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Aim. The aim of our work is to establish the prognostic significance of demographic indicators and the Charlson comorbidity index (CCI) in oxygen-dependent patients with coronavirus disease (COVID-19).Material and methods. The research included 211 oxygen-dependent patients with COVID-19: I group - 94 patients who reco-vered;II group - 117 patients, the disease ended fatally. We used the WHO age classification when analyzing the age structure of patients. The Charlson comorbidity index was calculated for each patient. The patients were divided into groups Statistical data processing was carried out in the program Statistica for Windows 13 (StatSoft Inc., No. JPZ804I382130ARCN10-J).Results. It was established that the median age of the II group patients was higher (P < 0.001) than patients the I in group. Elderly patients were more often registered in the II group than among patients in group I (25.6 % vs. 8.5 %, P = 0.001). Middle-aged patients were more often registered in the I group than among patients in the II group (34.0 % vs. 19.4 %, P = 0.02). According to the result of the ROC analysis, the prognostic value of the age of the patients was established, namely, under conditions of age >66 years (AUC = 0.636, P = 0.002), the probability of a fatal outcome of COVID-19 was significant.Analysis of the influence of comorbid conditions on the risk of COVID-19 fatal outcome in oxygen-dependent patients according to the CCI showed that the absence of comorbid pathology was more common among patients of group I than among patients of group II (12.8 % vs. 2.6 %, P = 0.004). The level of CCI in patients of the II group significantly exceeded the corresponding indicator of the patients of the I group (P < 0.01), who recovered. According to the obtained result of the ROC analysis, the prognostic value of this indicator was established, namely under the conditions of the CCI index >5 in oxygen-dependent patients with COVID-19 (AUC = 0.652, P < 0.001) the probability of fatal outcome of the disease was significant.Conclusions. In oxygen-dependent patients with COVID-19, patient age and comorbidity are associated with disease outcome. Under conditions of age >66 years (AUC = 0.636, P = 0.002) and the Charlson comorbidity index >5, the probability of a fatal outcome of the disease is significant (AUC = 0.652, P < 0.001).
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The aim of the work - to provide variants of extrapulmonary manifestations of coronavirus disease (COVID-19) based on the analysis of the relevant course of the disease in adults.Results. The paper presents two clinical cases of coronavirus disease (COVID-19) with the manifestation of extrapulmonary symptoms, which required some individualization of therapy.The first clinical observation showed that in a 56-year-old patient with moderate COVID-19, the development of oxygen dependence on the 8th day of the disease was combined with the manifestation of extrapulmonary symptoms in the form of cutaneous manifestations. Individualization of glucocorticosteroid therapy and endothelioprotective therapy has been shown to be effective in regressing both oxygen dependence and cutaneous vasculitis.The second clinical observation showed that in a 35-year-old patient, moderate COVID-19 without oxygen dependence was accompanied by the development of extrapulmonary manifestations, namely short-lasting diarrheal syndrome, which manifested in the onset of the disease and of the development of orchiepididymitis on the 9th day of illness, which required the appointment of anti-inflammatory therapy.Conclusions. The abovementioned clinical observations of COVID-19 cases show relatively rare cases of SARS-CoV-2-associated extrapulmonary manifestations in patients with moderate disease, but their development necessitated individualization of treatment.
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The aim of the study is to analyze the literature data on modern views concerning extrapulmonary manifestations of coronavirus disease (COVID-19).Based on the analysis of current publications, the article analyzes the clinical manifestations of coronavirus disease (COVID-19) as a multisystem disorder with two main types of clinical manifestations, namely pulmonary and extrapulmonary. Determining pathogenetic mechanisms of extrapulmonary symptoms are, on the one hand, the tropism of SARS-CoV-2 to ACE2 receptors, expressed not only by alveolar epithelial type II cells, but also by cells of the heart, nervous system, vascular endothelium, small and large intestine, basal layer cells of the epidermis, cells of endocrine organs, etc., and on the other hand, immune-dependent mechanisms, in particular the development of "cytokine storm".It is shown that the spectrum of extrapulmonary manifestations of COVID-19 is very wide, and clinical manifestations are characterized by significant polymorphism. Extrapulmonary symptoms of COVID-19 were analyzed considering the organs of the gastrointestinal tract, nervous, cardiovascular and endocrine systems, skin and others. Attention is drawn to a certain association between definite extrapulmonary manifestations and the severity of COVID-19 course.Thus, particular extrapulmonary manifestations are associated with a milder course of COVID-19 (anosmia, dysgeusia, etc.), others, vice versa, occur in severe disease (damage to liver, kidney, heart, pancreas). In addition, some extrapulmonary manifestations, especially of the nervous system, may remain in patients even after an acute period of the disease. Some extrapulmonary manifestations, which are currently described in a small number of patients, are also reviewed.Conclusions. COVID-19 is characterized by a wide range and high frequency of extrapulmonary manifestations, which is ex-plained by both the direct action of SARS-CoV-2 and immune-dependent mechanisms. Some extrapulmonary manifestations are associated with a milder course of COVID-19, others, on the contrary, occur in severe disease.
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The aim of the work - to present a case of positive use of tocilizumab in the treatment of pregnant woman with severe COVID-19. Materials and methods. A self-observation clinical case of severe coronavirus disease (COVID-19) in pregnant K., 40 years old, who was treated at Municipal Non-Profit Enterprise "Regional Infectious Diseases Clinical Hospital" of Zaporizhzhia Regional Council. The patient was treated in accordance with the "Protocol for the provision of medical care for the treatment of coronavirus disease (COVID-19)". Results. Our own clinical observation demonstrates the formation of severe COVID-19 in a 40-year-old pregnant woman in the second trimester of pregnancy. Combination treatment with glucocorticoids in the presence of oxygen dependence on the 11th day of the disease was ineffective for two days of clinical and laboratory parameters monitoring, which required a decision on the additional appointment of tocilizumab. The development of "cytokine storm" clinical and laboratory signs on the 12th day of the disease was evidenced by the preservation of fever in the range of 37.5-37.8 degrees C, no regression of oxygen dependence. According to laboratory data, an increase in the severity of lymphopenia as a relative quantity - up to 5 % and absolute quantity - up to 0.5 x 10(9)/l, an increase in fibrinogen - up to 5.8 g/l and D-dimer - up to 1.9 ng/ml, high level of C-reactive protein - up to 190 mg/l. These data justify the additional use of tocilizumab, which was administered at a dose of 8 mg/kg in the absence of contraindications. Tocilizumab administration was effective, contributing to oxygen dependence regression and recovery of laboratory parameters within a week. Conclusions. Our own clinical observation demonstrates the formation of severe COVID-19 in pregnant woman in the second trimester of pregnancy. Due to the ineffectiveness of glucocorticosteroid therapy and the presence of clear clinical and laboratory signs of "cytokine storm" on the 12th day of the disease, the use of tocilizumab was effective, which contributed to the oxygen dependence regression and recovery of laboratory parameters within a week. Treatment of pregnant woman with severe COVID-19 requires adherence to existing protocols.
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In patients with COVID-19, histological examination of the pulmonary vessels shows serious disorders (local thrombosis and microangiopathy), significantly different to those in the control group composed of patients with influenza. Some studies have shown that coronavirus enters cells by binding angiotensin-converting enzyme 2 which is found mainly on the alveolar epithelium and endothelium. The increase in D-dimer levels is typical for patients with COVID-19. Although many inflammatory processes can affect D-dimer levels, an increase in D-dimer during COVID-19 is more likely to indicate thrombosis. The aim. To analyze the patients who have suffered from COVID-19 and to determine possible risk factors for the development of thrombotic complications and define the surgical or medical therapy tactics. Material and methods. The study was conducted from October 2020 to April 2021 in Ukraine (Zaporizhzhia, Uzhhorod, Kherson and Kyiv). We analyzed 121 patients aged 46.9± 15.3 years, 64 (52.8%) men and 57 (47.1%) women. All the patients had positive PCR test for COVID-19. The changes in D-dimer were analyzed. Results. Forty-one (33.9%) patients had thrombotic complications. Pulmonary embolism (PE) was diagnosed in 14 patients, deep vein thrombosis (DVT) in 17, acute stroke in 2 and peripheral artery thrombosis in 8 cases. An increase in D-dimer level was observed in most patients and was not associated with clinical manifestations of thrombosis. At a D-dimer level of 11,000-10,564 ng/ml the patients had clinical symptoms of thrombotic condition which was confirmed by computed tomography or ultrasound examination. At an increase over 725-7000 ng/ml, there were no clinical signs of thrombosis. We performed standard medical therapy in patients with PE and DVT. In case of arterial thrombosis open surgery was performed in 4 patients and direct catheter thrombolysis in 1 case. Conclusion. In our opinion, anticoagulants should be prescribed for patients with a D-dimer level of more than 700 ng/ml. Full anticoagulation is prescribed for severe forms of COVID-19 or confirmed thrombosis. We didn’t find any correlation between the development of thrombotic complications in patients with COVID-19 and comorbidities, body mass index and other factors. Medical therapy was successful in all cases of PE and DVT, anticoagulants were prescribed for 1 year. Femoral artery thrombectomy was successfully performed in 4 patients. After direct catheter thrombolysis we got peripheral pulse. In all cases of arterial thrombosis, we prescribed anticoagulants for 2 months after discharge and acetylsalicylic acid for a long time. © 2022 The Authors. Published by Professional Edition Eastern Europe.
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The aim of the work - to conduct clinical and pathomorphological analysis of deaths from COVID-19 in 2020. Materials and methods. We analyzed 41 case histories and results of pathological-anatomical examination of patients who were died of COVID-19 during 2020. Results. The lethal outcome of COVID-19 disease was recorded at day 22 (16;27) of the disease. Among the dead, there is a high percentage of men (73.2 %), early old age and middle old age patients (75.6 %) with comorbid pathology (92.7 %). Early lung damage with COVID-19 in the deceased was determined by pronounced interstitial and interstitial-alveolar edema, the presence of erythrocyte stasis in the pulmonary microvessels, blood clots and hypoperfusion leukocyte stasis, as well as the presence of erythrocytes in the alveoli. Bilateral polysegmental subtotal viral pneumonia in 90.2 % of dead patients was characterized by significant edema and thickening of the alveolar walls with their moderate infiltration by lymphocytes, focal peribronchial and perivascular inflammatory polymorphonuclear infiltration, multiple and small exfoliated alveolar epithelium (87.8 %), as well as metaplasia of a few alveolocytes preserved on the luminal surface of the alveoli (82.9 %). Every tenth person who died of COVID-19 had signs of secondary bacterial microflora. In 85.4 % of patients who died on day 22-27 of the disease focal or sublobar pneumofibrosis was diagnosed. In those who died due to COVID-19, multiorgan failure was characterized by focal necrosis of the renal tubular epithelium (73.2 %), focal lymphocytic-leukocyte infiltration (12.2 %) and renal microvascular thrombosis (17.1 %), focal centro-lobular necrosis (90.2 %) and focal lymphocytic-leukocyte infiltration of lobes (7.3 %) of the liver. Thrombotic complications were confirmed in 22.0 % of deceased patients: ischemic cerebral infarction, transmural myocardial infarction, pulmonary embolism, deep vein thrombosis of the lower extremities under the pathology. These thrombotic complications were not diagnosed during life in all patients. The majority of deaths due to COVID-19 had morphological signs of chronic cardiovascular pathology. Ischemic heart disease and hypertension during the life of patients were not diagnosed in all cases. Conclusions. Early lung damage in COVID-19 in the deceased was determined by pronounced interstitial-alveolar edema, blood clots and leukocyte stasis in microvessels, less often - the presence of "hyaline membranes". In 90.2 % of the dead patients bilateral polysegmental subtotal pneumonia with edema and lymphocytic infiltration of the pulmonary interstitium, inflammatory peribronchial and perivascular focal polymorphonuclear infiltrates, foci of atelectasis and dyscryphaseses was found. In 9.7 % of patients bilateral subtotal viral-bacterial fibrinous-purulent bronchopneumonia developed. In those who died on the 22nd-27th day of the disease focal pneumofibrosis was determined. Pathomorphologically, thrombotic complications, which were not diagnosed in all patients during their lifetime, were confirmed in 22.0 % of deceased patients. Most deaths from COVID-19 had morphological signs of chronic cardiovascular disease.
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The aim was to analyze spectrum of comorbid pathology and age structure of oxygen-dependent patients with severe coronavirus disease 2019 (COVID-19) depending on outcomes of the disease. Materials and methods. The study included 85 oxygen-dependent patients with severe COVID-19. The patients were divided into groups: I - 70 patients with recovery;II - 15 patients in whom the disease was fatal. Statistical data processing was performed in the program Statistica for Windows 13 (StatSoft Inc., No. JPZ804I382130ARCN10-J). Results. Among the patients with fatal outcomes of the disease, elderly and senile were dominated - 93.3 % (14 of 15) versus 67.1 % (47 of 70) among patients who recovered (P < 0.05). Analysis of comorbid pathology structure in oxygen-dependent patients with severe COVID-19 showed that patients who died more often had hypertension (93.3 % vs. 30.0 %, P < 0.001), postinfarction cardiosclerosis (26.7 % vs. 2.9 %, P < 0.001), rhythm disturbance as persistent atrial fibrillation (20.0 % vs. 1.4 %, P < 0.01) as compared to those who survived. The patients of group II were more commonly diagnosed with chronic kidney disease (20.0 % vs. 4.3 %, P < 0.05) as the comorbid pathology. The presence of ischemic stroke in COVID-19 infection influenced the disease outcome (20.0 % vs. 4.3 %, P < 0.05). Fatal outcomes in the patients with COVID-19 were associated with a combination of 3 or more comorbid conditions in 46.7 % versus 17.4 % among oxygen-dependent survivors with severe disease (P < 0.01). Conclusions. Elderly and senile oxygen-dependent patients are more likely to die from severe COVID-19 (P < 0.05). Comorbid hypertension, postinfarction cardiosclerosis, arrhythmia in the form of persistent atrial fibrillation, chronic kidney disease and ischemic stroke or the combination of 3 or more comorbid conditions listed are more common among patients with COVID-19 who died (P < 0.05) as compared to survivors.