Potential predictors of severe course and outcome of community-acquired pneumonia.

Severe pneumonia is a condition with a high risk of death and mandatory hospitalization in the intensive care unit. The incidence of severe pneumonia has increased dramatically during the pandemic of new coronavirus infection. Timely diagnosis and early initiation of adequate treatment of severe pneumonia are crucial for improving survival of critically ill patients. The aim of this review was to analyze published scientific research on molecular markers that allow to objectively assess the severity of pneumonia and to determine treatment tactics based on the predicted outcome upon admission to the hospital. A systematic search was conducted in the electronic databases PubMed, Medline, Web of Science for the period 2019 - 2022. Conclusion. The review focuses on the prognostic role of a number of markers of immune response, vascular transformation, as well as angiotensin II and angiotensin converting enzyme-2. Further prospective studies of potential predictors of severe pneumonia will enable using marker molecules in a comprehensive clinical and laboratory diagnosis for early prediction of the hospitalized patient's condition and expected outcome.Copyright © Volchkova E.V. et al., 2023.

Potential predictors of severe course and outcome of community-acquired pneumonia

Severe pneumonia is a condition with a high risk of death and mandatory hospitalization in the intensive care unit. The incidence of severe pneumonia has increased dramatically during the pandemic of new coronavirus infection. Timely diagnosis and early initiation of adequate treatment of severe pneumonia are crucial for improving survival of critically ill patients. The aim of this review was to analyze published scientific research on molecular markers that allow to objectively assess the severity of pneumonia and to determine treatment tactics based on the predicted outcome upon admission to the hospital. A systematic search was conducted in the electronic databases PubMed, Medline, Web of Science for the period 2019 – 2022. Conclusion. The review focuses on the prognostic role of a number of markers of immune response, vascular transformation, as well as angiotensin II and angiotensin converting enzyme-2. Further prospective studies of potential predictors of severe pneumonia will enable using marker molecules in a comprehensive clinical and laboratory diagnosis for early prediction of the hospitalized patient's condition and expected outcome. © Volchkova E.V. et al., 2023.

Potential predictors of severe course and outcome of community-acquired pneumonia.

Severe pneumonia is a condition with a high risk of death and mandatory hospitalization in the intensive care unit. The incidence of severe pneumonia has increased dramatically during the pandemic of new coronavirus infection. Timely diagnosis and early initiation of adequate treatment of severe pneumonia are crucial for improving survival of critically ill patients. The aim of this review was to analyze published scientific research on molecular markers that allow to objectively assess the severity of pneumonia and to determine treatment tactics based on the predicted outcome upon admission to the hospital. A systematic search was conducted in the electronic databases PubMed, Medline, Web of Science for the period 2019 - 2022. Conclusion. The review focuses on the prognostic role of a number of markers of immune response, vascular transformation, as well as angiotensin II and angiotensin converting enzyme-2. Further prospective studies of potential predictors of severe pneumonia will enable using marker molecules in a comprehensive clinical and laboratory diagnosis for early prediction of the hospitalized patient's condition and expected outcome.Copyright © Volchkova E.V. et al., 2023.

Cytokine patterns of fatal hyperinflammatory conditions, caused by secondary hemophagocytic lymphohistiocytosis, bacterial sepsis and COVID-19

Introduction. In severe cases of coronavirus disease 2019 (COVID-19) pulmonary infiltration is accompanied by cytokine storm syndrome (CSS) development. Besides COVID-19, CSS can be triggered by the range of pathologies, which include hemophagocytic lymphohistiocytosis (sHLH) and septic shock (SS). The aim of this study was to compare immunological profiles in fatal cases of COVID-19, sHLH and SS. Material and methods. Serum levels of IL-1β, IL-2, IL-6, IL-8, IL-10, IL-17A, IL-18, IFN-γ, TNF-α, procalcitonin, neopterin, ferritin with percent of glycosylated fraction (% GF) were measured in 37 COVID-19 fatal cases, collected during 2020 year prospectively;and in 39 sHLH and 47 SS fatal cases, collected within 2018–2019 years retrospectively. Comparison groups also included 194 non-fatal COVID-19 cases and 20 healthy donors, collected during 2020 year. Cytokine concentrations, procalcitonin and neopterin were measured by enzyme-linked immunosorbent assay;the ferritin level was determined by the turbidimetry method. The percent of glycosylated ferritin fraction (% GF) was calculated by the modified method of M. Worwood et al. Results. Deceased patients with COVID-19 had higher IL-6, IL-8, IL-10, IL-18, procalcitonin median levels compared to the survived. Meanwhile IL-8, IL-18, IFN-γ, TNFα and ferritin concentrations were significantly lower in deceased COVID-19 patients compared to sHLH and SS. The levels of IL-6 and procalcitonin in fatal COVID-19 were comparable to SS, but significantly higher than in sHLH. Leucocytes were higher in COVID-19 compared to both SS and sHLH. Conclusion. Each fatal condition was accompanied by specific features of the cytokine profile: high IL-6 combined with low IFN-γ, TNFα in COVID-19;high IL-8, IL-6 with low IL-17A, IL-2 in SS;high IL-18, ferritin, IFN-γ with low IL-6, procalcitonin, % GF in sHLH.

Changes in pulmonary microcirculation after COVID-19

The endothelium is a tissue most vulnerable to the SARS-CoV-2 virus. Systemic endothelial dysfunction leads to the development of endothelitis which causes the main manifestations of the disease and systemic disturbance of microcirculation in various organs. Pulmonary microcirculatory damage, the most striking clinical manifestation, was the reason to perform SPECT to detect microcirculation disorders. Aim. To assess microcirculatory changes in the lungs of patients who had no previous respiratory diseases and had a COVID-19 infection at different times from the onset of the disease. Methods. SPECT data were analyzed in 136 patients who had a proven coronavirus infection of varying severity from May 2020 to June 2021. Results. All patients showed changes in microcirculation in the lungs in the post-COVID period. The severity of microcirculation disorders had a significant correlation (rs = 0.76;p = 0.01) with the degree of damage to the pulmonary parenchyma and an average correlation (rs = 0.48;p = 0.05) with the timing of the post-COVID period and the degree of residual lesions on CT (rs = 0.49;p = 0.01). The examined patients with persistent clinical complaints had pulmonary microcirculatory lesions, which may indicate the development of vasculitis, at all stages of the post-COVID period. Despite regression of the lesions confirmed by CT in 3 to 6 months after the acute COVID-19 infection, specialists from Russian and other countries report that 30–36% of patients develop pulmonary fibrosis. Similar changes were identified in 19.1% of the examined patients in our study. Conclusion. Microcirculation disorders are detected in all patients in the post-COVID period, irrespective of the severity according to CT. Progressive decrease in microcirculation in the lower parts of the lungs, local zones of hypoperfusion with the critically low accumulation of radiopharmaceuticals, persistent areas of compaction of the lung tissue (so-called “ground glass”), reticular changes, and the development of traction bronchiectasis, a decrease in the diffusion capacity of the lungs and alveolar volume may indicate fibrotic lesions with subsequent development of virus-associated interstitial lung disease. © 2021 Medical Education. All rights reserved.

Single-photon emission tomography of the lungs in the diagnosis of coagulopathyin patients in the postcovid period

Introduction. Exposure to SARS-CoV-2 leads to damage and dysfunction of the microvasculature of the lungs. The development of vasculitis, an increase in the permeability of the vessel wall, changes in the vascular-platelet and coagulation hemostasis, lead to the development of thrombosis / thromboembolism and hemorrhages. Single-photon emission tomography of the lungs is optimal for assessing changes in microcirculation in the lungs of patients with COVID-19 infection, since CT angiography can detect these formidable complications only in the large vessels of the lungs. Objective of the work. To assess changes in the microvasculature of the lungs in patients with the development of postcovid syndrome and to assess the possibilities of single photon emission computed tomography in the diagnosis of thromboembolism, thrombosis and hemorrhages. Material and methods. The data of radiological studies performed in 138 patients in the postcovid period were analyzed, directed for examination to assess changes in blood circulation in the lungs and identify complications of the disease (thromboembolism, thrombosis, hemorrhages). Results. In patients who underwent an infection caused by the SARS-CoV-2 virus in a mild form, we identified changes in microcirculation most characteristic of manifestations of vasculitis and small local blood flow defects close to a triangular shape (microthrombosis), which correlated with an increase in fibrinogen (4.32 ± 0.21 g/L) (rs = 0.97;p = 0.001). Signs of microthrombosis, pulmonary embolism were detected in 35.9% of moderately severe patients who did not receive anticoagulant therapy or was prescribed it on day 10-12 of illness, and in 67.2% of severe and extremely severe patients who received anticoagulant therapy during the illness. Signs of postthromboembolic changes were detected in 16 patients (59.2%) in the late postcovid period, which correlated to a high degree (rs = 0.81;p = 0.03) with an increase in the level of fibrinogen (4.5 ± 1.9 mg/l). Conclusions. The severity of microcirculation disorders in the lungs depends on the severity of the disease and the timing of the postcovid period. Signs of small branch thromboembolism / thrombosis are detected in the early postcovid period. In patients who have undergone COVID-19 with the development of thrombosis, signs of postponed pulmonary embolism are revealed and zones of local pneumosclerosis are formed. © 2021, Remedium Group Ltd. All rights reserved.

The effectiveness of combination of 7% hypertonic saline and 0.1% natrii hyaluronas in patients with chronic obstructive pulmonary disease who have suffered a new coronavirus infection

Introduction. New coronavirus infection (COVID-19) contributes to the aggravation of respiratory symptoms in patients with COPD, including affecting the intensity and nature of cough. Hypertonic solution (HS) has a positive effect on the rheological properties of sputum and mucociliary clearance. However, there are no studies in the available literature on the use of HS in patients who have undergone COVID-19. Goal. To evaluate the effect of the combination of 7% hypertonic saline and 0.1% natrii hyaluronas on the intensity and productive nature of cough in patients with COPD who have undergone a new coronavirus infection and the safety of its use in this cohort of patients. Materials and methods. 50 patients with severe COPD in remission who suffered a new coronavirus infection were examined. The rehabilitation stage of treatment was carried out in the conditions of the pulmonology department. From the moment of receiving the last negative PCR result for SARS-CoV-2 to admission to the hospital for rehabilitation, it took from 2 to 3 weeks. The duration of follow-up of patients was 10 days. The patients were divided into two groups: group 1 (n = 25) - patients who received combination of 7% hypertonic saline and 0.1% natrii hyaluronas 7% by inhalation through a nebulizer;group 2 (n = 25) - patients who did not receive combination of 7% hypertonic saline and 0.1% natrii hyaluronas. The severity of cough was assessed (cough severity scale;shortness of breath, cough and sputum scale), clinical and biochemical blood tests, ECG, spirometry. Results. In patients treated with combination of 7% hypertonic saline and 0.1% natrii hyaluronas, a significant decrease in the severity of cough, the amount of sputum was revealed. The tendency to reduce shortness of breath and improve the quality of life is determined. No serious adverse events were detected when using the drug. Conclusions. The use of the combination of 7% hypertonic saline and 0.1% natrii hyaluronas in patients with COPD who have suffered a new coronavirus infection at the rehabilitation stage leads to a decrease in the intensity of cough and improved sputum discharge, which helps to reduce the severity of shortness of breath and improve the quality of life. The use of the drug is safe and does not lead to clinically significant adverse events. © 2021, Remedium Group Ltd. All rights reserved.

Critical values of laboratory tests in outcomes of patients with covid-19

Laboratory monitoring during the SARS-CoV-2 pandemic is essential in providing emergency care to patients with COVID-19. Objective. To determine the critical values of laboratory tests in patients with COVID-19 pneumonia for optimizing the treatment. Material and methods. Case histories of 6151 patients were retrospectively analyzed at the St.-Petersburg City Multi-field Hospital No. 2 redesigned for providing medical care to COVID-19 patients between March 30, 2020 and July 26, 2020. All patients were retrospectively divided into 3 groups: group 1 — patients without mechanical ventilation (n=5646 (92%));group 2 — invasive mechanical ventilation without lethal outcome (n=69 (1%));group 3 — invasive mechanical ventilation with lethal outcome (n=436 (7%)). Results. Considering literature data, we distinguished the following perspective tests: ferritin, leukocyte count, absolute neutrophil count, absolute lymphocyte count, platelet count, C-reactive protein, alanine aminotransferase, aspartate aminotransferase, total bilirubin, troponin I, creatinine, and urea. Medians and 25— 75% percentiles were calculated for all laboratory tests in 3 groups. We compared the results between all groups and assessed their reference intervals for the final choice of critical values. Conclusion. The authors propose to use their results as reference critical values of laboratory tests for assessing the condition of patients with COVID-19 pneumonia. © 2021, Media Sphera Publishing Group. All rights reserved.

Disorders of microcirculation in the lungs according to perfusion spect data in patients in post COVID-19 condition

Сonsidering the influence of the SARS-CoV-2 virus on the pulmonary vascular system, manifested by the development of endotheliitis, vasculitis, thrombosis and coagulopathies, one of the leading directions of radiological examination may be the study of microcirculation by SPECT. Purpose. To assess changes in the microvasculature of the lungs of patients who have undergone COVID infection at different times from the onset of the disease. Material and methods. SPECT data were analyzed in 170 patients with previous coronavirus infection from May 2020 to June 2021 of varying severity. The results of SPECT, MSCT, FVD and coagulation hemostasis (D-dimer, fibrinogen) were compared. Results. All patients were found to have changes in microcirculation in the lungs in the postcoid period. The severity of microcirculation disorders had a significant dependence (p <0.05, r = 0.76) on the degree of damage to the pulmonary parenchyma and an average correlation dependence (r = 0.51) on the timing of the postcoid period. Signs of PE / microthrombosis changes were significantly more frequent (p <0.05, r = 0.82) in patients with a more severe course of the disease. In patients with CLD, microcirculation decreased to critical levels, the overall level of decrease was up to 30% or more compared to the dock period (p = 0.034). The detection of small subsegmental level of triangular microcirculation defects, with partially restored blood flow, correlated to a high degree (r = 0.84) with an increase in the level of fibrinogen (4.6 + 1.8 mg / l) and indicated the consequences of PE, and an increase in the level of D-dimer (1750+ 215 ng / ml) with the presence of a triangular shape of defects in the accumulation of radiopharmaceuticals correlated to a high degree (r = 0.88) with PE. Conclusion. Disorders of microcirculation in the lungs persist for a long time. They are detected in patients, regardless of the severity of the course of the pathological process, they increase during a dynamic study in patients, the deficit of perfusion depends on the degree of damage to the pulmonary parenchyma. The SARS-CoV-2 virus has a detrimental effect on the state of blood circulation in patients with chronic lung diseases. In patients who have undergone COVID-19 with the development of thrombosis, signs of postponed pulmonary embolism are revealed and zones of local pneumosclerosis are formed. © 2021 Russian Electronic Journal of Radiology. All rights reserved.

Endothelial progenitor cells in pathogenesis of new coronaviral infection

Pulmonary vascular endothelium dysfunction is one of the main pathogenic factors responsible for many clinical manifestations of the severe course of COVID-19. Circulating endothelial progenitor cells (EPCs) are the endogenous regenerative reserve that maintains the integrity of the vascular endothelium and its restoration in case of damage by pathogenic factors. A decrease in the circulating EPCs is regarded as a predictor of morbidity and mortality in conditions associated with development of endothelial dysfunction, including COVID-19. The exact phenotype of progenitor cells capable of differentiating into endothelial cells has not been determined. In most laboratories antigens CD133+, CD34+, VEGFR-2+ (CD 309) or combination of these are used to identify EPCs. The process of EPCs mobilization and migration is controlled by molecular signals from immune cells located in the damage area. Stromal cell factor 1 (SDF-1), produced by the bone marrow and many other tissues, is an important chemoattractant for EPCs which express its receptors. The results of studies carried out in 2020 indicate that SARS-Cov-2 infects both hematopoietic stem cells, transforming into EPCs, and directly circulating EPCs, causing inflammatory and procoagulant reactions that complicate the COVID-19 course. There is no consensus on the mechanism of EPCs infection with coronavirus – directly through the expression of angiotensin-converting enzyme (ACE2) receptor or through an ACE2-independent mechanism. Today there is no effective therapy for COVID-19. The use of the EPCs regenerative potential, and the search for ways to enhance the EPCs mobilization from the depot, and increase their functional activity may become a promising approach to the prevention of severe complications and mortality from COVID-19. © 2021, Remedium Group Ltd. All rights reserved.

Analysis of COVID-19 cases in adult cystic fibrosis patients in Saint-Petersburg and the Leningrad region

March 11, 2020 WHO has declared the COVID-19 coronavirus pandemic. The European Society for Cystic Fibrosis (ECFS) has developed the ECFSCOVID-19 surveillance program to collect information on the characteristics of COVID-19 in patients with cystic fibrosis (CF). CF centers in the Russian Federation also joined the ECFS study. The ECFS collected information only through national Registers. In our country, the national register of CF patients has existed since 2011, its data is included in the European Register. Тo analyze the prevalence and course of COVID-19 in adult CF patients in Saint-Petersburg and the Leningrad region. Methods. From 11.03.20 to 24.12.20, 10 cases of adult CF patients (4 women, 6 men) with COVID-19 were analyzed in Saint-Petersburg and the Leningrad region. At the beginning of the study, 56 adult CF patients lived in Saint-Petersburg and Leningrad Region. All patients were monitored remotely by telephone, in case of ARVI symptoms, disease exacerbation, a PCR smear was performed on SARS-CoV-2, therapy was prescribed remotely, and inpatient treatment was prescribed if indicated. Results. COVID-19 was diagnosed in 10 adult CF patients aged 21 to 43 years. Two patients (32-year-old male and 31-year-old female with severe mixed cystic fibrosis form) were hospitalized with polysegmental pneumonia. 8 people were treated on an outpatient basis. Only 1 outpatient patient aged 43 years had pronounced clinical manifestations of COVID-19, the condition was regarded as moderate, the remaining outpatient patients suffered from a mild ARI disease. All patients were treated with positive dynamics. During the period of this follow – up, 3 CF patients (2 men, 1 woman) died, the death cause was the respiratory failure progression. Clinical and radiological, repeated laboratory data for COVID-19 were not obtained. At the point of December 24, 2020 53 adult CF patients are alive. Conclusion. According to our data, the incidence of COVID-19 among adult CF patients in Saint-Petersburg and the Leningrad Region was 17.85%, which is a lower indicator than in the general population. The disease was rarely severe, and effective treatment was noted in outpatient settings. There were no deaths from COVID-19.

Results and Prospects of Using Activator of Hematopoietic Stem Cell Differentiation in Complex Therapy for Patients with COVID-19.

The paper presents the results of a standard and complex treatment method using the peptide drug thymus thymalin in patients with COVID-19. One of the mechanisms of the immunomodulatory effect of thymalin is considered to be the ability of this peptide drug to influence the differentiation of human hematopoietic stem cells (HSCs). It was found that, as a result of standard treatment, patients in the control group showed a decrease in the concentration of the pro-inflammatory cytokine IL-6, C-reactive protein, D-dimer. The addition of thymalin to standard therapy accelerated the decline in both these indicators and the indicators of the T cell system. This has helped reduce the risk of blood clots in COVID-19 patients. The revealed properties of the thymus peptide preparation are the rationale for its inclusion in the complex treatment of coronavirus infection. Peptideswith potential biological activity against SARS-CoV-2 virus [29]. Note: Nitrogen atoms are shown in blue, oxygen atoms - in red, carbon atoms - in gray, hydrogen atoms - in white, and phosphorus atoms - in yellow.