Прогнозирование летального исхода у госпитальных пациентов с COVID-19 и коморбидной патологией

Abstract

Aim. To identify predictors of fatal outcome of COVID-19 in comorbid patients hospitalized in a specialized сovid-hospital in Nizhny Novgorod. Design. A single-center retrospective study. Material and methods. The data of 284 patients admitted to the specialized covid hospital in Nizhny Novgorod were analyzed. Three study groups were identified: the main group (n = 207) included people with new coronavirus infection (NCI) who had cardiovascular (CVD) and comorbid diseases, the comparison group consisted of patients with NCI and CVD without a burdened comorbid background (n = 24), the control group included the remaining patients with NCIS without CVD and comorbid pathology (n = 53). A comprehensive analysis of clinical and demographic, laboratory, instrumental indicators, the structure of comorbid pathology, as well as therapeutic approaches was Performed. Results. The assessment of the occurrence of CVD showed that hypertension was diagnosed in the majority of hospitalized patients — 226 (79.6%) persons, about half of the studied (146 (51.4%) people) had coronary heart disease, in 148 (52.1%) cases there was chronic heart failure, atrial fibrillation of various forms was in every fifth patient — in 59 (20.8%) cases. The analysis of the comorbid status among the main group (n = 207) demonstrated the widespread occurrence of chronic kidney disease (CKD) of various stages, which was recorded in 192 (92.7%) patients, and type 2 diabetes in 76 (36.7%) patients. The peculiarities of the course of COVID-19 among patients on hemodialysis were established: they had a tendency to hypercoagulation, estimated by the level of D-dimer (p = 0.045), sepsis developed more often, respiratory failure progressed more rapidly, requiring artificial lung ventilation (p = 0.011). Among people with CKD C5, mortality was also statistically significantly higher than in patients with other stages of CKD (p = 0.048). A mathematical model was developed to determine the risk of death among hospitalized patients with NCI. According to this model, the risk of death increased with the development of acute myocardial infarction, newly diagnosed atrial fibrillation, sepsis, decreased saturation, with increasing age of patients, with a decrease in the level of C-reactive protein (CRP), and an increase in D-dimer. Taking favipiravir, tocilizumab and statins reduced the risk of death. Conclusion. The most common cardiovascular pathology in patients hospitalized for NCI was hypertension, and atrial fibrillation prevailed among cardiac arrhythmias. It was noted that CKD prevails in the structure of comorbid pathologies. In people with severe NCI, who have CVD and CKD C5, a greater predisposition to the development of sepsis and an increase in respiratory failure was estamblished, which was the cause of progressive deterioration of the condition and subsequently led to death. In addition, we have shown that the probability of death in patients with CVD and COVID-19 was influenced by the older age of the patient, a decrease in saturation, a decrease in CRP, and an increase in D-dimer. As a drug therapy, the most beneficial effect on survival was the administration of favipiravir, tocilizumab and statins. Keywords: COVID-19, comorbidity, cardiovascular diseases, mortality, hemodialysis