Table 1 presents data on the studied cohort of patients. There were 49 patients under observation in the hospital, of which 33 were positive for COVID PCR, the average age was 67.6 ± 12 years, men - 11 women - 22, designated as group 1 – main studied. In 16 patients, the virus was not confirmed (COVID PCR negative), the average age was 65.5 ± 8.2 years, 7 women and 9 men, designated as group 2 - control.
Table 1
Comparison COVID-19 positive and COVID-19 negative patients
|
Group 1
|
|
Group 2
|
|
PCR COVID positive status
|
33
|
100%
|
0
|
0%
|
Number of patients
|
33
|
100%
|
16
|
100%
|
Age
|
67.6±12
|
|
65.5±8.2
|
|
Gender F (M)
|
22 (11)
|
66.7% (33.3%)
|
7(9)
|
47% (53%)
|
CT polysegmental bilateral pneumonia
|
28
|
84.8 %
|
7
|
43.75%
|
CT Bronchopneumonia
|
0
|
0
|
9
|
56.25%
|
Arterial hypertension
|
23
|
69.7%*
|
8
|
50%
|
Ischemic heart disease
|
11
|
33.3%
|
8
|
50%
|
Type 2 diabetes
|
7
|
21.2%
|
2
|
12.5%
|
Hospitalization (days)
|
22.4±14,6
|
|
16±11
|
|
Among 33 COVID-positive patients with signs of acute pneumonia, in 28 (84.8%) confirmed by spiral computed tomography revealed polysegmental bilateral pneumonia. It should be noted that they have comorbid pathology, in 23 of 33 (69.7%) patients arterial hypertension (AH) was noted, in 11 (33.3%) ischemic heart disease (IHD), diabetes mellitus (DM type 2) - 7 (21.2%) sick. The duration of hospitalization in COVID-positive patients was 22.4±14.57 days and in COVID-negative patients 16±11 days.
Among 16 COVID-negative patients with pneumonia, according to CT of the lungs, 7 patients (43.75%) confirmed polysegmental bilateral pneumonia, and 9 (56.25%) - bronchopneumonia.
Table 2 shows the saturation data according to pulse oximetry and hemodynamic data, including heart rate, respiration rate (RR), blood pressure (BP), body temperature and serum hemoglobin.
Table 2
Hemodynamics and respiration in pneumonia patients with or without COVID-19
|
Group 1
|
COVID positive
|
Group 2
|
Control
|
|
Measurement 1 (a)
|
Measurement 2 (b)
|
Measurement 1 (c)
|
Measurement 2 (d)
|
Saturation (%)
|
93.2±2.78
|
97.34± 1.47%*
|
87.88±6.87
|
96.38±1.74
|
Heart rate (beats per min)
|
89.3± 7.6
|
|
99.94 ±31.18
|
|
Respiration rate (per minute)
|
20.03± 2,35
|
|
21.8± 3.97
|
|
Body temperature (t°C)
|
36.86±0.67
|
|
36.95±0.86
|
|
Haemoglobin (g/l)
|
130.79±16.8
|
126.71±16
|
146.3 ±20.26
|
135.6±16.6
|
*р < 0.05 between a и b |
In patients with confirmed COVID, the average saturation values were 93.2±2.78%, and at discharge significantly increased to 97.34±1.47%. At admission, the patients were found to have shortness of breath, number of respiration movements per minute 20.03±3.04 per minute, which was accompanied by tachycardia up to 89.84±7.6 beats/min. The body temperature was sub-febrile, 36.86±0.67°C. Serum hemoglobin level is 130.79±16.8 g/l, and at discharge 126.71±16 g/l. In patients with negative COVID, the mean saturation values were 87.88±6.87%, and at discharge it significantly increased to 96.38 ± 1.74%. At admission, the patients were found to have shortness of breath, 21.03±3.97, which was accompanied by tachycardia up to 99.94±31.18 beats/min. The body temperature was subfebrile, 36.95±0.86 ° C. Serum hemoglobin level was 146.3±20.26 g / l, and at discharge 135.6±16.6 g /L. The difference between the groups was insignificant (p≤0.01), except for the saturation index.
Table 3 presents the data of the general blood test (GBT). It is noteworthy that at admission, patients with COVID infection had leukocytosis of 8.9±2.65 x 109 per ml, which significantly decreased to 7.31±4.05 x 109 (p≤0.01), monocytosis 8.26±2.81%, which decreased from 4.82±2.31% after 8-10 days.
Table 3
Laboratory data: blood counts and blood biochemisrty
Groups
|
|
Group 1
|
COVID +
|
Group 2
|
Control
|
Number of patients
|
n=32
|
|
n=15
|
|
Measurements
|
Units
|
Measurement 1a
|
Measurement
2b
|
Measurement 1c
|
Measurement 2d
|
Haemoglobin
|
g/L
|
130.79±16.8
|
126.71±16
|
146.3 ±20.26
|
135.6±16.6
|
Erythrocytes
|
109/L
|
4.46±0.5
|
4.28±0.66
|
4.91±0.69
|
4.52±0.7
|
Leucocytes
|
103/L
|
8.26±2.81
|
4.82±2.31*
|
10.11±4.14
|
11.11±3.48¶
|
Monocytes
|
%
|
8,9±2,65
|
7.31±4.05*
|
7.72±7.16
|
8.25±5.13
|
Lymphocytes
|
%
|
23.075±14.38
|
22.31±11,89
|
16.41±11,43
|
20.93± 12.59
|
ESR
|
mm/h
|
18.89± 11,31
|
19.61± 13,33
|
24.71±17.91
|
21.55±16.5
|
Thrombocytes
|
109/L
|
311.32±108,6
|
197.36±76.09*
|
258.41±73.95
|
289.21±75.91¶
|
CRP
|
mg/L
|
42.945±47.2
|
12.46±14.36*
|
65.84±60.57
|
34.11±31.51*
|
Blood protein
|
mmol/L
|
62.72±9.06
|
63.82±12.62
|
66.74± 17.91
|
56.13 ±19.72
|
Urea
|
mmol/L
|
6.855±2.77
|
6.35±2.73
|
5.84 ±2.19
|
6.45± 2.47
|
Creatinine
|
mmol/L
|
91.31±23.67
|
72.01±17.87*
|
72.83± 21.51
|
64.64 ±19.9
|
Prothrombin time
|
seconds
|
14.42±2.54
|
13.36±1.61
|
27.90± 29.06
|
20.97± 17.2*¶
|
Prothrombin index
|
%
|
90,7 ±18.7
|
95.2± 14.4
|
83.97 ±35.02
|
107.73 ±28.39
|
Glucose
|
mg%
|
7.3 ±2.5
|
7.17± 4.87
|
7.75±3.49
|
7.98±5.00
|
*р < 0,05 between и b, ¶*р< 0,05 between а, в и c, d |
In the control group without COVID, leukocytosis was 10.11±4.14 x 109/ ml, which is significantly higher than in patients of the first group, and at discharge 11.11±3.48 x 109/ ml, which is explained by the resolution stage. Monocytosis was higher in patients with СOVID pneumonia than in the control, 8.9±2.6% and 7.72±7.16%, respectively. At discharge in patients of the first group, monocytosis significantly decreased by 7.31±4.05%, and in patients of the control group it remained high at 8.25±5.13%. This indicates the pleocytosis observed in sepsis in the group of COVID-positive patients, C-reactive protein (CRP) in most patients during hospitalization was high and significantly decreased at discharge, 42.95±47.2 mmol/L and 12.46±14.36 mmol/L (p≤0.05). In the group of COVID-negative patients with CRP, there were 65.84±60.57 and 34.11±31.51 mmol/L (p≤0.05) pneumonia [5].
The patients showed a tendency to an increase in the level of creatinine, which decreased at discharge, 91.31±23.67 mmol/L and 72.01±17.87 mmol/L (p≤0.01), respectively, in the first group, and 72.83±21.51 mmol/L and 64.64±19.9 mmol/L, in the control group.
In patients of the first group, the prothrombin time at hospitalization was 14.42±2.54 sec., and at discharge 13.36±1.61 sec., which in patients of the control group was 27.90±29.06 sec. and 20.97±17.2 sec., respectively (difference between groups p≤0.01). This may indicate a thrombotic orientation in patients with COVID, in the absence of such in the control group.
It is possible that this fact was responsible for the rapid recovery of the initially lower oxygen saturation in patients with COVID with the standard treatment of community-acquired (non- COVID pneumonia). Platelets were increased in patients with COVID 311.32 ± 108.6 x 109 per liter at the beginning and decreased at discharge 197.36 ± 76.09 x 109 per liter. In the control group at admission 258.41 ± 73.95 and 289.21 ± 75.91 x 109 per liter at discharge.
In general, this may be a consequence of kidney overload, due to the accompanying COVID-19 lesion of the vascular wall and thickening of the blood, since the platelet level in most patients was elevated upon admission. Probably, the patients had transient changes in blood flow in the renal arteries, as a manifestation of disseminated intravascular coagulation (DIC) syndrome. At the end of treatment, platelets decreased, which is a consequence of the use of direct and indirect anticoagulants.
Diagram 1 presents an analysis of the therapy. The absence of antiviral treatment is noteworthy, although blood counts indicate a predominantly viral lesion in viral pneumonia. In patients with pneumonia (PCR negative), antibiotics agents, as cephalosporins and fluoroquinolones were reliably used more often, and dexamethasone was prescribed reliably more often, most likely in the complex treatment of the bronchitic component of bronchopneumonia. Patients with PCR-positive COVID pneumonia were significantly more likely to receive Hageman factor inhibitors.
Due to the severity of the clinical course, as well as the prevention of bacterial complications against the background of COVID, as well as in the group without confirmed COVID, the patients were prescribed several antibacterial drugs of different pharmacological groups, namely cephalosporins, fluoroquinolones, and carbopinems. All patients underwent anticoagulant therapy, fccjrding to approved clinical protocol, with two groups of agents, direct and indirect, as low molecular weight heparins and factor Xa inhibitors.