Журнал для непрерывного медицинского образования врачей COVID-19 у больных, получающих лечение программным гемодиализом ОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ 1 Государственное бюджетное учреждение здравоохранения города Москвы «Городская клиническая больница № 52 Департамента здравоохранения города Москвы», 123182, г. Москва, Российская Федерация 2 Федеральное бюджетное учреждение науки «Московский научноисследовательский институт эпидемиологии и микробиологии им. Г.Н. Габричевского» Федеральной службы по надзору в сфере защиты прав потребителей и благополучия человека, 125212, г. Москва, Российская Федерация 3 Филиал федерального государственного бюджетного военного образовательного учреждения высшего образования «Военно-медицинская академия имени С.М. Кирова» Министерства обороны Российской Федерации, 107392, г. Москва, Российская Федерация 4 Федеральное государственное бюджетное образовательное учреждение высшего образования «Московский государственный медикостоматологический университет имени А.И. Евдокимова» Министерства здравоохранения Российской Федерации, 127473, г. Москва, Российская Федерация 5 Федеральное государственное бюджетное учреждение «Главный военный клинический госпиталь им. Н.Н. Бурденко» Министерства обороны Российской Федерации, 105229, г. Москва, Российская Федерация
Polymyalgia rheumatica (PMR) is a rare chronic inflammatory disease. It predominantly affects the elderly. The disease has a slow onset, pain and stiffness in the muscles of the shoulder and pelvic girdle, fever, weight loss, and a high acute-phase inflammatory response. The disease is concurrent with giant cell arteritis in a quarter of cases, which allows some authors to consider them as two different manifestations of the same pathological process. The kidneys are rarely involved. This disease is rarely complicated by AA amyloidosis. The authors describe a case of RPM in a patient who has developed secondary AA amyloidosis.
Background. Present concepts of the novel coronavirus infection prognosis in haemodialysis (HD) patients are rather controversial. There is little information on therapy efficiency and safety in such patients. We studied COVID-19 course specifics, prognostic factors associated with fatal outcomes, therapy efficiency and its transformation at different stages of the pandemic first year. Materials and methods. Single-centre retrospective uncontrolled study included 653 COVID-19 HD-patients treated at Moscow City Nephrology Centre from April 1 to December 31, 2020. Results. This period mortality rate was 21.0%. Independent predictors of COVID-19 unfavourable outcome in HD patients were pulmonary lesion extension (CT grades 34), high comorbidity index, and mechanical ventilation. Approaches to COVID-19 treatment modified significantly at different periods. Immunomodulatory drugs (monoclonal antibodies to IL-6, corticosteroids) were used largely at later stages. With tocilizumab administration, mortality was 15.1%, tocilizumab together with dexamethasone 13.3%; without them 37.8% (р0,001). Tocilizumab administration in the first 3 days after hospitalization of patients with CT grades 12 was associated with more favourable outcomes: 1 out of 29 died vs 6 out of 20 (tocilizumab administered at later periods); p0.04. There was no significant difference in death frequency in patients with CT grades 34 depending on tocilizumab administration time. Conclusion. COVID-19 in HD patients can manifest in a severe course with unfavourable outcome. It is urgent to identify reliable disease outcome predictors and develop efficient treatment in this population.
Background and Aims SARS-CoV-2 infection has a severe course in immunocompromised (RTR) patients. The aim is to study the clinical course and risk factors for adverse outcomes and results of COVID-19 treatment in RTR. Method At the beginning of the study there were 2580 RTR observed at Moscow Nephrology Center, by the end of it there were 2776 RTR. A retrospective uncontrolled observational study included 279 RTR (M: 172/F: 107, aged 49.9±10.9 yrs.), infected with SARS-CoV-2 from April 1 to November 30, 2020. The period after kidney transplantation before the onset of the disease was 54,0 months (14.0;108.0). After confirmation of COVID-19 by PCR and chest СТ MMF/Аza were canceled, CNI dose was minimized (target blood level was CyA 30-50 ng/ml, Тac 1,5-3 ng/ml), a CS dose was increased to 10-15 ng/day. Observation endpoints: discharge/recovery or death. Results The number of RTR infected with SARS-CoV-2 from April 1 to May 31, 2020 was 108; there were 42 RTR from June 1 to August 31, 2020; and 129 RTR - from September 1 to November 30, 2020. 59 RTR (21,1%) had a mild course of COVID-19. Patients with moderate and severe course (220/78.9%) were treated in the hospital. The period from the onset of the disease to the hospitalization was 7.1 ± 5.1 days. Severe lung damage (> 50%) occurred in 97 of 220 (44.1%); decrease in SpO2 <95% was seen in 128 of 220 (58.2%); 31 patients died. Thus, hospital mortality was 14.1%, overall mortality was 11.1%. Scr during the course increased from 160.9 ± 68.2 μmol/l to 185.4 ± 130.9 μmol/l (p <0.01) with no signs of acute rejection; and after the recovery, it decreased to 158.1 ± 63.2 μmol/l (p <0.01). Risk factors associated with fatal outcome were analyzed among the survivors (group 1; n-189) and the deceased (group 2; n-31). Groups 1 and 2 differed in the frequency of severe lung damage (69/36.9% vs 24/77.4%, p <0.001); the Charlson comorbidity index (4.4 ± 1.7 vs 6.1 ± 2.5, p <0.001); the frequency of IMV use (0 vs 23, p <0.0001), Scr upon admission (160.3 ± 67.1 µmol/l vs 208.9 ± 99.4 µmol/l, p <0.03), Hb levels (116.3 ± 21.8 g/l vs 91.7 ± 23.9 g/l, p <0.001), white blood cell сount (11.1 ± 4.8 × 109/L vs 18.1 ± 7.5 × 109/L, p <0.001), lymphocyte count (0.7 ± 0.4 × 109/l vs 0.4 ± 0.4 × 109/L, p <0.02), albumin (32.4 ± 4.1 g/l vs 25.8 ± 2.8 g/l, p <0.001), glucose (6.1 ± 1.9 mmol/l vs 7.8 ± 2.8 mmol/l, p <0.001), LDG (305.6 ± 135.6 U/l vs 800.8 ± 313.8 U/l, p <0.0001), CRP (74.1 ± 68.4 mg/L vs 160.7 ± 74.4 mg/L, p <0.0001), D-dimer (967.3 ± 949.0 μg/L vs 2810.1 ± 1807.7 μg/L, p <0.0001) and the frequency of procalcitonin increase (29.5 vs 86.4%, p <0.001). The independent factors of adverse outcome (Cox model) were high levels of comorbidity index (p <0.006) and procalcitonin (p <0.006), as well as the IMV use (p <0.0001). It was not possible to establish differences in Groups 1 and 2 depending on the use of individual drugs (Corticosteroids, Baricitinib, Monoclonal Ab IL-6/IL-17/IL-1β, antiCOVID plasma) as well as their combinations. Conclusion The frequency of SARS-CoV-2 infection in RTR was more than 2 times lower in summer compared to spring and autumn, which suggests a seasonal nature of this infection. The course of the disease was characterized by high hospital and general mortality. High values of the comorbidity index, procalcitonin and the IMV use were independent predictors of the fatal outcome.
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