Abstract
Objective:To identify predictors of severe pneumonia in COVID-19.
Material and methods.To determine the predictors and the general characteristics of the condition of patients with a poor prognosis, we analyzed clinical data, laboratory, instrumental investigations in the deceased (group I, n = 36) and discharged (group II, n = 187) patients at each stage of treatment.
Results. In patients of the I group, the volume and degree of damage to the lung tissue during hospitalization were greater than in those who recovered. Among the deceased, the number of patients with body mass index over 40 kg/m2 was 21.6% more (p < 0.05). The level of C-reactive protein in the first group from the stage of progression to the end of treatment increased by 2.36 and 44.7 (p < 0.01) respectively. The number of deceased with leukocytes more than 9 × 109/l was 45%, while number of those who recovered was 10.5% (p < 0.05). The level of lactate dehydrogenase, which is one of the nonspecific markers of lung tissue damage, was 21% higher in the deceased (p < 0.05) than in those who recovered. The progression of COVID-19 disease leads to a decrease in the number of red blood cells, monocytes and hemoglobin. According to the coagulogram data, the D-dimer level in the deceased patients was 4.66 times higher than in the recovered patients (p < 0.01).
Conclusion. The results of a retrospective analysis showed that the predictors of a poor prognosis are advanced age, need for hospitalization early from the onset of the disease, grade 3 obesity, NEWS > 7, SpO2 at admission less than 92%, 3–4 degree of changes on CT at admission or in the next days after hospitalization, volume of lung parenchyma lesion on CT > 45% or progression of any degree, comorbidity, lactate dehydrogenase level more than 360 U/l, persistence of a high level of C-reactive protein or its increase during treatment, level, D-dimers more than 1,000 μg/l, increased fibrinogen in dynamics, leukocytosis, neutrophilia, lymphopenia and monocytopenia.
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About the authors
- Elena Z. Golukhova, Dr. Med. Sc., Professor, Academician of RAS, Director;
- Mikhail M. Rybka, Dr. Med. Sc., Head of Department of Anesthesiology and Intensive Care, Associate Director
for Anesthesiology and Intensive Care, Professor of Chair of Anesthesiology and Intensive Care with a Course
of Clinical Laboratory Diagnostics of the Institute of Training of Highly Qualified Personnel and Professional
Education (ITHQPPE); ORCID
- Maksim L. Mamalyga, Dr. Med. Sc., Senior Researcher; ORCID
- Ivan V. Klyuchnikov, Dr. Med. Sc., Professor, Chief Researcher; ORCID
- Inessa V. Slivneva, Cand. Med. Sc., Researcher, Associate Professor of Chair of Cardiology and Functional Diagnostics of ITHQPPE; ORCID
- Tat’yana V. Ramnenok, Cand. Med. Sc., Senior State Inspector of Department of Quality Control and Safety of Medical Activities; ORCID
