DOI: https://doi.org/10.22263/2312-4156.2020.6.62
Ziamko V.Y.1, Nikitsina K.V.1, Dzyadzko A.M.2
Features of clinical course and intensive therapy of severe COVID-19 pneumonia
1Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
2Minsk Scientific and Practical Center of Surgery, Transplantation and Hematology, Minsk, Republic of Belarus
Vestnik VGMU. 2020;19(6):62-69.
Abstract.
Objectives. To establish special features of clinical course and intensive therapy of severe pneumonia in coronavirus infection.
Material and methods. A study of the results of examination and treatment of 30 patients with severe pneumonia of coronavirus and 30 of bacterial etiology was conducted.
Results. Patients with COVID-19 pneumonia were characterized by lymphopenia, hyperglycemia, hypoproteinemia, a statistically significantly higher level of C-reactive protein and creatinine. Acute respiratory distress syndrome (ARDS) complicated the course of COVID-19 pneumonia in more than half of cases (66.7%) with a low respiratory index (219.8 [103.6-235]) indicating a more severe course of the disease. Interleukin-6 as a marker of the cytokine storm was 2.5 times higher than the norm in viral pneumonia (p<0.05). Elevated lactate, interleukin-6 and lymphopenia correlated with lethal outcome (r=0.69, r=0.57, r=0.5, p<0.05).
The most common antibiotic therapy schemes were meropenem and levofloxacin or cefepime and levofloxacin – 10 cases each (33.3%). In most cases prone-position during 8 hours allowed to improve 1.6 times, p<0.05 blood oxygenation on the average. On the 5th day the patients returned to normal temperature, their leukocyte count, C-reactive protein, and blood oxygenation and CT scan of the lungs improved after intensive therapy including antibacterial, hormonal therapy and hydroxychloroquine (p<0.05).
Conclusions. Lymphopenia, elevated levels of creatinine, C-reactive protein, interleukin-6, lactate, hyperglycemia, hypoproteinemia, and a low respiratory index were characteristic of a more severe course of the disease. High levels of lactate, interleukin-6, and lymphopenia correlated with mortality.
Complex intensive therapy, including prone-position, treatment with hydroxychloroquine as well as hormone therapy allowed to improve the results of treatment of patients with COVID-19 pneumonia.
Key words: COVID-19, viral pneumonia, bacterial pneumonia, severe course, the department of resuscitation and intensive therapy.
The study was conducted within the frames of the research theme «Systemic inflammatory reaction in severe bacterial pneumonia: molecular- genetic mechanisms of the pathogenesis and their prognostic value in the effectiveness evaluation of antibacterial therapy», treaty with BRFFR No. M19M-028 of 02.05.2019.
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Information about authors:
Ziamko V.Y. – postgraduate of the Chair of Anesthesiology and Resuscitation with the course of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University,
ORCID: https://orcid.org/0000-0002-6753-2074
Nikitsina K.V. – Candidate of Medical Sciences, associate professor, head of the Chair of Anesthesiology and Resuscitation with the course of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University.
ORCID: https://orcid.org/0000-0003-4744-6838
Dzyadzko A.M. – Doctor of Medical Sciences, associate professor, head of the Department of Anesthesiology and Resuscitation, Minsk Scientific and Practical Center of Surgery, Transplantation and Hematology,
ORCID: https://orcid.org/0000-0003-1965-1850
Correspondence address: Republic of Belarus, 210009, Vitebsk, 27 Frunze ave., Vitebsk State Order of Peoples’ Friendship Medical University, Chair of Anesthesiology and Resuscitation with the course of the Faculty for Advanced Training & Retraining. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Viktoriya Y. Ziamko.
