Comparative characteristics of the clinical course of COVID-19 infection in hospitalized patients

Размещено на http://www.allbest.ru/

Comparative characteristics of the clinical course of COVID-19 infection in hospitalized patients

Afanasiuk Oksana Ivanivna Ph.D., associate professor of HEI

National Pirogov Memorial Medical University, Vinnytsya, Ukraine

Shmaliy Valentin Ivanovych Ph.D., associate professor of HEI

National Pirogov Memorial Medical University, Vinnytsya, Ukraine

Topicality. In early 2020, an epidemic of the new, at that time, SARS-CoV-2 virus occurred in Ukraine, which led to a high level of morbidity with fatal consequences, costs for hospitalization and treatment of patients, which negatively affected the level of the economy, including. The clinical picture was characterized by the appearance of febrile temperature, dyspnoea, dry paroxysmal cough, loss of smell, taste, muscle pain, pronounced general weakness and rather rapid development of pulmonary insufficiency. On the 7-10th day, a cytokine storm developed, which over time led to the development of various complications, exacerbations of chronic diseases, and a high percentage of fatal consequences [1]. With the introduction of vaccination, the clinical picture of coronavirus infection has changed significantly: the percentage of asymptomatic patients has increased, and a much smaller number of patients need oxygen therapy.

The purpose of the study is to study the clinical and laboratory features of COVID infection in hospitalized patients.

Materials and methods. The study included 75 patients with severe COVID infection and diagnosed pneumonia, 40 of whom were hospitalized in 2020 and 35 in 2022. The average age of patients in both groups was 54.3±2.16 and 56.31±2.85, respectively. Clinical symptoms before hospitalization, during hospitalization, laboratory indicators of the inflammatory process, concomitant pathology and availability of complete vaccination were evaluated.

The results. In the first group, whose patients were hospitalized in 2020, general weakness, febrile temperature, headache, muscle pain, dry cough, shortness of breath occurred in 100% of patients before and during hospitalization, runny nose, sore throat - in 92.5% of patients before hospitalization and disappeared after 3-5 days. 52.5% of patients at the pre-hospital stage complained of a lack of taste and smell, another 30% had a distortion of taste sensations, which lasted almost the entire period of hospitalization. All patients of the first group were hospitalized within 8-11 days from the appearance of the first signs of the disease and required oxygen therapy, among which 6 patients (15%) were transferred to CIPAP therapy on the second or third day. The peculiarity of the impression of the lungs is the absence of the classic auscultatory picture of pneumonia: slightly weakened vesicular breathing was heard, mainly in the lower segments of both lungs without additional respiratory sounds, which appeared during the development of respiratory distress syndrome and were characterized by small alveolar moist rales. Oxygen saturation ranged from 65 to 87%, while the lung impression on computer tomography was 87.6+7.2%. An important point was that all patients had a history of coronary heart disease, 77.5% - hypertension, 65% - diabetes, 22.5% - chronic obstructive pulmonary disease, 23.2% - various degrees of obesity.

Among the laboratory indicators: leukocytes fluctuated with in 9.8+2.01*10⁹/l, rod-shaped cells 15.1+2.34%, the absolute number of lymphocytes - 0.58+0.09*10⁹/l, which indicated exhaustion compensatory mechanisms of the body. Thrombocytopenia was determined in the range of 172.6+2.14*10⁹/l, C- reactive protein (CRP) 262.9+13.05 mg/l, D-dimer 8.51+4.32 pg/ml, significantly increased CRP and D-dimer indicators indicated an unfavorable prognosis for patients. The presented changes also coincide with the data of other authors [2]. It should be noted that 9 (22.5%) patients of the first group died of progressive respiratory failure. Among hospitalized patients in 2022, in 54.29% of cases, a COVID infection was diagnosed during hospitalization for other reasons (preparation for surgery, exacerbation of chronic diseases, etc.), while the general condition of the patients was satisfactory and without pronounced signs of viral infection (absent runny nose, cough, fever). All patients experienced moderate general weakness, but argued that it was due to various reasons, not a viral infection. 31.43% had slight nasal congestion, sore throat, low-grade fever and dry cough, unexpressed general weakness. Complaints of headache, muscle pain, disturbance or distortion of taste, smell, shortness of breath were not noted by the patients. A peculiarity was that, according to computer tomography data, the impression of the lungs was significantly less, but it was 64.22+8.13% (р<0.05), while only 8 (22.86%) patients needed oxygen therapy, although the saturation ranged from 91 to 98%. In 15 patients (43.6%), the temperature rose on the 2nd-3rd day of hospitalization, but didn't exceed 38⁰C. No pathological changes were heard by auscultation. It should be noted that in this group of patients all had coronary heart disease, 74.29% of patients had hypertension, 62.86% - had diabetes, but 3 of them (8.57%) were diagnosed for the first time during hospitalization.14.29% of patients had chronic obstructive pulmonary disease and 17.14% - various degrees of obesity. Regarding complete vaccination, 65.71% of patients were vaccinated with two vaccines, and no patient with booster vaccination. Indicators of leukocytes, the absolute number of lymphocytes in all patients of the second group were within the normal range, platelets - the lower limit of normal. CRP was significantly lower by 12.7+3.05 mg/l (p<0.001), D-dimer by 0.57+0.21 pg/ml. No patient died in this group.

Conclusions

The introduction of vaccination significantly weakened the virulence of the SARS-CoV-2 virus, increasing the number of asymptomatic patients, reducing the manifestations of pulmonary failure and mortality, respectively, and hospitalizations, which more likely reduced the timely diagnosis of this disease.

However, the long-term consequences of lung impression require further study, even in asymptomatic patients, especially those with concomitant internal organ pathology.

References

covid infection vaccination clinical picture

[1] Андрейчин М.А., Ничик Н.А., Завіднюк Н.Г., Йосик Я.І., Іщук І.С., Івахів О.Л. (2020). COVID-19: епідеміологія, клініка, діагностика, лікування та профілактика. Інфекційні хвороби. 2(100), 41 -55. DOI: 10.11603/1681 -2727.2020.2.11285

[2] Трихліб, В.І. та ін. (2021). Клініко-лабораторні прояви в тяжкохворих із COVID-19 та померлих. Медицина невідкладних станів. 17(4), 51-64. DOI:https://doi.org/10.22141/2224-0586.17.4.2021.237727

Размещено на Allbest.ru