy was not available in 48 ICUs, ultrasound — in 10 ICUs. ECMO was available only in 17 ICUs. If we consider the pandemic as a model of health system response to non-standard global challenges, these data are essential for critical analysis despite small sample size. © 2021, Media Sphera Publishing Group. All rights reserved.