Description of the clinical picture of COVID-19 in patients with fatal outcome

Abstract

In the Chelyabinsk region in 2020, 33 473 cases of a new coronavirus infection (COVID-19) were detected, of which 493 were fatal. The peak incidence of COVID-19 was recorded in November–December 2020.

Purpose of research: description of the course of the infectious process of COVID-19 in patients with a fatal outcome.

Material and methods. A retrospective analysis of case histories of patients with COVID-19 who had a lethal outcome was carried out using the method of continuous sampling from November 2020 to April 2021 on the basis of the Regional Infectious Diseases Center of the Regional Clinical Hospital No. 3 of the Chelyabinsk Region. Diagnosis was based on a comprehensive assessment of the anamnesis, clinical, laboratory and instrumental data in accordance with the Interim Guidelines “Prevention, Diagnosis and Treatment of Novel Coronavirus Infection (COVID-19)” version 9 dated 10/26/2020. Verification of the etiological diagnosis was carried out by PCR with reverse transcription to detect SARS-CoV-2 RNA in the nasopharyngeal secretion. The autopsy material was studied in the Pathoanatomical Department No. 9 of the Chelyabinsk Regional Pathological Bureau.

Results and discussion. The average age of patients with a fatal outcome was 70 years, more often they were people with blood groups I and II, not vaccinated against COVID-19, pneumococcal infection and influenza; no gender differences were found. For patients with a fatal outcome from COVID-19, the presence of concomitant pathology is most characteristic: arterial hypertension (58%), atherosclerosis (45%), type 2 diabetes mellitus (41.5%), malignant neoplasms (17%). Among the “lethal patients”, 50% had lung lesions at admission CT 2 and 25% had changes in the lungs consistent with CT 1; there was also a violation of cognitive functions in 21% of individuals. When comparing the analysis of studies of autopsy material and the clinical picture of patients, it was found that the morphological substrate of COVID-19 is both diffuse alveolar damage and simultaneous damage to the vascular bed, which is accompanied by damage to various organs and systems of the patient’s body.

Keywords:new coronavirus infection; COVID-19; fatal cases; epidemic waves

Funding. No financial support was provided.

Conflict of interest. The authors declare that there is no conflict of interest.

Contribution. The concept and design of the study – Ter-Bagdasaryan L.V., Ratnikova L.I., Sychugov G.V.; statistical processing and writing of the text – Ter-Bagdasaryan L.V., Sychugov G.V., Nikulina K.A., Lokteva M.A.; collection and processing of the material – Ter-Bagdasaryan L.V., Lebedeva E.Yu., Sychugov G., Ivanova A.V., Pirogov D.V., Nikulina K.A., Lokteva M.A.; editing – Ratnikova L.I.

For citation: Ter-Bagdasaryan L.V., Ratnikova L.I., Lebedeva E.Yu., Sychugov G.V., Ivanova A.V., Pirogov D.V., Nikulina K.A., Lokteva M.A. Description of the clinical picture of COVID-19 in patients with fatal outcome. Infektsionnye bolezni: novosti, mneniya, obuchenie [Infectious Diseases: News, Opinions, Training]. 2022; 11 (3): 52–60. DOI: https://doi.org/10.33029/2305-3496-2022-11-3-52-60

References

1. State report «On the state of sanitary and epidemiological welfare of the population in the Chelyabinsk region in 2020» prepared by Federal Service for Supervision of Consumer Rights Protection and Human Welfare in the Chelyabinsk Region (Director Semyonov A.I.) with Federal Budget Healthcare Institution «Center for Hygiene and Epidemiology in the Chelyabinsk Region» (head doctor Valeullina N.N.). Chelyabinsk, 2021: 237 p. (in Russian)

2. State report «On the state of sanitary and epidemiological welfare of the population in the Chelyabinsk region in 2020» prepared by Federal Service for Supervision of Consumer Rights Protection and Human Welfare in the Chelyabinsk Region (Director Semyonov A.I.) with Federal Budget Healthcare Institution «Center for Hygiene and Epidemiology in the Chelyabinsk Region» (head doctor Valeullina N.N.). Chelyabinsk, 2021: 154 р. (in Russian)

3. Temporary guidelines «Prevention, diagnosis and treatment of a new coronavirus infection (COVID-19)». Version 9 (26.10.2020). (in Russian)

4. Zhidkova E.A., Gutor E.M., Tkachenko Yu.A., Rogova I.V., Popova I.A., Gurevich K.G. Retrospective analysis of risk factors for COVID-19 among the working population. Infektsionnye bolezni: novosti, mneniya, obuchenie [Infectious Diseases: News, Opinions, Training]. 2021; 10 (2): 25–30. DOI: https://doi.org/10.33029/2305-3496-2021-10-2-25-30 (in Russian)

5. Guan X., Zhang B., Fu M., Li M., Yuan X., Zhu Y., et al. Clinical and inflammatory features based machine learning model for fatal risk prediction of hospitalized COVID-19 patients: results from a retrospective cohort study. Ann Med. 2021; 53 (1): 257–66. DOI: https://doi.org/10.1080/07853890.2020.1868564

6. Polyakova A.S., et al. Diagnostic value of determining the level of procalcitonin in the practice of an infectious disease specialist. Voprosy sovremennoy pediatrii [Problems of Modern Pediatrics]. 2017; 16 (4): 334–41. (in Russian)

7. Hamade B., Huang D. T. Procalcitonin: where are we now? Crit Care Clin. 2020; 36 (1): 23–40.

8. Spiezia L., Boscolo A., Poletto F., et al. COVID-19-related severe hypercoagulability in patients admitted to intensive care unit for acute respiratory failure. Thromb Haemost. 2020; 120 (6): 998–1000. DOI: https://doi.org/10.1055/s0040-1710018

9. Tang N., Bai H., Chen X., et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020; 18 (5): 1094–9. DOI: https://doi.org/10.1111/jth.14817

10. Zhou F., Yu T., Du R., et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395 (10 229): 1054–62.

11. Klypa T.V., Bychinin M.V., Mandel’ I.A., Andreychenko S.A., Minets A.I., Kolyshkina N.A., et al. Clinical characteristics of patients with COVID-19 admitted to the intensive care unit. Predictors of severe course. Klinicheskaya praktika [Clinical Practice]. 2020; 11 (2): 6–20. DOI: https://doi.org/10.17816/clinpract34182 (in Russian)

12. Onder G., Rezza G., Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA. 2020; 323 (18): 1775–6. DOI: https://doi.org/10.1001/jama.2020.4683

13. Winthrop K.L., Mariette X. To immunosuppress: whom, when and how? That is the question with COVID-19. Ann Rheum Dis. 2020; 79 (9): 1129–31.

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)

CHIEF EDITOR
Aleksandr V. Gorelov
Academician of the Russian Academy of Sciences, MD, Head of Infection Diseases and Epidemiology Department of the Scientific and Educational Institute of Clinical Medicine named after N.A. Semashko ofRussian University of Medicine, Ministry of Health of the Russian Federation, Professor of the Department of Childhood Diseases, Clinical Institute of Children's Health named after N.F. Filatov, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Deputy Director for Research, Central Research Institute of Epidemiology, Rospotrebnadzor (Moscow, Russian Federation)

Journals of «GEOTAR-Media»