ANALYSIS OF FATAL CASES IN CORONAVIRUS INFECTION COVID-19
Introduction. An important characteristic of an infectious disease, especially caused by a new pathogen such as SARS-CoV-2, is its severity, the ultimate measure of which is its ability to cause death. Mortality rates help us understand the severity of the disease, identify risk groups, and assess the quality of medical care.
Objective. To study the risk factors for the development of an unfavorable outcome in patients with COVID-19-associated pneumonia.
Material and methods. A retrospective analysis was conducted of 292 medical records of inpatient patients with COVID-19-associated pneumonia (251 patients (86%) with confirmed cases and 41 patients (14%) with probable cases of COVID-19) who had a fatal outcome. The study was conducted based on the stories of deceased patients who were on inpatient treatment at the GCP at the City Infectious Diseases Center of Astana in the period from 2021 to 2022.
The statistical processing of the obtained data was carried out using methods of descriptive statistics. Quantitative data were described using the median (Me) and lower and upper quartiles (Q1 – Q3), categorical data were described with absolute values and percentages using IBMSPSS Statistics 20.0 and Jamovi.
Results and discussion. The conducted studies have shown that the fatal outcome in patients with COVID-19-associated pneumonia is more often registered in older age groups (mainly in people over 65 years of age). Predictors of an unfavorable outcome of the disease are late hospitalization (38.6% of patients were hospitalized for 7-9 days of illness, 21.4% of patients were hospitalized for 10 days or more), the severity of the condition during hospitalization (severe course was registered in 66.7% of patients, extremely severe – in 33.3% of patients), associated with the presence of complications already at the time of hospitalization against the background of severe concomitant diseases. The lack of vaccination status for COVID-19 could also affect the possibility of the development and severity of the course of the COVID-19 coronavirus infection. The main causes of death in COVID-19 are respiratory failure, pulmonary embolism, sepsis, and acute respiratory distress syndrome. Concomitant diseases such as hypertension, chronic heart failure, cardiac arrhythmia, obesity, and type 2 diabetes mellitus aggravate the course of COVID-19 infection.
Laboratory predictors of an unfavorable outcome are lymphopenia, increased erythrocyte sedimentation rate (ESR), the content of C-reactive protein (CRP), interleukin-6 (IL-6), D-dimers and procalcitonin (PCT). The severity of these changes correlated directly with the severity of the disease.
Conclusions: Risk factors for an unfavorable outcome of COVID-19-associated pneumonia are old age, late hospitalization, severity of the condition, and the presence of complications at the time of admission of patients to the hospital against the background of severe concomitant pathology. The severity of the condition and the risk of death were associated with the severity of lymphopenia, the degree of increase in ESR, the content of CRP, IL-6, D-dimers and procalcitonin.
Identification and consideration of the above-mentioned risk factors for the development of a fatal outcome will make it possible to predict the possibility of an unfavorable course of the disease in a timely manner and adjust the necessary therapeutic measures to prevent the occurrence of complications that may cause death.
Sholpan A. Kulzhanova1, https://orcid.org/0000-0002-4118-4905
Zhadira M. Sapar1, https://orcid.org/0009-0004-2831-2564
Gulsimzhan O. Turebaeva1, https://orcid.org/0000-0001-8777-4874
1NAO "Astana Medical University", Astana, Republic of Kazakhstan.
1. Авдеев С.Н., Адамян Л.В. Временные методические рекомендации Министерства здравоохранения Российской Федерации. Профилактика, диагностика и лечение новой коронавирусной инфекции 2019-nCoV // Пульмонология.2019. 29(6): 655-672.
2. Бабкина А.С., Голубев А.М., Острова И.В. Морфологические изменения головного мозга при COVID-19 // Общая реаниматология. 2021. Т. 17. №3:14-15.
3. Гареева М. Коронавирус в Казахстане: статистика за 2022 год // Информбюро https://informburo.kz/novosti/koronavirus-v-kazaxstane-statistika-za-2022-god.(Дата обращения: 30.12.2022)
4. Губернаторов Е. Что происходило с вирусов COVID-19 в 2022 году //Общество. https://www.vedomosti.ru/society/articles/2022/12/30/957680. (Дата обращения: 31.12.2022)
5. Лян Т. Справочник по профилактике и лечению COVID-19. - Изд-во Чжэцзянского университета, 2020. - 68 с.
6. Устьянцева. И.М., Зинченко М.А., Гусельникова Ю.А.SARS-CoV-2. Маркеры воспаления // Политравма. 2020. № 4:35-43.
7. Хаджиева М.Б., Грачева А.С., Ершов А.В. Биомаркеры повреждения структур аэрогематического барьера при COVID-19 // Общая реаниматология. 2021. Т. 17. № 3: 16-31.
8. Хасанова Д.Р., Житкова Ю.В., Васкаева Г.Р. Постковидный синдром: обзор знаний о патогенезе, нейропсихиатрических проявлениях и перспективах лечения. // Неврология, нейропсихиатрия, психосоматика. 2021. Т. 13(3):93–98. doi: 10.14412/2074-2711-2021- 3-93-98.
9. Шляхто Е.В., Конради А.О., Арутюнов Г.П. и др. Руководство по диагностике и лечению болезней системы кровообращения в контексте пандемии COVID-19 // Российский кардиологический журнал. 2020. 25(3):3801.
10. Bazykina E.A., Trotsenko O.E. Features of pneumonia caused by the new coronavirus SARS-COV-2 // Bulletin of Respiratory Physiology and Pathology. 2020; 78:135-146.
11. Channappanavar R., Perlman S. Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology // Semin Immuno pathol. 2017. Vol. 39: 529–539.
12. Chen T., Wu D., Chen H., Yan W., Yang D., Chen G. et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study // Br. Med. J. 2020;26:368:m1091.
13. Cummings. M.J. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study // Lancet. 2020. 395(10239): 1763-1770.
14. Fogarty H., Townsend L., Ni Cheallaigh C., Bergin C., Martin Loeches I., Browne P. et al. COVID19 coagulopathy in Caucasian patients // Br J Haemato. 2020.189(6):1044–1049.
15. Gong J. A Tool for Early Prediction of Severe Coronavirus Disease 2019 (COVID-19): A Multicenter Study Using the Risk Nomogram in Wuhan and Guangdong, China // Clin. Infect. Dis. 2020.71(15): 833-840.
16. Gu J., Han B., Jian Wang J. COVID-19: Gastrointestinal manifestations and potential fecal-oral transmission// Gastroenterology. 2020. 158 (6): 1518-1519.
17. Guan W.J., Ni Z.Y., Hu Y. et al. Clinical characteristics of coronavirus disease 2019 in China // N Engl J Med. 2020. 382(18):1708-1720.
18. Hadid T., Kafri Z., Al-Katib A. Coagulation and anticoagulation in COVID-19 // Blood Rev. 2021.47:100761.
19. Henderson L.A., Canna S.W., Schulert G.S., Volpi S., Lee P.Y., Kernan K.F. et al. On the alert for cytokine storm: immunopathology in COVID-19 // Arthritis Rheum. 2020.72(7):1059-1063.
20. Lippi G, Plebani M. Laboratory abnormalities in patients with COVID-2019 infection // Clin Chem Lab Med. 2020;58(7):1131–1134.
21. Liu F., Li L., Xu M. et al. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19 // J ClinVirol.2020.127:104370.
22. Mainous A.G., Rooks B.J., Orlando F.A. Risk of new hospitalization post COVID-19 infection for non-COVID-19 conditions // J. Am. Board Fam. Med. 2021.34:907–913.
23. Pfeifer N. Risk stratification nomogram for COVID-19 patients with interstitial pneumonia in the emergency department: A retrospective multicenter study // Med Klin Intensiv med Notfmed. 2022. 117 (2): 120-128.
24. Yan L. An interpretable mortality prediction model for COVID-19 patients // Nat Mach Intell. 2020. 2: 283-288.
25. Yanping Zhang. Vital Surveillances: The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) //China CDC Weekly, China, 17.02.2020. 2 (8):113-122.
26. Zhang C., Shi L., Wang F.S. Liver injury in COVID-19: management and challenges // Lancet Gastroenterol Hepatol. 2020. 5 (5): 428-430.
27. Zhang L., Xu J., Qi X. Development and Validation of a Nomogram for Predicting the Risk of Coronavirus-Associated Acute Respiratory Distress Syndrome: A Retrospective Cohort Study // Infect Drug Resist.2022. 15:2371-2381.
28. Zhou Xianlong, Ding Guoyong, Fang Qing,Guo Jun. Clinical features of 162 fatal cases of COVID-19: a multi-center retrospective study//Emergency and Critical Care // Medicine. 2022. 2(3):109-115.
References:
1. Avdeev S.N., Adamyan L.V. Vremennye metodicheskie rekomendatsii Ministerstva zdravookhraneniya Rossiiskoi Federatsii. Profilaktika, diagnostika i lechenie novoi koronavirusnoi infektsii 2019-nCoV [Temporary methodological recommendations of the Ministry of Health of the Russian Federation.Prevention, diagnosis and treatment of the new coronavirus infection 2019-nCoV]. Pul'monologiya [Pulmonology]. 2019. 29(6): 655-672. [in Russian]
2. Babkina A.S., Golubev A.M., Ostrova I.V. Morfologicheskie izmeneniya golovnogo mozga pri COVID-19 [Morphological changes in the brain during COVID-19] Obshchaya reanimatologiya [General resuscitation]. 2021. T. 17. No. 3:14-15. [in Russian]
3. Gareeva M. Koronavirus v Kazakhstane: statistika za 2022 god [Coronavirus in Kazakhstan: statistics for 2022]. [Information Bureau] https://informburo.kz/novosti/koronavirus-v-kazaxstane-statistika-za-2022-god.(accessed: 30.12.2022) [in Russian]
4. Gubernatorov E. Chto proiskhodilo s virusom COVID-19 v 2022 godu [What happened with the COVID-19 virus in 2022]. Obshchestv o[Society]. https://www.vedomosti.ru/society/articles/2022/12/30/957680.(accessed: 31.12.2022) [in Russian]
5. Liang T. Spravochnik po profilaktike i lecheniyu COVID-19. - Izd-vo Chzhetszyanskogo universiteta [Handbook on the prevention and treatment of COVID-19. - Zhejiang University Publishing House], 2020. - 68 p. [in Russian]
6. Ustyantseva I.M., Zinchenko M.A., Guselnikova Yu.A. SARS-CoV-2. Markery vospaleniya [SARS-CoV-2. Markers of Inflammation]. Politravma [Polytrauma]. 2020. No. 4:35-43. [in Russian]
7. Khadzhieva M.B., Gracheva A.S., Ershov A.V. Biomarkery povrezhdeniya struktur aerogematicheskogo bar'era pri COVID-19 [Biomarkers of damage to air-blood barrier structures during COVID-19]. Obshchaya reanimatologiya [General resuscitation]. 2021. T. 17. No. 3: 16-31. [in Russian]
8. Khasanova D.R., ZhitkovaYu.V., Vaskaeva G.R. Postkovidnyi sindrom: obzor znanii o patogeneze, neiropsikhiatricheskikh proyavleniyakh i perspektivakh lecheniya [Post-Covid syndrome: a review of knowledge about pathogenesis, neuropsychiatric manifestations and treatment prospects]. Nevrologiya, neiropsikhiatriya, psikhosomatika [Neurology, neuropsychiatry, psychosomatics]. 2021. Vol. 13(3):93–98. doi: 10.14412/2074-2711-2021-3-93-98. [in Russian]
9. Shlyakhto E.V., Konradi A.O., Arutyunov G.P. et al. Rukovodstvo po diagnostike i lecheniyu boleznei sistemy krovoobrashcheniya v kontekste pandemii COVID-19 [Guidelines for the diagnosis and treatment of diseases of the circulatory system in the context of the COVID-19 pandemic]. Rossiiskii kardiologicheskii zhurnal [Russian Journal of Cardiology]. 2020. 25(3):3801. [in Russian]
Number of Views: 54
Category of articles:
COVID-19 - Topical Subject
Bibliography link
Kulzhanova Sh.A., Sapar Zh.M., Turebaeva G.O. Analysis of fatal cases in coronavirus infection COVID-19 // Nauka i Zdravookhranenie [Science & Healthcare]. 2023, (Vol.25) 5, pp. 7-16. doi 10.34689/SH.2023.25.5.001Related publications:
IMMUNOLOGICAL CHANGES IN CHILDREN WITH MULTISYSTEM INFLAMMATORY SYNDROME ASSOCIATED WITH SARS-COV-2
EFFICACY OF THE ANTIVIRAL DRUG ENISAMY IODIDE IN SEVERE ADULT ACUTE RESPIRATORY INFECTIONS IN THE COVID-19 ERA
APPLICATION OF ARTIFICIAL INTELLIGENCE IN COMBATING THE COVID-19 PANDEMIC: CURRENT TRENDS AND PROSPECTS. REVIEW
CONSEQUENCES OF THE CORONAVIRUS INFECTION: THE POST-COVID SYNDROME AND MENTAL MANIFESTATIONS. LITERATURE REVIEW
FEATURES OF THE SICKNESS BEHAVIOR OF ARTERIAL HYPERTENSION AND OBESITY DURING THE PANDEMIC OF COVID-19 CORONAVIRUS. REVIEW