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

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 (SpO2), 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.