Assessment of risk factors for thrombosis in ICU patients with COVID-19

Introduction: According to scientific studies, a high incidence of thrombotic events is known in hospitalized patients with COVID-19. Less than 50% of pulmonary embolisms (PE) are associated with signs of deep vein thrombosis (DVT) of the lower extremities. Background: To identify significant risk factors for thrombosis thrombosis (DVT) in intensive care patients with COVID-19. Materials and methods: We conducted a prospective cross-sectional study that included 465 adult patients with laboratory-confirmed COVID-19 admitted to the intensive care unit. All patients underwent computer tomography of the chest organs, ultrasound angioscanning of lower extremities, body mass index was calculated, the presence of comorbotity diseases and indicators of volumetric blood saturation were considered. The level of D-dimer in blood plasma, coagulation parameters (fibrinogen, factor VIII) were taken from laboratory parameters in calculations. For subgroups with 5 or fewer people, the chi-square test and Fisher's exact test were used. For quantitative variables, analysis of variance (ANOVA) and the Pearson and Spearman correlation coefficient were used. For multiple variables, ordered logistic regression models were built, with likelihood ratio tests performed to compare the models. Results: A total of 465 patients were included in the study. Comorbidities were present in 435 of 465 patients (93.55%) had at least one comorbidity. The most common was arterial hypertension - 370 (79.57%), followed by chronic heart failure - 196 (42.15%), obesity - 161 (34.62%), diabetes mellitus - 144 (30.97%), chronic renal failure (CRF) -58 (12.47%) and oncological diseases -25 (5.38%). The average body mass index was 29.7 kg/m2. In patients with DVT and venostasis, the body mass index (BMI) was more than 30 kg/m2 than without DVT (32.57+or-10.92 kg/m2, and 30.24+or-6.85 kg/m2, versus 29.22+or-6.46 kg/m2, respectively). Ultrasound angioscanning (USAS) confirmed deep vein thrombosis in 60 patients (13.8%) and was associated with older age (71.12+or-13.98 versus 67.20+or-11.16, p < 0.006), venous stasis was detected in 56 patients (12%) no DVT was detected in the rest of the studied patients. In the majority of cases, DVT was detected in the tibial segment -26 (43.33%), in 18 (30%) patients it was diagnosed in the popliteal veins and in 14 (23.33%) cases in the femoral segment. Diabetes mellitus (p=0.041), obesity (p=0.01) and CRF (p=0.028) were also significant risk factors for DVT. Conclusions: Significant risk factors for deep vein thrombosis in intensive care patients with COVID-19 are high levels of D-dimer (>=2.33 g/ml) and comorbidities such as obesity, chronic kidney failure, and diabetes mellitus.

COMPLEX ASSESSMENT OF COMPUTED TOMOGRAPHY OF THE LUNGS AND CLINICAL DATA IN COVID-19 PATIENTS, HOSPITALIZED IN THE CLINIC IN NUR-SULTAN

The ambiguity of the X-ray picture and clinic in patients with coronavirus infection (CVI) was the reason for this analysis in order to avoid diagnostic errors and to achieve the effect of the treatment. Conducted a comparative description of three clinical cases of patients with coronavirus infection COVID-19. All three patients differed in different parameters of SARS Co-2 PCR. In the first two patients who underwent CT on the 7th and 10th days from the onset of the disease on control CT after treatment, a regressive positive dynamics was observed;in the third patient, after an early CT scan on the second day of illness and on the next CT scan performed on the 10th day after the appearance of the clinic and a positive PCR test, progression of signs of viral pneumonia was observed with an increase in the affected area. Thus, the earlier CT was performed, the less pronounced the changes in the CT picture (the lesion volume is up to 5% or no changes are detected). When performing CT scan, patients with a long-term clinic (7-10 days from the onset of the disease) showed a characteristic picture of lung damage - up to 25-30%. The analysis of CT scans performed in the described clinical cases at different times from the onset of the disease, regardless of the results of PCR, confirms the need for CT scans 5-7 days after the first clinical signs appear. Also, as a result of our work, we once again received confirmation from numerous studies conducted in the world on the absence of a correlation between SARS Co-2 PCR and CT data.