ОСОБЕННОСТИ ТЕЧЕНИЯ И КЛИНИКО-ЛАБОРАТОРНАЯ ОЦЕНКА COVID-19 ИНФЕКЦИИ У ПАЦИЕНТОВ С СОПУТСТВУЮЩЕЙ СЕРДЕЧНО-СОСУДИСТОЙ ПАТОЛОГИЕЙ

Abstract

The infection caused by the SARS-CoV-2 coronavirus continues to spread throughout the world. The high social and medical significance of this disease has led to a tangible increase in the number of publications about COVID-19 in many well-known publications. Currently, there is no systematic analysis of information on the diagnosis and treatment of concomitant conditions in patients with coronavirus infection, therefore, in this article, we have analyzed the revealed changes in clinical and laboratory parameters in patients with coronavirus infection and concomitant cardiovascular pathology, as well as their significance for practical medicine. Objective. To assess the features of changes in the clinical and laboratory parameters of patients with COVID-19 and concomitant cardiovascular pathology and to find out their significance. Materials and methods. A randomized retrospective analysis of medical records of 82 patients was carried out on the basis of the 4 N. E. Savchenko State Clinical Hospital. Clinical and laboratory parameters of 82 men (age 54 ± 5.6 years) were studied for the period August 2020 - January 2021. The results of a detailed biochemical blood test, analysis of the acid-base state, hemostasiogram, and analysis for cardiomarkers were taken into account. All patients were divided into 3 groups: the first group - patients with the presence of COVID-19 without concomitant pathology, the second group - patients with the presence of cardiac pathology without coronavirus infection, the third group - patients with coronavirus infection and concomitant cardiovascular diseases (ischemic heart disease , arterial hypertension). Results. When comparing the values of biochemical blood test indicators in patients of the third group, with those in patients of the first group, it was revealed: an increase in the content of blood ferritin in 2.69 times (p <0.05), C-reactive protein - in 2.13 times (p < 0.05), activity of lactate dehydrogenase - 1.26 times (p <0.05). When comparing the indicators of the third group with the second, an excess of triglycerides was found - 1.36 times (p <0.05), LDL - 1.14 times (p <0.05), atherogenic index - 1.36 times (p <0.05), a decrease in the level of HDL - 1.37 times (p <0.05). When comparing the values of the acid-base state in patients of the third group, with those in the patients of the first group, it was found: a decrease in PaO2 in 1.05 times (p <0.05), and sO2 - in 1.14 times (p <0.05 ). When comparing the values of hemostasiogram indicators, it was found: an increase in the content of fibrinogen in 1.09 times (p <0.05), D-dimers - in 1.23 times (p <0.05), INR - in 1.14 times (p < 0.05) and a decrease in APTT in 1.09 times (p <0.05). When comparing the values of clinical and laboratory indicators of these groups, an extension of the length of stay in the hospital was revealed: the number of bed-days in men increased 1.32 times (p <0.05). It is worth noting that, apparently, in conditions of COVID-19 infection, complicated by concomitant cardiovascular pathology, the processes of using glucose as an energy substrate is inhibited. As a result, lactate becomes a new substrate. Conclusion: 1. In patients with COVID-19 and concomitant cardiovascular pathology, respiratory and tissue hypoxia is aggravated by circulatory hypoxia, which leads to more severe consequences of COVID infection and leads to an increase in the number of bed-days spent in the hospital. 2. The violation of energy supply processes is the most important factor, the cause of impaired glucose metabolism and leads to the development of tissue hypoxia. 3. The processes of inflammation in the body caused by COVID-19 infection are aggravated in conditions of concomitant cardiovascular pathology.