Current, effectiveness of therapy and outcomes of new coronavirus infection: preliminary analysis

Sergey A. Sayganov; Vadim I. Mazurov; Igor G. Bakulin; Elguja L. Lataria; S A Artyushkin; Olga Yu. Chizhova; Irina A. Ruslyakova; Natalia A. Prokofieva; Tatiana S. Fil; Daridzhan B. Tsurtsumiya; Sergey V. Tikhonov; Mariya I. Skalinskaya; Irina A. Rasmagina; Marianna K. Alieva; E A Trofimov; Nataliay V. Bakulina; Elena V. Kolmakova; Anna D. Sheyko; Lia N. Belousova

doi:10.17816/mechnikov202012227-38

HERALD of North-Western State Medical University named after I.I. Mechnikov ›› 2020, Vol. 12 ›› Issue (2) :27 -38. DOI: 10.17816/mechnikov202012227-38

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research-article

Current, effectiveness of therapy and outcomes of new coronavirus infection: preliminary analysis

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North-Western State Medical University named after I.I. Mechnikov

professor, MD, PhD, Head of the Chair of Hospital Therapy and Cardiology n.a. M.S. Kushakovsky, rector of "North-West State Medical University n.a. I.I. Mechnikov" Ministry of Health of Russia, Saint Petersburg, Russia

D. Sci. (Med.), Prof., RAS academician, Head of the research institute of Rheumatology North-Western State Medical University named after I.I. Mechnikov, head of Department of Therapy, Rheumatology, Examination of Temporary Disability and Quality of Medical Care named after E.E.Eichwald FSBEI HE North-Western State Medical University named after I. I. Mechnikov

Dean of the medical faculty, Professor, doctor of medical Sciences, head of the Department of propaedeutics of internal diseases of gastroenterology and dietetics named after S. M. Rys

MD, PhD, associate Professor, Vice-Rector for Clinical Work, Head Doctor of Clinics North-West State Medical University named after I.I. Mechnikov "Ministry of Health of Russia, Saint Petersburg, Russia

Vice Rector for Academic Affairs of North-Western 
State Medical University named after I.I.Mechnikov,
Saint Petersburg, Russia

MD, PhD, Professor of the Chair of the Propedeutics of Internal Diseases, Gastroenterology and Dietology n.a. S.M. Ryss North-Western State Medical University n.a. I.I. Mechnikov, Saint Petersburg, Russia

MD, PhD, assistant of the Chair of propaedeutics of internal diseases, gastroenterology and dietetics n.a. S.M. Ryss North-Western State Medical University n.a. I.I. Mechnikov, anesthetist-resuscitator, head of the intensive care unit for the patients of the therapeutic profile of the Clinic North-Western State Medical University n.a. I.I. Mechnikov, Saint Petersburg, Russia

Head of the therapeutic department of the Clinic North-Western State Medical University n.a. I.I. Mechnikov, Saint Petersburg, Russia

MD, PhD, Head of the gastroenterological department of the Clinic North-Western State Medical University n.a. I.I. Mechnikov, Saint Petersburg, Russia

MD, PhD, associate Professor of the Chair of Internal Medicine, Clinical Pharmacology and Nephrology North-Western State Medical University n.a. I.I. Mechnikov, Saint Petersburg, Russia

MD, PhD, associate Professor of the Chair of Internal Medicine, Clinical Pharmacology and Nephrology North-Western State Medical University n.a. I.I. Mechnikov

Associate proffessor of the Chair of the Propedeutics of Internal Diseases, PhD Gastroenterology and Dietology n.a. S.M. Riss

resident of the Chair of the Propedeutics of Internal Diseases, Gastroenterology and Dietology n.a. S.M. Riss North-Western State Medical University n.a.I.I.Mechnikov, Saint Petersburg, Russia

associate professor, MD, PhD, associate professor of the Сhair of therapy, rheumatology, examination of temporary disability and quality of medical care n.a. E. E. Eichwald North-Western State Medical University n.a. I.I. Mechnikov.

professor, MD, PhD, Head of the Chair of Internal Medicine, Clinical Pharmacology and Nephrology North-Western State Medical University n.a. I.I. Mechnikov, Saint Petersburg, Russia

MD, PhD, associate Professor of the Chair of Internal Medicine, Clinical Pharmacology and Nephrology North-Western State Medical University n.a. I.I. Mechnikov, Saint Petersburg, Russia

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MD, PhD, associate professor of the Chair of the Propedeutics of Internal Diseases, Gastroenterology and Dietology n.a. S.M. Riss North-Western State Medical University n.a.I.I.Mechnikov, Saint Petersburg, Russia

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Abstract

Relevance. Verification of a new coronavirus infection (COVID-19) requires clear algorithms for the diagnosis and treatment of patients, depending on clinical, laboratory and instrumental dates. Timely and informed decisions on optimizing management tactics and prescribing proactive anti-inflammatory therapy before development of a complete symptom complex life threatening conditions are needed in some cases.

Aim of the study. To analyze the course and outcomes of a new coronavirus infection, depending on the initial characteristics of the patients and treatment options.

Materials and methods. A preliminary analysis of the case histories of 129 people hospitalized in the center for treating patients with a new coronavirus infection at North-Western State Medical University n.a. I.I. Mechnikov was made by random sampling. Among the hospitalized patients there were 67 men (51.9%), the average age was 57.9 ± 16.4 years, 62 women (48.1%), and the average age was 60.2 ± 13.6 years. During hospitalization, all patients underwent standard clinical laboratory and instrumental examination, as well as determination of saturation (S_pO₂), markers of the cytokine storm (CRP, ferritin, AST, D-dimer, fibrinogen, lymphocytes), compute tomography (CT) of the lungs. The effectiveness and safety of therapy was evaluated by the outcome (recovery, death), as well as by the presence of adverse events in the background of the therapy. Statistical processing of the research results was carried out using the Statistica 12 for Windows application software package, the significance of differences between the two relative values was evaluated using the Student t-test (t > 2, p < 0.05).

Results. Fatal outcomes were significantly more frequently recorded among patients of older age groups and males. The presence of concomitant diseases such as obesity, diabetes mellitus, pathology of the cardiovascular system was accompanied by more frequent fatal outcomes. That allows considering comorbidity as a risk factor for severe course and poor prognosis of COVID-19. However, in general, in the presence of the indicated forms of concomitant diseases, it was not possible to establish significant differences with the outcomes of COVID-19, which may be due to an insufficient amount of patients. Predictors of fatal outcome was low values of saturation, the presence of respiratory failure, a significant amount of lung tissue damage (CT-3-4), as well as high values of CRP, ferritin, AST, D-dimer, neutrophilia, lymphopenia, thrombocytopenia. The use of anticytokine drugs (ACD) in complex therapy can be considered a favorable predictor of outcome, which indicates the advisability of wider use. The materials of the study allow not only a preliminary assessment of the course and effectiveness of complex therapy using anticytokine drugs with COVID-19 in patients with comorbid diseases, but also to develop therapeutic and diagnostic algorithms in patients of this category.

Keywords

new coronavirus infection / SARS-CoV-2 (COVID-19) / comorbidity / cytokine storm syndromes / data analysis / therapy

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Sergey A. Sayganov, Vadim I. Mazurov, Igor G. Bakulin, Elguja L. Lataria, S A Artyushkin, Olga Yu. Chizhova, Irina A. Ruslyakova, Natalia A. Prokofieva, Tatiana S. Fil, Daridzhan B. Tsurtsumiya, Sergey V. Tikhonov, Mariya I. Skalinskaya, Irina A. Rasmagina, Marianna K. Alieva, E A Trofimov, Nataliay V. Bakulina, Elena V. Kolmakova, Anna D. Sheyko, Lia N. Belousova. Current, effectiveness of therapy and outcomes of new coronavirus infection: preliminary analysis. HERALD of North-Western State Medical University named after I.I. Mechnikov, 2020, 12(2): 27-38 DOI:10.17816/mechnikov202012227-38

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Sayganov S.A., Mazurov V.I., Bakulin I.G., Lataria E.L., Artyushkin S.A., Chizhova O.Y., Ruslyakova I.A., Prokofieva N.A., Fil T.S., Tsurtsumiya D.B., Tikhonov S.V., Skalinskaya M.I., Rasmagina I.A., Alieva M.K., Trofimov E.A., Bakulina N.V., Kolmakova E.V., Sheyko A.D., Belousova L.N.