Objective — to determine the association of basic demographic, clinical, and routine laboratory characteristics with the risk of adverse outcomes in patients with COVID-19. Materials and methods. Data of 320 patients hospitalized in the City Clinical Hospital No. 21 named after Prof. Ye. G. Popkova with a diagnosis of coronavirus disease19 (SARS-CoV2+ RNA)) were studied. Women — 156 (48.8 %), men — 164 (51.2 %), the mean age of the patients — (60.3 ± 13.6) years. Patients were divided into 2 groups: Group I — 270 (84.4 %) people who were discharged from the hospital with recovery or significant improvement in their condition, Group II — 50 (15.6 %) patients who died as a result of the disease (p = 0.010). The average period from the onset of the disease to hospitalization was 9 (7; 11) days. Statistical processing of the research results was carried out using the Statistica v. 6.1 software package. Results and discussion. Most of the deceased patients were older than 60 years — 36 (72.0 %) (p < 0.001). The maximum number of fatalities is in the age range of 60—69 years. Mortality among men was 1.5 times higher than among women — 30 (60.0 %) vs 20 (40.0 %) (p = 0.046). In the II group, the following were observed significantly more often: ischemic heart disease and hypertension — respectively 54.0 vs 20.7 % (p < 0.001) and 70.0 vs 50.0 % (p = 0.009); other heart diseases (OR — 7.23, rv = 0.202, p < 0.001), obesity (OR — 2.97, rv = 0.186, p < 0.001), diabetes (OR — 2.38, rv = 0.146; p = 0.009).The risk of mortality increased in the presence of cough (OR — 11.87, p = 0.012), fever (OR — 3.44, p < 0.001); lymphopenia (OR — 3.82, p < 0.001); hyperglycemia (OR — 4.69, p < 0.001); increased C-reactive protein (CRP) (OR — 5.96, p < 0.001), especially above 100 mg/l (OR from 39.86 to 52.35 at p < 0.01 and p < 0.001). However, thrombocytosis and lymphomonocytosis were more often observed during the benign course of the disease (respectively: p < 0.001, p = 0.051). A direct relationship between the probability of mortality and age (rs = 0.143, p = 0.011), respiratory rate (rs = 0.332, p < 0.001) and heart rate (rs = 0.159, p = 0.004) was revealed; fever (rs = 0.152, p = 0.006), quantitative indicators: segmented neutrophils (rs = 0.275, p < 0.001), urea (rs = 0.309, p < 0.001), urea nitrogen (rs = 0.300, p < 0.001), residual nitrogen (rs = 0.288, p < 0.001), creatinine (rs = 0.111, p = 0.047), glucose (rs = 0.273, p < 0.001), CRP (rs = 0.348, p < 0.001), prothrombin time (rs = 0.149, p = 0.008), international normalized ratio (rs = 0.193, p = 0.001). A inverse relationship was determined with blood oxygen saturation (rs = – 0.431, p < 0.001); levels of lymphocytes, bands, platelets and prothrombin index (respectively: rs = – 0.278, p < 0.001; rs = – 0.118, p = 0.034; rs = – 0.223, p < 0.001; rs = – 0.170, p = 0.002). Conclusions. The following are associated with in-hospital mortality in patients with COVID-19: older age, coronary heart disease, stage III hypertension, diabetes, stage III obesity, clinical and laboratory signs: fever, shortness of breath, cough, lymphopenia, CRP content in the blood more than 100 mg/l, hyperglycemia, increased markers of kidney damage and hypercoagulation. The obtained results may be useful for predicting the course of the coronavirus disease.
Порівняно клініко-лабораторні показники хворих на COVID-19 віком 60 років і старше (люди похилого віку – основна група) та пацієнтів до 60 років (група порівняння). Встановлено, що тяжкий ступінь захворювання не залежав від віку, але летальний вислід вдвічі частіше був у пацієнтів похилого віку – 36 (20,0 %) проти 14 (10,0 %) випадків у групі порівняння (р=0,015). Особи віком 60 років і старше значно частіше страждали на ішемічну хворобу серця – 65 (36,1 %) проти 18 (12,9 %) хворих групи порівняння; гіпертонічну хворобу – 133 (73,9 %) проти 37 (26,4 %) пацієнтів молодшого віку (p<0,001); цукровий діабет – 49 (27,2 %) проти 16 (11,4 %) (p<0,001). У пацієнтів старшого віку також достовірно частіше виявляли хронічні захворювання респіраторного тракту – 9 (5,0 %) проти 1 (0,7 %) випадку в групі порівняння (р=0,029) та вен нижніх кінцівок – 6 (3,3 %) проти 0 % (р=0,037). Статистично значущі відмінності між групами за показниками систолічного та діастолічного артеріального тиску (АТ) (відповідно p=0,002 і p=0,047), за рівнем глюкози (р=0,004), сечовини (р<0,001), азоту сечовини (р=0,005) у сироватці крові відповідають тим соматичним захворюванням, які частіше бувають в осіб 60 років і старше й можуть мати маркерну роль для встановлення прогнозу недуги.
The new strain of coronavirus SARS CoV-2 can affect any organ and system of the body. The pathogenesis of these lesions is due to both direct damage to body cells by the virus and the development of immunopathological reactions that can lead to demyelinating diseases of the nervous system. The article presents a clinical case of the development of Guillain-Barré syndrome associated with coronavirus disease in a 71-year-old man who developed after infection with a new strain of SARS CoV-2 virus. The man was hospitalized on the seventh day of the disease with complaints of unproductive cough, weakness, fever in the range of 37.5-38.7°C, shortness of breath during exercise. The clinical diagnosis was confirmed by the presence of SARS CoV-2 RNA in the nasopharyngeal secretion. According to digital radiography, the presence of interstitial pneumonia was determined. Against the background of treatment, the condition gradually improved and on the 14th day after the onset of the disease, a negative PCR result (SARS CoV-2 (-) RNA) was obtained. However, on the 16th day of hospital stay (23-24th days of the disease) he was diagnosed with polyneuropathy (Guillain-Barré syndrome), severe tetraparesis. Despite the therapy, the condition gradually deteriorated due to the progression of polyneuropathy. On the 9th day after the onset of neurological symptoms (25th days of illness), on the background of severe neurological deficits, the signs of respiratory and cardiovascular insufficiency developed, which led to the death of the patient. It has been shown that the course of Guillain-Barré syndrome, which developed after infection with a new strain of SARS CoV-2 virus, in this case has a severe course and lethal outcome of the disease. It is necessary to look for clinical predictors that would predict the occurrence of neurological complications in patients with coronavirus disease.
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