Aim. To assess the effect of serum homocysteine levels on treatment outcomes in patients with COVID19-associated lung damage, depending on the use of folic acid in complex treatment.Materials and methods. An open, prospective comparative study included 71 hospitalized adult patients with COVID-19-associated lung disease who did not require mechanical ventilation. The main group included 51 patients who received folic acid 15 mg per day in a complex treatment in a fixed combination with pyridoxine hydrochloride and cyanocobalamin. The comparison group included 20 patients in whose therapy folic acid was not used.Results. The use of folic acid was accompanied by a decrease in serum homocysteine concentration by 2.120 (-0.230; 3.680) µmol/L (p=0.004). When constructing a logistic regression model, the effect of a decrease in serum homocysteine (OR 1.289; 95% CI 1.026‒1.620; p=0.029), methylenetetrahydrofolate reductase MTHFR C677T genotype (OR 10.897; 95% CI 1.240‒95.772; p=0.031) on the achievement of 7th day of hospitalization, the cessation of isolation of SARS-CoV-2 virus RNA from the respiratory tract. Multiple linear regression analysis showed an association between the duration of hypoxemic respiratory failure, determined with SaO2≤93%, with the degree of change in serum homocysteine concentration after treatment, single nucleotide polymorphisms of methylenetetrahydrofolate reductase MTHFR C677T, methionine synthase MTR A2756G and methionine synthase reductase MTRR A66G, initial volume of lung damage ≥50% according to CT data, indicators of D-dimers, C-reactive protein, hemoglobin, platelets, concomitant hypertension, diabetes mellitus (R=0.699; R2=0.489; p=0.005).Conclusion. The dynamics of the decrease in serum homocysteine after treatment is an important predictor of the cessation of isolation from the respiratory tract of the SARS-CoV-2 virus RNA on the 7th day of treatment, reducing the duration of hypoxemic respiratory failure in patients with lung damage associated with COVID-19 infection.
Aim of study. To evaluate the influence exerted by additional use of a fixed combination of folic acid with pyridoxine hydrochloride and cyanocobalamin in complex therapy for hospitalised patients with COVID-19-associated lung damage on parameters of inflammation and clinical outcomes. Material and methods. A comparative prospective interventional study included 117 patients with a lung lesion volume caused by the SARS-CoV-2 coronavirus corresponding to CT-1 and CT-2. The study group included 78 patients who additionally received a fixed combination of 5mg folic acid, 4mg pyridoxine hydrochloride, and 6μg cyanocobalamin three times a day in combination with standard therapy. The comparison group included 39 patients. Results. By days 14-21 of hospitalisation, the main group showed a decrease in the proportion of patients with CT symptoms of “cobblestone appearance” by 26% (p = 0.005) and an increase in the proportion of patients with transformation of viral lung lesions into areas of consolidation of the pulmonary parenchyma by 23% (p <0.001). The effect of a fixed combination of folic acid with vitamins B6, B12 on the achievement of the level of C-reactive protein <20 mg / l by day 7 depending on the red blood parameters and the number of platelets was established (likelihood ratio test in the logistic regression model: 13.925; P = 0.084) as well as the shortening of the time period required to reach the first negative result of the SARS-CoV-2 RNA test (in the linear regression model, R = 0.437; R2 = 0.191; F = 4.552; p = 0.006). Conclusion. The use of a fixed combination of folic acid with vitamins B6, B12 for patients with COVID-19 is associated with earlier achievement of positive dynamics in CT symptoms of lung damage. The additional use of these micronutrients in combination with restoration of red blood count and platelet count improves the odds ratio of an early decrease in serum C-reactive protein, negative result of the SARS-CoV-2 RNA test.
Introduction. Infection with human coronavirus 2 (SARS-CoV-2) associated with severe acute respiratory syndrome, forms polymorphous pattern of the infectious disease (COVID-19) in the range from mild acute respiratory infection to severe and life-threatening variations of systemic infection with respiratory tract involvement. Among significant predictors of the severe course and lethal outcome in the individuals with lung affection associated with COVID-19 infection, the increase of plasma levels of D-dimer, homocysteine, and some single-nucleotide polymorphisms (SNPs) of genes of the folate cycle proteins are singled out. Aim. To assess the role of genetic markers of folic acid metabolic disorders in the development of symptoms and the outcomes of viral lung damage associated with SARS-CoV-2 infection in the hospitalized patients. Materials and methods. In an open prospective comparative study the assessment of outcomes depending on polymorphic markers of protein genes of the folate cycle and the use of fixed combination of folic acid and vitamins В6, В12 in comprehensive therapy was performed in 117 patients with lung damage associated with SARS-CoV-2 infection. Results. Patients showed an increased relative risk of the heterozygous minor G-allele carriage of 66AG SNP of the methionine synthase reductase gene (MTRR). The homozygous MTRR G66G genotype was associated with indicators of anemia and thrombocytopenia. A statistically significant decrease in the odds ratio in achieving negative results for SARS-CoV-2 RNA detection by the 14th day of therapy in patients with the heterozygous 677CT genotype and the homozygous 677TT genotype of the MTHFR (methylenetetrahydrofalate reductase) gene was established. Conclusion. Lung damage caused by SARS-CoV-2 infection is associated with an increased risk of genetic metabolic disorder of folate and vitamin B12.
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