ABSTRACT
Coronavirus is an infection that affects not only the human immune and respiratory systems. COVID-19 has similar symptoms to that of acute respiratory infections and influenza, with complications of a new coronavirus infection affecting the heart, kidneys and other internal organs. Patients with chronic kidney disease (CKD) belong to the group of particularly high risk of COVID-19 infection and high lethality in the development of the disease. This is due to the fact that the cause of CKD is the main population diseases (diabetes mellitus, hypertension, obesity, atherosclerosis), as well as old age, which themselves contribute to high morbidity and mortality from COVID-19. Objective. To evaluate the frequency of development of renal function disorders and their semiotics in patients with COVID-19, complicated by pneumonia, who were hospitalized in the Moscow multidisciplinary hospital for diagnosis and treatment, as well as their pre-morbid background, the frequency of chronic pathology of the urinary system and disorders of carbohydrate metabolism and diabetes. Material and methods. The data were analyzed from 206 patients (82 men and 124 women) aged 26 to 97 years (average age 56.8±6.1 years) undergoing treatment in the 3rd department of Clinical Hospital No. 15 named after O.M. Filatov. 197 patients were discharged from the hospital, 6 patients died. CKD classifications were used from 2006 and 2013 years for division of patients into groups. There were 2 groups of patients of different ages: the 1st group - 78 patients (31 men, 47 women) aged 26-60 years (average age 48.6 years);the 2nd group - 128 patients (51 men, 77 women) aged 61-97 years (average age 74.2 years). The kidney ultrasound was performed on a Lojik-400 ultrasound scanner («General Electric», USA). In total, kidney ultrasound was carried out on 26 patients. The glomerular filtration rate (GFR) was calculated using the Cockroft-Golt formula, taking into account the level of creatinine concentration in blood serum, age and sex of the patient. The concentration of creatinine in the blood serum was determined by the method of O. Shyuk with sodium picrate on a spectrophotometer Getpremier (USA). Results. GFR was on average 23.7% higher (p<0.05, the difference was significant) in patients of group 1. When analyzing normal and pathological GFR values, it was found that GFR values classified in stage III-IV CKD (below 60 ml/min) were 4 times more likely to be detected in younger patients with COVID-19 and pneumonia (16.6% versus 67.2% in group 2). In 48 (23%) patients, diagnostically significant dynamics of creatinine concentration and GFR level (by 11-36 ml/min) was observed during the period of inpatient treatment. In all such patients, leukocyte and erythrocyturia, proteinuria (0.3-1 g/l) were detected in the urinary sediment, a history of arterial hypertension was found, and only 17 (8.2%) had bacteriuria. The urea concentration according to the mean values was higher in the 2nd group, in older patients, by 25.2% (p<0.03, significant). Increased values of the indicator were observed more often in the 2nd group - by 16.6%, (p>0.1, unreliable). The frequency of detection of urinary syndrome by the level of proteinuria, leukocyte, erythrocyte, cylindruria and the sign of bacteriuria in both groups of patients with COVID-19 and pneumonia was high - within 37-44%. Results. 1. Possible signs of acute renal injury and pathological urinary syndrome were identified in more than 20% of patients. 2. The average level of urea concentration in the blood serum in patients with COVID-19 in the age group over 60 years old significantly and reliably exceeded the values in the group of younger patients, which may be a sign of the development of an inflammatory process in the lungs with more pronounced intoxication, including due to more severe impairment of renal function of nitrogen excretion. 3. The incidence of stage III-IV CKD in the group of older patients with COVID-19 exceeds this indicator in the group of younger patients by 4 times. The most significant reason for the development of stage III-IV CKD, apparently, is arterial hypertension, 2.7 times more often diagnosed in patients over the age of 60 years. Коронавирус является инфекцией, которая поражает не только иммунную и дыхательную систему человека. COVID-19 имеет схожую симптоматику с ОРВИ и гриппом, при этом осложнения новой коронавирусной инфекции касаются функционирования сердца, почек и других внутренних органов. Пациенты с хронической болезнью почек (ХБП) принадлежат к группе особо высокого риска заражения COVID-19 и высокой летальности при развитии заболевания. Это связано с тем, что причиной ХБП являются основные популяционные болезни (сахарный диабет, гипертензия, ожирение, атеросклероз), а также пожилой возраст, которые сами способствуют высокой заболеваемости и смертности от COVID-19. Цель исследования. Оценить частоту развития нарушений почечной функции и их семиотику у больных COVID-19, осложненным пневмонией, которые были госпитализированы в московский многопрофильный стационар для диагностики и лечения, а также их преморбидный фон, частоту наличия хронической патологии мочевыводящей системы и нарушений углеводного обмена и сахарного диабета. Материал и методы. Проанализированы данные 206 больных (82 мужчин и 124 женщин) в возрасте от 26 до 97 лет (средний возраст 56,8±6,1 года), проходивших лечение в 3-м отделении ГКБ №15 им. О.М. Филатова. Из стационара были выписаны 197 пациентов, 6 больных скончались. Для разделения больных на группы использовали классификации ХБП 2006 и 2013 гг. Были выделены две группы пациентов разного возраста: 1-я группа - 78 больных (31 мужчина, 47 женщин) в возрасте 26-60 лет (средний возраст 48,6 года);2-я - 128 больных (51 мужчина, 77 женщин) в возрасте 61-97 лет (средний возраст 74,2 года). Ультразвуковое исследование (УЗИ) почек выполняли на ультразвуковом сканере Lojik-400 (GeneralElectric, США). Всего УЗИ почек было проведено у 26 больных. Скорость клубочковой фильтрации (СКФ) рассчитывали по формуле Кокрофта-Голта, с учетом уровня концентрации креатинина в сыворотке крови, возраста и пола больного. Концентрацию креатинина в сыворотке крови определяли по методике О. Шюк с пикратом натрия на спектрофотометре Getpremier (США). Результаты. СКФ была в среднем на 23,7% выше (p<0,05, различие достоверно) у больных 1-й группы. При анализе нормальных и патологических значений СКФ было установлено, что значения СКФ, классифицируемые при ХБП III-IV стадии (ниже 60 мл/мин), в 4 раза чаще выявлялись у более молодых больных COVID-19 и пневмонией (16,6 против 67,2% во 2-й группе). У 48 (23%) больных была отмечена за период стационарного лечения диагностически значимая динамика концентрации креатинина и уровня СКФ (на 11-36 мл/мин). У всех таких больных в мочевом осадке выявлялись лейкоцит- и эритроцитурия, протеинурия (0,3-1 г/л), была обнаружена артериальная гипертензия в анамнезе, и только у 17 (8,2%) отмечалась бактериурия. Концентрация мочевины по средним значениям была выше во 2-й группе, у более возрастных пациентов на 25,2% (p<0,03, достоверно). Повышенные значения показателя выявлялись чаще во 2-й группе - на 16,6%, (p>0,1, недостоверно). Частота выявления мочевого синдрома по уровню протеинурии, лейкоцит-, эритроцит-, цилиндрурии и признаку бактериурии в обеих группах больных COVID-19 и пневмонией была высокой - в пределах 37-44%. Выводы. 1. Возможные признаки острого почечного повреждения ипатологического мочевого синдрома были выявлены более чем у 20% пациентов. 2. Средний уровень концентрации мочевины в сыворотке крови у больных COVID-19 в возрастной группе старше 60 лет значительно и достоверно превышал значения в группе более молодых больных, что может быть признаком развития воспалительного процесса в легких с более выраженной интоксикацией, в том числе за счет более тяжелого нарушения почечной функции азотовыведения. 3. Частота ХПБ III-IV стадии в группе больных COVID-19 более старшего возраста превышает этот показатель в группе больных более молодых возрастов в 4 раза. Наиболее существенной причиной развития ХБП III-IV стадии, видимо, является артериальная гипертензия, в 2,7 раза чаще диагностируемая у пациентов в возрасте старше 60 лет.
ABSTRACT
In the first half of 2020, there were reports in the medical press about the presence of signs of polyorganic infection with coronavirus SARS-CoV-2. It was suggested that an additional role in the pathogenesis of COVID-19 hemoglobinopathy, hypoxia and iron overloading of cells of the parenchymatous organs. Based on these concepts and hypotheses, a system of pathogenetic therapy has been formed, but the positions of some hypotheses have not yet been confirmed by clinical studies. To clarify them, additional laboratory tests are required. Objective. To study peripheral blood parameters and their dynamics in COVID-19 patients treated with the diagnosis of «viral pneumonia» in the municipal hospital in Moscow from April to June 2020. Material and methods. Were examined 206 patients (82 men and 124 women) aged 26 to 97 years (average age 56.8±6.1 years) who were undergoing treatment in the 3rd department of GKB No. 15. O.M. Filatov with diagnoses: COVID-19 and pneumonia. 197 of them were discharged from the hospital, 9 died. The study of peripheral blood and counting of leukocyte formula were performed on Cobas Micro and Advia-21-20 analyzers (Simens, Germany). Biochemical studies were performed on spectrophotometer Getpremier (USA). Results. Analysis of the nature of changes in the number of leukocytes in the peripheral blood of patients with COVID-19 and pneumonia showed that cases of leukocytopenia were rare in patients (7% of patients), leukocytosis was detected in more than 20% of patients. The difference between the incidence of leukopenia and leukocytosis was 13.5%, but was not significant (p>0.2). Signs of lymphopenia were observed somewhat more frequently than lymphocytosis (in the evaluation of relative lymphocytosis - by 13.1%), but the difference was not statistically reliable. In assessing the number of lymphocytes in blood in patients with COVID- 19. Conclusion. The data obtained indicate a combined, multi-component pathogenic effect of COVID-19 virus on all three sprouts of hemopoiesis system in pneumonia patients: oppression of erythrocyte saturation processes with hemoglobin, erythropoiesis stimulation in some of them, change in platelet volume, formation of abnormal macroform plates, absence of reactive leukocytosis for acute inflammation, decrease in number of monocytic phagocytes and lymphoid cells. It is possible that some of these changes may affect the prognosis and the severity of the disease course. © 2020, Media Sphera Publishing Group. All rights reserved.
ABSTRACT
During the period of accumulation of scientific data on the pathology of COVID-19 caused by SARS-CoV-2 virus, it was considered that coronavirus is the most dangerous for elderly people, and in young people the disease occurs mainly in mild form. Later on, these perceptions changed. WHO experts, despite their initial recommendations, already recognized the danger of COVID-19 for all ages. Objective. To evaluate the pathology structure in young patients aged 18-30 years who were hospitalized with the diagnosis of COVID-19 in a converted speedy hospital in Moscow in the period from April to June 2020. Material and methods. The data of 228 patients (156 men and 72 women) aged 18-30 years (average age 22.8±3.1 years) admitted to the hospital for diagnostics and treatment in the period from 10.04.20 to 22.06.20 with ICD-10 diagnoses were analyzed retrospectively: B.34.2. Coronavirus infection unspecified;U07.1. COVID-19, the virus is identified (confirmed by laboratory testing, regardless of the severity of clinical signs or symptoms);U07.2. COVID-19, the virus is not identified (COVID-19 is diagnosed clinically or epidemiologically, but laboratory tests are inconclusive or unavailable;J12.9. Extra-hospital pneumonia. Results. In more than 1/3 of patients in the age group 18-30 years COVID-19 with pneumonia developed without a pre-morbid background. The percentage of patients with COVID-19 with chronic upper respiratory tract, lung and pathology with immune regulation disorders was 10-19%, which requires the identification of such patients in the group of high risk of disease. Conclusions. Without severe concomitant diseases, including oncohematological and neurological forms of pathology, COVID- 19 in patients of young age in hospital care and treatment most often does not lead to death. © 2020, Media Sphera Publishing Group. All rights reserved.
ABSTRACT
The pandemic of the COVID-19 viral infection in 2020 is accompanied by a massive infection of the world’s population with the great-est involvement of the urban population in the North American (USA) (over 1.788 million cases), South American (Brazil) (over 438 thousand cases), European (Russia) (over 379 thousand cases) and Asian (China) (over 82 thousand cases) continents. Aim of study. Assessment of the available treatment methodologies, physical and psychological rehabilitation in patients (men and women) with a viral infection COVID-19 in 2020, complicated by viral pneumonia, who underwent inpatient treatment in the therapeutic department of CCH No. 15 named after. O.M. Filatov of HD of Moscow. Materials and methods. The data of case histories and clinical and laboratory diagnostics of 185 patients discharged from the hospital in the period from 02.04.20 to 28.05.20 with a diagnosis of «U07.1 Coronavirus infection and acute lung injury» were ana-lyzed. Multispiral computed tomography (MSCT) of the chest was performed using an Aqualion Prime SP tomograph (Canon Medical System, Japan) to assess the pulmonary parenchyma and blood vessels. The indicators of gas exchange and acid-base state of blood were assessed. Results. According to MSCT data of the chest organs in patients, the percentage of severe bilateral pneumonia of the 3rd degree did not exceed 8% in both men and women. At the same time, there were slight gender differences: the maximum number (51.5%) of cases of pneumonia of the 2nd degree of severity was observed in men, and in women — pneumonia of the 1st degree was en-countered with the highest frequency (48.2%). Drugs with antimalarial activity (Plaquenil, hydrochloroquine) were used to treat respiratory infections in patients of working age most often, as well as expectorants and mucolytics. Among women, 73.2% of patients received them, i.e. significantly more than in the group of men (44.7%). Conclusions. Signs of COVID-19 infection complicated by bilateral viral polysegmenary pneumonia, with an approximately equal ratio of mild and moderate lesions, were found in the general population of a therapeutic hospital in more than 60% and in the ab-sence of significant gender differences. Virological methods made it possible to verify the signs of virus infection in more than 65% of patients of working age who were treated with a diagnosis of acute respiratory viral infection. © 2020, Media Sphera Publishing Group. All rights reserved.