C-reactive protein as predictor of severe course of the new coronavirus infection in patients with chronic obstructive pulmonary disease in the intensive care unit

Abstract

SummaryDespite a large number of observations, the role of chronic obstructive pulmonary disease (COPD) in the course and development of a new coronavirus infection is still unknown. The combination of these two process-es, which are characterized by the development of a sys-temic inflammatory reaction, leads to the development of a pronounced immune response, more severe com-plications and the formation of an atypical radiological pattern. In our work, 387 patients with a new coronavi-rus infection were examined in the intensive care unit. Among these 387 patients, 41 patients were diagnosed with COPD according to the GOLD criteria. The aim of the work is to determine the features of radiological manifes-tations and the course of a new coronavirus infection in patients with chronic obstructive pulmonary disease in the intensive care unit. Typical radiological manifesta-tions of a new coronavirus infections were detected in 90.5% of cases. 23 (56.1%) patients had a secondary infec-tion, 20 (48.8%) — sepsis, 10 (24.4%) — ARDS, 29 (70.7%) patients required mechanical ventilator, 24 (58.5%) pa-tients developed a fatal outcome. A 2-fold increase in the concentration of C-reactive protein was statistically significantly associated with an increase in the chances of more severe damage to lung tissue during primary CT examination (upon admission to hospital). A 2-fold increase in ferritin concentration was statistically signifi-cantly associated with an increase in the chances of more severe lung tissue damage (the maximum degree of lung tissue damage during the entire period of hospital stay). A comparative analysis revealed a tendency to a higher frequency of secondary infections in patients with pan-lobular emphysema and a higher frequency of the need for ventilation in patients with diffuse emphysema. Also, the presence of bullous emphysema was statistically sig-nificantly associated with a higher frequency of CT-3 de-grees of lung tissue damage upon admission. A compar-ative analysis revealed a statistically significantly higher concentration of C-reactive protein in a mixed COPD phe-notype compared with an emphysematous phenotype, a higher incidence of sepsis in patients with a mixed COPD phenotype compared with patients with an emphysema-tous and bronchitic phenotype.