Moscow City Clinical Hospital Research Articles

Clinical and epidemiological analysis of intestinal infections in a children's infectious diseases hospital, experience in using the PEWS scale

Purpose of the work: to conduct a clinical-epidemiological analysis of intestinal infections in a pediatric infectious diseases hospital and the effectiveness of the PEWS scale.Materials and methods: a retrospective study was conducted at the Moscow City Clinical Hospital «Communarka» and City Clinical Hospital No. 1 in the pediatric infectious disease departments from June 1, 2023, to August 31, 2023. Laboratory, clinical, and anamnestic data were obtained from the medical information system «EMIAS» and the laboratory information system (LIS) «ALISA». The study analyzed 838 medical records of children with acute respiratory infections.Results: when conducting a statistical analysis of indicators in two groups (group 1 — PEWS ≥ 3 points, recorded at least once during the entire period of hospitalization, group 2 — PEWS from 1 to 2 points, recorded at least once during hospitalization period) no significant differences were observed in terms of etiology, age, day of illness, blood test results, and length of hospital stay. All patients had a moderate form of acute respiratory infection, however, patients with PEWS ≥ 3 points required increased attention from medical staff and had a higher risk of deterioration without additional medical intervention, with the most significant risk in predicting deterioration being related to changes in the cardiovascular system. All children were discharged home in satisfactory condition with PEWS = 0.Conclusion: In our conducted research, for the first time in the Russian Federation, the experience of using the PEWS scale in pediatric practice for patients with gastrointestinal infections was applied with the aim of early detection of the risk of clinical deterioration. It can be assumed that the most significant risk in predicting deterioration in the condition of a child with acute gastrointestinal infection, as well as with acute respiratory infection, is predominantly due to disturbances in the cardiovascular system.

Meteoropathy: myth or reality? Assessment of the relationship between cardiovascular diseases and weather conditions according to data from a Moscow hospital

Many patients and some doctors associate the worsening of cardiovascular diseases with meteoropathy (changes in atmospheric pressure and air temperature). Opinion about lack of weather influence on the increase in overall morbidity and the lack of related research data indicate the need to study the relationship between cardiovascular diseases and meteorological conditions.Aim. To assess the prevalence of hospitalizations with symptomatic increases in blood pressure (BP), atrial fibrillation (AF), and decompensated heart failure (HF) in a Moscow hospital depending on meteorological conditions.Material and methods. This retrospective analysis of the number of emergency hospitalizations of patients with symptomatic increases in blood pressure, AF, and decompensated HF in Moscow City Clinical Hospital № 24 was carried out in the period from October 1, 2018 to September 30, 2019. Information from the website www.weather.com was used as a source of meteorological data. The following indicators were assessed daily: daytime air temperature (t), nighttime air temperature, maximum diurnal air temperature variation, atmospheric pressure, maximum diurnal atmospheric pressure variation, amount of precipitation. To assess statistical significance, the Mann-Whitney and Kruskal-Wallis tests were used. A correlation analysis was carried out, and a prognostic model was created using multiple linear regression.Results. During the period from October 1, 2018 to September 30, 2019, 4354 patients were hospitalized at City Clinical Hospital № 24 with symptomatic BP increase and/or AF and/or decompensated HF. The highest number of hospitalizations occurred in November, December and January. The median number of admissions per day was 12 patients. When comparing the mean number of patients admitted to the hospital per day, depending on day- and nighttime air temperature, following statistically significant differences were obtained (p<0,001): with day- and nighttime air temperature ≥0о C, the number of admissions was less compared to sub-zero temperatures. Significant inverse correlations were established between the number of patients hospitalized with symptomatic BP increase, AF and HF per day, with air temperature at night (correlation coefficient r=-0,339; p<0,001), air t during the day (r=-0,316; p<0,001), temperature difference over 48 hours (r=-0,205; p<0,001); direct correlations with atmospheric pressure (r=0,106; p=0,044) and its changes (r=0,115; p=0,028) were identified. All identified relationships were of moderate strength. According to prognostic model, only nighttime air temperature turned out to be a significant indicator associated with the hospitalization rate per day. With a decrease in air temperature at night for every 7,5о C <0, one more patient is expected to be hospitalized with a symptomatic BP increase, decompensated HF, or paroxysmal AF.Conclusion. Negative air temperature in a metropolis is associated with an increase in hospitalizations for symptomatic BP increase, AF or decompensated HF. Atmospheric pressure and precipitation do not affect these conditions.

Spondylodiscitis: Understanding pathophysiology, surgical strategies, and postoperative management - A single-center study.

Spondylodiscitis (SD) is an inflammatory condition affecting the intervertebral discs and adjacent structures, often leading to serious complications, including epidural abscesses. This study aimed to differentiate postoperative SD from spontaneous cases caused by osteoporotic defects and associated pathologies, evaluating the frequency of SD in spinal diseases at a single center. A retrospective observational study involving 25 patients was conducted, analyzing variations between postoperative revisions in SD patients and spontaneous SD due to concurrent pathology and osteoporotic defects. The effects of postoperative wound healing following transforaminal lumbar interbody fusion and decompressive hemilaminectomy with pedicle screws were also investigated. Ethical guidelines were strictly followed during the study, conducted from January 2023 to September 2023 at Moscow City Clinical Hospital No. 68, Demikhova V.P. Among the 25 patients with spontaneous SD, 15 females and 10 males were included, with only two undergoing surgical revision. Predominant purulent inflammatory foci were observed at specific spinal levels, and demographics revealed prevalent comorbidities such as arterial hypertension (80%) and type 2 diabetes mellitus (60%). Postoperative complications included paravertebral abscesses and wound-related issues. Structural observations indicated vertebral destruction, joint gaps, and localized spinal canal narrowing, revealing complexities in SD cases. Surgical intervention remains crucial for addressing SD-related vertebral complications, while antimicrobial therapy tailored to specific pathogens is pivotal. Concurrent conditions necessitate comprehensive management, often involving cardiological interventions. Postoperatively, a combined approach of conservative therapy and calcium phosphate adjuncts is recommended, especially considering the observed low bone density, aiming to optimize patient recovery and spinal stability.

Treatment of Diffuse Large B-Cell Lymphoma at the Moscow City Clinical Hospital No. 52: A Retrospective Clinical Trial Based on the Single-Center Experience and Analysis of Data from Its In-House Registry

Background. The term diffuse large B-cell lymphoma (DLBCL) defines a heterogeneous group of lymphatic tumors. DLBCL is the most frequent immunomorphological variant among aggressive non-Hodgkin lymphomas (NHLs) in adults. It accounts for 30–40 % of all NHLs. Long-term results of treating newly diagnosed DLBCL have not been reliably evidenced in healthcare practice and, therefore, require further study.
 Aim. To assess the efficacy of chemotherapy for newly diagnosed DLBCL in terms of the 5-year progression-free survival (PFS) based on the analysis of data from the in-house hematology service registry at the Moscow City Clinical Hospital No. 52.
 Materials & Methods. The study enrolled 156 patients with newly diagnosed DLBCL in the period from 2015 to 2022. The patients were 35–85 years of age (median 65 years).
 Results. First-line R-CHOP/R-miniCHOP chemotherapy was administered to 70 % of patients, 28 % of patients received R-DA-EPOCH, and 2 % were treated either with R-B or R-CVP. Complete response was achieved in 100 (65 %) patients: 75 out of them (75 %) received R-CHOP/R-miniCHOP, whereas 25 (25 %) received R-DA-EPOCH. Induction mortality was below 2.5 %. The 5-year PFS was 32 % with the survival median of 20 months. As confirmed by the multivariate analysis, the age over 60 years (p = 0.003), high IPI risk group (p = 0.015), advanced stage of the disease (p = 0.002), and non-GCB subtype of tumor (p = 0.045) can be regarded as independent predictors of early DLBCL progression.
 Conclusion. DLBCL is an aggressive B-cell lymphoma and one of the most frequent immunomorphological NHL variants in the clinical practice of the Moscow City Clinical Hospital No. 52. Despite the use of generally accepted standard immunochemotherapy regimens, the results attained by the present study illustrate unresolved challenges in chemotherapy for newly diagnosed DLBCL patients. By now, more effective first-line DLBCL therapy methods already exist, which are confirmed by the results of clinical trials. As it is sometimes impossible to further escalate immunochemotherapy for obvious reasons (age restrictions, health status, co-morbidities, etc.), a new promising strategy appears to be the personalized chemotherapy based on the study of genetic DLBCL profile of each particular patient.

Feasibility and introduction of assessing the quality of care into information system of the Pirogov Moscow City Clinical Hospital No. 1

Feasibility and introduction of assessing the quality of care into information system of the Pirogov Moscow City Clinical Hospital No. 1

Effect of second warm ischemia elimination on kidney graft function: an experiment and clinical study

Objective: to evaluate the effectiveness of a new device for second warm ischemia (SWI) elimination in kidney transplantation (KT).Materials and methods. The study included clinical and experimental stages. The clinical stage included 63 patients out of 219 who underwent KT at Botkin Moscow City Clinical Hospital between July 2018 and August 2022. The inclusion criteria were kidneys from donation after brain death (DBD) donors with expanded criteria or kidneys from donation after circulatory death (DCD) donors, and an SWI time greater than 45 minutes. The first group consisted of 24 recipients operated on using the new SWI elimination device. The second retrospective control group consisted of 39 patients where sterile ice bags were used at the implantation stage. The groups had no statistically significant differences in the main recipient and donor characteristics, as well as in perioperative parameters. Also, from November 2021 to April 2022, 23 kidney autotransplantation experiments in female Landrace pigs were performed. The animals were cared for in accordance with the European Convention for the Protection of Vertebrate Animals used for Experimental and other Scientific Purposes (Strasbourg, 18 March 1986). Efficiency of different SWI elimination techniques was compared on two experimental models: standard donor (group 1, n = 12) and asystolic donor (group 2, n = 11).Results. In the clinical trial group, mean graft temperature (tm) before reperfusion was statistically significantly lower in group 1 using the special SWI elimination device: 6.4 ± 1.7 °C (95% CI 3.2–8.5) versus 22.1 ± 2.3 °C (18.1–24.6), р < 0.001. The risk of delayed graft function (DGF) was 3.86 times higher (95% CI 1.11–13.43) with the standard SWI elimination technique. In the experimental group, in the subgroups using the new device (n = 12), graft tm before reperfusion was 5.1 ± 0.4 °C (95% CI 4.5–5.8), whereas in the ice bag subgroups (n = 11), tm was 29.3 ± 1.3 °C (95% CI 27.7–30.8), which was significantly higher (p < 0.001). The overall 1-week survival of the experimental animals was significantly higher in the SWI elimination device subgroup (logrank p = 0.036).Conclusion. The developed device is effective in eliminating SWI of renal graft.

ИНТЕРЛЕЙКИН-6 КАК ИНДИКАТОР ТЯЖЕСТИ ПОЛИОРГАННОЙ НЕДОСТАТОЧНОСТИ У НЕДОНОШЕННЫХ ДЕТЕЙ С МАССОЙ ТЕЛА МЕНЕЕ 1500 г: РЕТРОСПЕКТИВНОЕ КОГОРТНОЕ ИССЛЕДОВАНИЕ

Multiple organ dysfunction syndrome (MODS), or multiple organ system failure (MOSF), or multiple organ failure (MOF) in children in the early neonatal period is usually developing against the background of severe birth asphyxia and/or hypoxemia due to various causes (e.g., against the background of critical congenital heart disease) or an infectious process, being one of the main and most frequent reasons for the poor outcome. The level of Interleukin-6 (IL-6) is considered the earliest biomarker for the presence of an infectious process in newborns. The relationship between the level of IL-6 in the blood of premature newborns and the severity of MOF has not been studied enough as yet. The purpose of this research was to study the relationship between the level of IL-6 in the blood and the severity of MOF in premature newborns with a birth weight (BW) of less than 1500 grams in the early neonatal period. Materials and methods used: a single-center retrospective cohort study was conducted in May 26 - September 26, 2022 on the basis of L.A. Vorokhobov Moscow City Clinical Hospital No. 67 of the Moscow Department of Healthcare (located in Moscow, Russia). All of the patients had been followed-up since birth until the discharge from the hospital. Authors have included premature infants with birth weight of less than 1500 grams, gestational age (GA) of less than 32 weeks, with MOF, who were determined by the level of IL-6 in blood serum by high-precision immunochemiluminescent analysis in the first 24 hours and 72 hours of life. Children with severe congenital developmental anomalies, chromosomal and/or genetic syndromes were excluded. Results: a total of 86 preterm infants were included. The patients were divided into 2 groups: G1 of 49 with IL-6<30 pg/ml, and G2 of 37 with IL-6≥30 pg/ml. The groups were identical in terms of gender, BW, GA, height, and the APGAR score. In G2 the premature rupture of amniotic fluid was more common - 6 (12.0%) vs. 15 (41.0%), p=0.005; there were fewer children on non-invasive mechanical ventilation - 15 (31.0%) vs. 3 (8.0%), p=0.015; NEOMOD MOF severity score was higher - 2.0 [1.0; 3.0], (n=47) vs. 3.0 [2.0; 6.0], (n=37), p=0.001; modified inotropic index by the 3rd day of life significantly prevailed - 3.0 [2.0; 5.0], (n=13) vs. 25.5 [19.0; 77.5], (n=12); p=0.001. The average level of IL-6 in G2 was significantly higher on the first day of life and amounted to 121.0 [71.6; 188.0] pg/ml vs. 13.95 [8.79; 17.52] pg/ml in G1; p<0.001. Conclusion: the level of IL-6 of more than 30 pg/ml in the blood of premature newborns with BW of less than 1500 grams in the first 24 hours of life can be considered as an indicator for the MOF severity.

Endoscopic lavage of the cerebral ventricular system for ventriculitis treatment in a patient with complicated new coronavirus infection (COVID‑19)

Introduction. The new coronavirus infection (COVID‑19) has a wide spectrum of complications. Frequency of neurological symptoms varies between 17.3 and 36.4 %. In 8 % of cases, COVID‑19 can be accompanied by bacterial or fungal infection. Since few descriptions of bacterial meningitis in adult patients with COVID‑19 and a single description of surgical treatment of purulent meningitis complicated by empyema of the 4th ventricle in a patient with COVID‑19 were found, and there are no meta‑analyses in this area, descriptions of such cases are of high scientific and practical value.Aim. The describe a case of surgical treatment of purulent ventriculitis in an adult (during treatment of the new coronavirus infection COVID‑19).Materials and methods. A man, 69 years old, with previously established diagnosis of the new coronavirus infection COVID‑19 and a comorbid pathology was admitted to the Moscow City Clinical Hospital No. 40 with newly diagnosed seizure disorder. Computed tomography imaging showed ventriculitis confirmed by MRI with obstructive hypertensive triventricular hydrocephalus.Results. The patient underwent treatment: three‑time endoscopic lavage of the ventricular system, removal of newly formed fibrin membranes with interventricular septostomy, removal of obstruction at the level of the Sylvian aqueduct; the surgery was concluded by external draining of the lateral ventricles, administration of an antibiotic intro the ventricular system and intravenously. Cerebrospinal fluid flow was restored, ventriculitis manifestations completely negated.Conclusion. Development of ventriculitis as one of the first signs of bacterial infection accompanying COVID‑19 is a very rare and life‑threatening complication requiring active surgical intervention. In was shown that endoscopic lavage of the ventricular system for ventriculitis treatment is an effective action against infection and cerebrospinal fluid flow disorders. Use of intraventricular endoscopy for ventriculitis treatment has several advantages compared to needle ventriculostomy. Further studies and analysis of treatment of bacterial ventriculitis using endoscopic surgical techniques in patients with and without the new coronavirus infection are needed.

FORMATION OF DEEP INFANTILE HEMANGIOMA AGAINST THE BACKGROUND OF CONGENITAL HERPES VIRUS INFECTION

The aim is to describe the main forms and etiology of deep infantile hemangioma. On a clinical example, to show the erroneous diagnosis of sialadenitis in a child with deep infantile hemangioma against the background of congenital herpesvirus infection, hospitalized in the Department of Maxillofacial Surgery of the Moscow City Clinical Hospital. In 75% of cases of observation in children, tumors of the outer integument are represented by hemangiomas. Sialoadenitis develops against the background of acute (bacterial, viral) infections. Primary care specialists — pediatricians, pediatric surgeons and dentists in the presence of a mother’s history of placental insufficiency, hypoxic state of the fetus, the threat of termination of pregnancy and the use of hormonal and vascular drugs, the presence of a persistent infection, must include the child in the risk group for developing a vascular tumor.

Prevalence and clinical associations of iron deficiency in patients with decompensated heart failure, depending on the diagnostic criteria used for iron deficiency

To compare the frequency of iron deficiency (ID) in patients with decompensated heart failure (HF), defined by international guideline criterion ferritin 100 ng/ml or ferritin from 100 to 299 ng/ml with TSAT20% (criterion A) and by bone marrow biopsy criterion TSAT19.8% and serum iron 13 mol/l (criterion B); to evaluate the effect of ID, diagnosed on the basis of different ID criteria, on NT pro-BNP, sST2, CRP levels and New York Heart Association (NYHA) functional classes (FC) distribution between groups with ID and without ID. The study included 223 patients (median age 73 [65; 82] years, 58% males) who were hospitalized to V.V. Vinogradov Moscow City Clinical Hospital No. 64 with decompensated HF. All patients underwent a standard physiological examination, laboratory and instrumental studies, including determination of NT-proBNP, sST2, CRP, and ferrokinetic parameters (serum iron, transferrin, ferritin). TSAT was calculated as: serum iron / transferrin 3.98. NYHA FC was determined according to Heart Failure Severity Rating Scale score. All patients underwent echocardiography to assess the ejection fraction of the left ventricle. According to criterion A ID was detected in 89% (n=199) of patients. There were no significant differences between levels of CRP, NT-proBNP and sST2. According to criterion B ID was detected in 70% (n=156) of patients. In the ID group, higher levels of CRP (15.1 mg/l vs 6.2 mg/l, p0.001), NT-proBNP (5422 pg/ml vs 2380 pg/ml, p0.001) and sST2 (59.6 ng/ml vs 42 ng/ml, p=0.02) were detected. Intravenous FCM admission according to current international guidelines (diagnosis of ID according to criterion A) is recommended to 57% of patients included in this study. Both methods formed groups with ID, in which patients had higher NYHA FC compared to groups without ID. According to current clinical guidelines, iron deficiency should be assessed according to method 1. More than half of patients (57, n=127) have indications for intravenous FCM to reduce risk of HF hospitalizations. The frequency of ID in patients with decompensated heart failure varies from 70 to 89% depending on the criterion used to diagnose ID, but in any case, remains high. Intravenous FCM should be prescribed in 57% (n=127) of patients. Criterion B, validated against the gold standard of diagnostics, unlike criterion A, makes it possible to form groups of patients with ID and without ID, significantly differing in CRP, NT-proBNP, and sST2 levels.

Evaluation of the Rationality of Antibiotic Therapy of Nosocomial Infections in Resuscitation and Intensive Care Patients with COVID-19: a Retrospective Analysis

The overall incidence of healthcare-associated infections (HAIs) in patients with COVID-19 is lower than 15%. However, in critical COVID-19 patients, the incidence of HAIs may reach 50%, and the mortality rate may exceed 50%. This makes effective antibiotic therapy in this category of patients extremely important. The aim of the study was to assess the rationality of antibiotic therapy in critically ill COVID-19 patients with HAIs, as well as analyse the timeliness and sufficiency of microbiological and laboratory diagnostic testing in these patients. Materials and methods: the study comprised a retrospective analysis of medical records of the patients with COVID-19 complicated by HAIs who had been admitted to an intensive care unit of Moscow City Clinical Hospital 4 from 27.04.2020 to 01.11.2020. Antibacterial therapy was analysed in accordance with the principles set forth in the Strategy for the Control of Antimicrobial Therapy (antimicrobial stewardship) and the current Interim Guidelines on the Prevention, Diagnosis and Treatment of Novel Coronavirus Infection (COVID-19) of the Russian Ministry of Health. Statistical significance was evaluated using Student’s unpaired t -test. The qualitative comparison of independent groups was made using the χ2 test. Results: HAIs developed in 138 (20.8%) of 664 patients admitted to the intensive care unit. The authors considered empirical antibiotic therapy irrational in 53.6% of these cases (74/138 patients) due to nonconformity to the current clinical recommendations. Empirical antimicrobial therapy was rational in 68.6% of survivors and 33.3% of non-survivors ( p < 0.001). It was corrected based on the results of microbiological testing in 56.9% of survivors and 30.2% of non-survivors ( p = 0.005). Procalcitonin levels, as a marker of bacterial infection, were determined in 74.5% survivors and 48.3% of non-survivors ( p = 0.003). Conclusions: Antibiotic therapy was rational in less than 50% of critically ill COVID-19 patients with HAIs. Having demonstrated a significant mortality decrease in the category of studied patients with rational antibiotic therapy, the study suggests that it is necessary to follow the current recommendations more carefully. The success of therapy also largely depends on its timely correction based on the results of HAI pathogen identification and other diagnostic measures, in particular, procalcitonin biomarker tests.

Инфаркт почки. Анализ 12 случаев острой окклюзии почечной артерии.

Introduction. Kidney infarction (KI) is a rare condition that most often develops as a result of renal artery thromboembolism and causes complete or partial loss of renal function. The diagnosis of this pathology is challangable. Objective. To analyze the features of diagnosis, clinical, laboratory and instrumental characteristics of renal infarction. To assess delayed changes in the renal parenchyma in patients with renal infarction. Materials and methods. Retrospective analysis of data from 12 patients with KI who were admitted to V.M. Buyanov Moscow City Clinical Hospital from 2018 to 2021 and consequent prospective analysis of the results of examination of these patients between 2 and 34 months after KI were done. Result. The mean age of the patients was 60,4 years. Eight patients were admitted to the hospital with surgical diagnoses. None of the patients was correctly diagnosed in the first 12 hours from the onset of the disease. Seven patients had atrial fibrillation. The most informative diagnostic method was contrastenhanced renal computed tomography (CT) scan. The average lactate dehydrogenase (LDH) level was 1563,4 U/L, creatinine - 149,5 μmol/L. Discussion. Evaluation of functioning parenchyma during the control examination showed that it volume was equal to volume of the parenchyma not involved in the infarction at the time of primary hospitalization. Delayed investigation also showed mild violation of the evacuation function on the affected side. Conclusions. Atrial fibrillation is the main risk factor for renal infarction development. Contrast-enhanced CT remains the most valuable method for detecting acute renal artery occlusion. Late diagnosis of the infarction is the main reason of futility of endovascular correction. It requires vigilance of urologists and surgeons in relation to this problem.

PB2272: THERAPY AND HOSPITAL MORTALITY PREDICTORS IN HEMATOLOGICAL PATIENTS WITH 4 GRADE NEUTROPENIA AND CONCOMITANT CORONAVIRUS INFECTION

Background: According to published data, cancer patients are 5 times more likely to contract coronavirus infection (COVID-19) than non-cancer patients. Aims: To assess and identify predictors of hospital mortality in hematological patients with grade 4 neutropenia and concomitant coronavirus infection. Methods: A prospective study included 130 patients (55% women, 45% men) aged 18 to 91 years (median 59) with acute leukemia (AL) and lymphoproliferative diseases (LPD) who had grade 4 neutropenia and coronavirus infection (COVID-19) and were observed from April 2020 to December 2021 at Moscow City Clinical Hospital 52 (Russia). The study also included a reference group of 130 patients matched by sex, age and diagnosis, with AL/LPD and COVID-19, but without grade 4 neutropenia. The statistical analysis was an intention to treat analysis with adjustment for false discovery rate. Results: AML prevailed in the AL group (80.6%), aggressive non-Hodgkin’s lymphomas in the LPD group. Distribution by disease status: 62 patients (47.7%) on chemotherapy (CT), 19 (14.6%) in remission, 23 (17.8%) with disease progression, 19 (14.6%) with newly diagnosed disease, 7 (5.3%) with a relapse. The patients had a high NEWS score (7.5) and a high Charlson comorbidity index (5). The majority had moderate or severe lung tissue damage (CT2 in 44 (33%), CT3 in 25 (20%), CT4 in 13 (10%)). There were increases in the levels of C-reactive protein (> 100 g/L in 55% of patients, mean 241.5 g/L), LDH (506 U/L), D-dimer (1866), procalcitonin (> 0.5 ng/mL in 73%). IL-6 and IL-1b blockers were used for hypercytokinemia; the dose of IL blockers was reduced in view of grade 4 neutropenia. Empiric antibiotic therapy for complications was used in 91.5% of patients. Antifungal therapy was carried out in 65% of cases. Sepsis developed in 63 (48.5%) patients. The median duration of hospitalization in patients with grade 4 neutropenia was 18 days. Transfer to the ICU was required in 78 (60%) patients in the total group and in 41 patients (52.5%) among those older than 60 years. Mortality in ICU patients: 80.7%, mortality in patients older than 60 years: 92.7%. In non-ICU patients with AL and LPD younger than 60 years, the mortality rate was 0%. Mechanical ventilation was used in 48.5% of cases. Mortality was lower in vaccinated patients than in unvaccinated ones (40% vs 51%). The mortality rates in the main group (AL 48.6%, LPD 51.7%, Fig. 1) and the reference group (AL 37.5%, LPD 13.8%, Fig. 2) showed that the presence of grade 4 neutropenia increased the risk of death almost twofold: the relative risk was 1.9 (95% CI 1.3–2.6), p=0.0001. According to the results of multivariate analysis (logistic regression), the predictors of hospital mortality in the main group were ICU stay (odds ratio 12.1 (1.4–24.0), p=0.0001), sepsis (3.0 (1.1–7.7), p=0.001), and age > 65 (3.0 (0.9–7.5), p=0.001). Severe disease progression/relapse is also a predictor of mortality (close to statistical significance). Image:Summary/Conclusion: Coronavirus infection with severe neutropenia (caused by tumor progression and/or combination chemotherapy) is a significant adverse factor of hospital mortality in patients with hematological cancers. Predictors of hospital mortality are age over 60 years, sepsis, ICU stay, and the absence of remission.

PB1870: COVID - 19 IN PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA: HOSPITAL MORALITY PREDICTORS

Background: Patients with chronic lymphocytic leukemia (CLL), as the disease progresses and the tumor load increases, are characterized by high susceptibility and severe course of viral infections. The depth of immune dysfunction can be influenced by factors such as age, comorbidity, disease status and previous treatment. The detection of SARS-COV2 in this cohort of patients made it possible to analyze the course of COVID-19, as well as to develop a strategy for the disease management of these patients. Aims: To assess the risk factors for the severe course of COVID-19, as well as to identify predictors of hospital mortality. Methods: 179 patients with verified CLL and COVID-19 were followed up by the hematology service of Moscow City Clinical Hospital No.52 (Moscow) from April 21, 2020 to November 31, 2021. Anthropometric, anamnestic, clinical and laboratory data were evaluated, treatment tactics of both CLL and COVID-19 were analyzed in 179 patients (69 women and 110 men, median age - 66 years). A statistical multivariate analysis of hospital mortality, factors of unfavorable prognosis of COVID-19 (complications, humoral response, hospital mortality) was carried out. Results: Age was a significant adverse factor for men: the age of a man from 73 years and more, increases the risk of death of the patient by 3.0 times (p<0.05). For women, age was not a significant adverse factor. Assessment of the effect of comorbidity: patients with 6 or more comorbidity scores according to Charlson have 2.2 times greater risk of death; the presence of cardiovascular diseases increases the risk of death of the patient by 2.3 times. The presence of 1 or more lines of chemotherapy in the anamnesis increased the risk of hospital mortality by 1.5 times. Patients who had previously undergone chemotherapy were treated until the moment of discharge statistically significantly longer than patients who had not undergone antitumor therapy. Relapse/progression of the disease was a factor of unfavorable prognosis for the survival of patients with CLL (mortality was 47% compared to 14.7% in patients in remission). A significant unfavorable prognosis is also the Binnet stage C (p<0.05). A valid factor in the failure of COVID-19 (p<0.05) was ICU therapy and the development of secondary bacterial complications (the use of 2nd-line antibacterial therapy). The assessment of the humoral response in 59 patients shows the presence of an increase in IgG on the 10th-14th days of the disease in 44% of patients, among whom no deaths were detected, 1/3 were vaccinated patients. The absence of a humoral response was a statistically significant adverse outcome factor in 25% of patients (p<0.05). Summary/Conclusion: Progression/recurrence of chronic lymphocytic leukemia is a factor in the severe course of COVID-19, and, as a result, increases the risk of hospital mortality. The absence of a humoral response determines the persistent course of COVID-19 and increases the risk of death by 25%. The study of the course of COVID-19 in patients with CLL allows us to identify key aspects affecting the choice of management tactics for this category of patients: additional booster vaccination (stimulation of the humoral response), early detection (screening) of SARS-COV2 for virus-neutralizing antibodies therapy, timely hospitalization of patients.

P1612: ACUTE MYELOID LEUKEMIA IN ADULT PATIENTS: FEATURES OF TREATMENT IN CONTEXT OF THE COVID-19 PANDEMIC.

Background: Acute myeloid leukemia (AML) is a disease with a poor prognosis and a high mortality rate, while patients with acute myeloid leukemia are at increased risk of complications from COVID-19 infection. Aims: To investigate the treatment effectiveness and survival of patients with AML who had the COVID-19 diagnosis confirmed, as well as evaluating predictors of hospital mortality among this group of patients. Methods: From April 2020 to November 2021, Moscow City Clinical Hospital 52 treated 149 patients with AML who had the COVID-19 diagnosis confirmed, with a median age of 61 years (range 18-91), while 56% of patients were over 60 years old. An equal ratio of men and women was performed, 70 and 79 respectively. 13% were diagnosed with APL, while the remaining 87% had other variants of AML. At the time of hospitalization the most of the patients admitted had first- or second-degree pulmonary lesions (28 and 35%, respectively), while 31% of patients performed more severe lesions and the other 6% had no pulmonary damage detected, but they had a positive PCR. At the time of hospitalization, 10 out of 149 patients (7%) achieved complete remissions (CR) and were withdrawn from therapy; 41 patients (28%) were diagnosed with AML for the first time in our clinic; and 98 patients (65%) were already in process of AML treatment in other clinics. The effectiveness of treatment was assessed by the frequency of CR, as well as by the amount of cases of lethality and in-hospital survival rates. The analysis of treatment results was performed as at 01 November 2021. Results: 60 patients (38%) with AML (excluding APL) and confirmed COVID19 received anti-tumor treatment. Palliative care was received by 23 patients (38%), these were predominantly elderly patients with a median age of 71 years (range 45-91 years), with severe COVID-19. 19 patients (32%) with a median age of 38 years (range 21-61 years) received the 7 + 3 treatment protocol. While 18 elderly patients (30%) with a median age of 70 years (range 60-85 years) received the low intensity therapy (low doses of cytarabine, hypomethylation therapy and venetoclax containing regimens). As a result of COVID-19, 79 patients (54%) died. The main factor determining the high mortality rate in our study was the absence of AML CR. The Survival of patients in CR was 96.3±3.6%, which means almost all patients have recovered from COVID-19 and were discharged to continue their treatment in other medical institutions. For patients out of remission and primary patients with AML the survival rate was 38.0±6.5% and 33.7±8.7%, respectively. For the purposes of analyzes of predictors of survival, we divided our patients into 2 groups, due to a great variety of prognosis. Remission status essentially outweighs all other factors, including presence of significant comorbidities, AML variants, isolated cytopenias, severity of COVID-19 (CT, CRP, D-dimer, etc.), nature of AML therapy and other factors. In the group of patients out of AML remission the negative predictive value for hospital survival was shown by age over 60 years, as well as by agranulocytosis, CT 3-4, the use of GCS and transfer to the ICU. Summary/Conclusion: The diagnosis of COVID-19 in patients with AML greatly worsens their life prognosis. The leading predictor of mortality becomes the lack of remission of AML. Thus, antitumor treatment allows achieving CR, which in turn reduces the risk of developing a severe course of coronavirus infection.

Adherence to Attendance at Outpatient Clinic and Longterm Survival of Patients after Stroke in Outpatient Setting: the Data of REGION-M Registry

Aim. Assess the two-year survival rate of patients who have undergone acute cerebral circulation disorder, depending on their commitment to visiting the district polyclinic before and after discharge from the hospital.Material and methods. The outpatient part of the REGION-M register included 684 patients attached to the Moscow City Polyclinic №64, discharged from the Moscow City Clinical Hospital n.a. F.I. Inozemtsev of from 01.01.2012 to 04.30.2017 with a confirmed diagnosis of acute cerebral circulation disorder (cerebral stroke / transient ischemic attack).Results. Of the entire cohort, 83.2% of patients and 84.2% after hospital discharge attended the clinic during the year before the development of reference acute cerebral circulation disorder. Patients who attended the clinic before and after the reference stroke were older, more likely to have diabetes, comorbid disease and disability. For 22 months of follow-up, mortality was 28.8% (197 out of 684 people). Among those who applied and did not apply to the clinic before the reference acute cerebral circulation disorder, the difference in mortality tended to be reliable (27.4% versus 35.7%, p &lt;0.1), while mortality was almost twice as low among patients who applied to the clinic at least 1 time after discharge (25.7%) than among patients who did not apply after discharge - 45.4%, p&lt;0.0001. When adjusting for sex and age (the relative risk of death for them was 1.009, 95% confidence interval 1.005-1.01 2, p&lt;0.0001 ), the statistical validity of reducing the risk of death was maintained when patients were committed to visiting the clinic after discharge - the relative risk of death 0.366 (95% confidence interval 0.269-0.500, p&lt;0.0001 ).Conclusion. Lower mortality among those who visited the district polyclinic after undergoing stroke confirms the important role of medical observation in the posthospital period. At the same time, there is a reserve in improving the long-term prognosis of the lives of patients who have suffered a cerebral stroke or transient ischemic attack, due to greater coverage of patients with medical supervision in the clinic.

Lung function in patients with lymphangioleiomyomatosis

Aim. To assess the functional parameters of the respiratory system and their impact on the survival of patients with lymphangioleiomyomatosis (LAM).Materials and methods. A study of lung function (spirometry, bodyplethysmography, diffusion test) was carried out in 131 patients with LAM (mean age 41±10 years), who were under observation and treatment in medical institutions in Moscow (Pulmonology Scientific Research Institute, Sechenov University, Moscow City Clinical Hospital named after D.D.Pletnev). The diagnosis of the disease was made based on the diagnostic criteria for LAM, formulated by a group of experts at the initiative of the European Respiratory Society in the guidelines for the diagnosis and treatment of LAM.Results. The mean VC value was 95±25% pred., FEV1 /VC − 56±20%, FEV1 − 64±31% pred., DLCO − 49±24% pred. DLCO, FEV1 /VC, FEV1 and VC were reduced in 87, 76, 70 and 27% of patients, respectively. The obstructive ventilatory defect was detected in the overwhelming majority of cases − in 75%, restrictive ventilatory defect − in 4 patients, mixed defect − in 1 patient. In 28 (21%) patients, there were no pulmonary ventilation disorders. The Cox regression model showed that baseline DLCO and FEV1 are the main factors determining the risk of death.Conclusion. In patients with LAM, the obstructive ventilatory defect predominates, the restrictive ventilatory defect is quite rare. The lung diffusion capacity is reduced in 87% of patients with LAM. Parameters of lung function are closely related to survival.

Specificity of chest computed tomography in COVID-19-associated pneumonia: a retrospective study

Aim: To assess the specificity of COVID-19- associated pneumonia detection by radiologists using a chest CT scan.Materials and methods: From mid-February to early March 2020, 65 patients have been retrospectively selected from the Moscow City Clinical Hospital database; all of them had been treated in an inpatient facility with a verified diagnosis of COVID-19. In addition, 75 patients from the Unified Radiological Information Service have been randomly selected. In December 2019, these outpatients had been sent by an attending physician for a chest CT scan with suspected pneumonia. The imaging studies showed non-specific inflammation signs in the lungs. All 140 scans were analyzed by seven radiologists from different Russian cities, who independently categorized each study as “COVID-19” or “Other pneumonia”.Results: Chest computed tomography had a 92% specificity in the differential diagnosis of COVID-19-associated pneumonia, and its specificity in the general population is expected to be at least 80% with a high probability. The inter-rater variability was low (coefficient of variation for specificity 12.6%). The sensitivity in our study was 76.2%, and the coefficient of variation for sensitivity 23.5%. These findings are generally consistent with other studies. The primary study limitation is the absence of a sample with confirmed pneumonia caused by other viruses.Conclusion: Chest CT is highly specific for the detection of COVID-19-associated pneumonia.

The effectiveness of the organization of medical care for elderly patients with acute coronary syndrome in the regional vascular center

The article provides a retrospective analysis of the activities of the regional vascular center (RCC) of the Moscow City Clinical Hospital named after M.P. Konchalovsky, working in the framework of the Regional program of specialized medical care for acute coronary syndrome (ACS). A multidisciplinary team of doctors based on the RIC has been created at the hospital. Organizational measures allowed to reduce the time interval from the moment a patient with ACS arrives at the hospital admission department until the mechanical recanalization and stenting of the infarct-related artery begins, increase operative activity and reduce the average hospital bed-day of the patient's hospital stay.

Factors associated with in-hospital mortality in patients after acute cerebrovascular accident (according to the REGION-M register)

Aim. To determine the main factors associated with in-hospital mortality in patients after acute cerebrovascular accident based on the medical history data. Material and methods. The study used the data of retrospective hospital part of the REGION-M register, which included all patients hospitalized in one Moscow city clinical hospital from January 1, 2012 to March 30, 2017 with stroke and transient ischemic attack. We analyzed the presence of following parameters’ information in case histories of patients who died in hospital and those who were discharged: risk factors (RF), socio-demographic factors, history of cardiovascular and concomitant diseases. The association of factors recorded at hospital admission with mortality rate was studied, and multivariate logistic regression was constructed. A combination of factors significantly associated with in-hospital mortality was determined. Results. Of 900 patients (365 (40,6%) men and 535 (59,4%) women) included in the REGION-M register, 216 (24,0%) died in the hospital. Assessment of the RF information presence showed that the smoking data was disclosed in 54,3% of case histories, family history — 1,1%, education level — 8,6%, alcohol consumption — 7,4%, disability — 79,1%, hypercholesterolemia — 6,4%. However, there were no significant differences on the completeness of the data collection on the listed RF between deceased and discharged patients. Factors such as gender, age, and outcome were described in all case histories. Univariate analysis of factors significantly associated with patients’ mortality marked out age and history of cardiovascular diseases (coronary artery disease (CAD), atrial fibrillation (AF), venous thrombosis) and/or concomitant diseases (diabetes, anemia). Multivariate logistic regression identified factors associated with increased in-hospital mortality as follows: CAD, AF, diabetes, venous thrombosis. Conclusion. Hospital-based physicians pay little attention to the recording of cardiovascular RF and sociodemographic parameters in patients with stroke, regardless of the condition severity and outcome. In-hospital mortality is associated with age, CAD, AF, diabetes, and venous thrombosis. Region-M register workgroup: Akimova A. V., Arutyunov G. P., Belova E. N., Blagodatskikh S. V., BoytsovS. A., Budaeva I. V., Vernokhae-va A. N., ViskovR. V., Voronina V. P., GladilkinaM. P., DeevA. D., Dmitrieva N. A., Drapkina O. M., Zagrebelny A.V., Kvitivadze G. K., Kudryashov E. N.., Kokareva I. V., Kudryashov E. V., Kutishenko N. P., Lerman O. V., Lukina Yu. V., LukyanovM. M., Martsevich S. Yu., Matveeva A. D., Matske-vich L. A., Mitichkin A. E., Nikitina G. I., Nekoshnova E. S., OvsepyanM. A., Okshina E. Yu., PalamarchukV. N., Parsadanyan N. E., PorezanovaM. V., Stakhovskaya L. V., Stolboushkina E. A., Hapaeva M. A., Chernyshova M. I., Shamalov N. A.