Rheumatic diseases in intensive care unit patients with COVID-19

Moiseev, Sergey; Авдеев, С. Н.; Brovko, Michail; Yavorovskiy, Andrey; Novikov, Pavel; Umbetova, Karina; Akulkina, Larisa; Tsareva, Natalya; Fоmin, Victоr

doi:10.1136/annrheumdis-2020-217676

Cited by 29 publications

(22 citation statements)

References 5 publications

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“…Однако в нашем исследовании частота аутоиммунных заболеваний, в том числе ревматоидного артрита, системной красной волчанки, системной склеродермии и др., была низкой (1,2%) и не превышала таковую в общей популяции (1-2%). Более того, у большинства больных с ревматическими заболеваниями имелись сопутствующие сердечно-сосудистые и другие заболевания, которые могли способствовать более тяжелому течению COVID-19 [34]. Высказано предположение, что различные противоревматические препараты, улучшающие цитокиновый профиль и подавляющие воспалительный ответ, такие как гидроксихлорохин/ хлорохин, ингибиторы интерлейкина-6 (тоцилизумаб, сарилумаб), ингибиторы JAK-киназ (барицитиниб, тофацитиниб), могут предупредить развитие ОРДС у пациентов с SARS-CoV-2 инфекцией [35].…”

Section: Discussionunclassified

Clinical characteristics of 1007 intensive care unitpatients with SARS-CoV-2 pneumonia

Глыбочко¹,

Fоmin²,

Авдеев³

et al. 2020

CPT

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Section: Discussionunclassified

Clinical characteristics of 1007 intensive care unitpatients with SARS-CoV-2 pneumonia

Глыбочко¹,

Fоmin²,

Авдеев³

et al. 2020

CPT

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“…Similar findings were described among 859 patients surveyed by telephone who were receiving DMARDs for rheumatic diseases and sarcoidosis in Siena, Italy, where only two of these patients had been diagnosed with COVID-19 [5]. Furthermore, a nationwide study in Russia found that the prevalence of systemic rheumatic diseases among COVID-19 patients admitted to ICUs with a severe course of COVID-19 was low (10 of 902 patients; 1.1%) and similar to that of the general Russian population [6]. Similar to their adult counterparts, paediatric patients with systemic rheumatic disease appear to be at no increased risk for the acquisition of COVID-19 [7,8].…”

Section: Are Patients With Systemic Rheumatic Diseases At Increased Rmentioning

confidence: 89%

Pharmacotherapeutic considerations for systemic rheumatic diseases amid the COVID-19 pandemic: more questions than answers

Kow

Hasan

2020

Drugs Ther Perspect

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Thus far, associations between the presence of systemic rheumatic disease and an increased risk of novel coronavirus disease 2019 (COVID-19) acquisition or a worse prognosis from COVID-19 have not been conclusive. It is not known for certain if there is an association between any pharmacological agent used for rheumatologic treatment, including biological and non-biological disease-modifying antirheumatic drugs (DMARDs), and an increased risk of COVID-19 acquisition or adverse outcomes from COVID-19, although these agents have been associated with an overall higher risk of infections. The pharmacological management of patients with a rheumatic disease without COVID-19 should currently follow usual treatment approaches. Individualized approaches to adjusting DMARD regimens in patients with documented COVID-19 seems prudent, with specific attention paid to the severity of the infection. Patients receiving antimalarials (hydroxychloroquine/ chloroquine) may continue treatment with these agents. Treatment with sulfasalazine, methotrexate, leflunomide, immunosuppressants and biological agents other than interluekin-6 receptor inhibitors and JAK inhibitors should be stopped or withheld. It should be reasonable to resume DMARD treatment when patients are no longer symptomatic and at least 2 weeks after documentation of COVID-19, although the decision should be individualized, preferably based on infection severity.

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“…В нашем исследовании частота ревматических аутоиммунных заболеваний среди пациентов с ОРДС, вызванным SARS-CoV-2, составила 1,3% и не превышала таковую в общей популяции. У большинства больных с ревматическими заболеваниями имелись сопутствующие заболевания, которые могли привести к более тяжелому течению COVID-19 [22]. Нельзя исключить, что подавление воспалительного ответа под действием различных противоревматических препаратов может препятствовать развитию синдрома выброса цитокинов у пациентов с COVID-19 [23].…”

Section: ðèñ 2 îø ðàññ÷èòàííîå â ëîãèñòè÷åñêîé ðåãðåññèîííîé ìîäåëunclassified

Risk factors for the early development of septic shock in patients with severe COVID-19

Glybochko

Fоmin

Avdeev

et al. 2020

Terapevticheskii arkhiv

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Aim. In a retrospective study, we evaluated factors associated with the early development of septic shock in patients with severe COVID-19. Materials and methods. We collected medical records of the intensive care unit patients submitted by the local COVID-19 hospitals across Russia to the Federal Center for the Critical Care at the Sechenov First Moscow State Medical University (Sechenov University). Septic shock in crticially ill patients requiring mechanical ventilation was defined as a need in vasopressors to maintain blood pressure. Results. We studied 1078 patients with severe COVID-19 who were admitted to the intensive care units for respiratory support. There were 611 males and 467 females. The mean age was 61.013.7 years. Five hundred twenty five medical records (48.7%) were received from the Moscow hospitals, 159 (14.7%) from the Moscow region, and 394 (36.5%) from the hospitals located in 58 regions of the Russian Federation. In 613 (56.9%) patients, diagnosis of SARS-CoV-2 infection was confirmed by PCR, and in the other cases it was established on the basis of the clinical picture and the results of the chest CT scan. Septic shock developed in 214 (19.9%) of 1078 patients. In the logistic regression model, the risk of septic shock in patients older than 50 years was higher than in patients of a younger age (OR 2.34; 95% CI 1.533.67; p0.0001). In patients with more severe SARS-CoV-2 infection, there was an increase in the prevalence of cardiovascular diseases, including coronary heart disease and atrial fibrillation, type 2 diabetes and malignant tumors. The risk of septic shock in patients with three or more concomitant diseases was higher than in patients without any concomitant chronic diseases (OR 1.76; 95% CI 1.762.70). Conclusion. The risk of septic shock in patients with acute respiratory distress syndrome induced by SARS-CoV-2 is higher in patients older than 50 years with concomitant diseases, although a severe course of the disease is also possible in younger patients without any concomitant disorders.

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Rheumatic diseases in intensive care unit patients with COVID-19

Cited by 29 publications

References 5 publications

Clinical characteristics of 1007 intensive care unitpatients with SARS-CoV-2 pneumonia

Clinical characteristics of 1007 intensive care unitpatients with SARS-CoV-2 pneumonia

Pharmacotherapeutic considerations for systemic rheumatic diseases amid the COVID-19 pandemic: more questions than answers

Risk factors for the early development of septic shock in patients with severe COVID-19

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