Clinical and laboratory manifestations and pathological anatomical picture of a severe course of a new coronavirus infection COVID-19 with a fatal outcome

Abstract

Aim – to study the clinical and laboratory manifestations of a severe course of COVID-19 in a lethal outcome with an assessment of the pathomorphological picture based on autopsy material.

Material and methods. A retrospective analysis of demographic, clinical and laboratory parameters, as well as the results of a pathoanatomical study of 54 patients with severe COVID-19 who died in the intensive care unit, was carried out.

Results. Among the patients included in the study, women and men were equally divided. The mean age was 73.1±1.86 years (median 73 years). An increase in body temperature above 38 °С was observed in 81.5% of cases, weakness – in 70.4%, dry cough – in 46.3%, a feeling of lack of air – in 46.3%, muscle pain – in 40.7%. The volume of lung damage by the type of bilateral polysegmental pneumonia with areas of compaction of the type of “frosted glasses” and consolidation was more than 75.0% and was determined in 68.5% of patients. Concomitant diseases were detected in 94.4% of patients. It was found that all patients had a pronounced systemic inflammatory response, as evidenced by an increase in the level of C-reactive protein and procalcitonin in all patients. A decrease in albumin levels was observed in 88.9% of cases. A hypercoagulable shift with intravascular coagulation was noted. Morphological studies revealed damage to the lungs, liver, kidneys and pancreas with the development of thrombovascular changes.

Conclusion. A severe course of COVID-19 with a fatal outcome was observed in older patients with clinical, radiological and laboratory manifestations of a systemic inflammatory response, which was accompanied by damage to various organs and systems.

Keywords:COVID-19; morphological studies; systemic inflammatory response

Funding. The work was carried out with the financial support of the Central Research Institute of Tuberculosis and prepared in the course of the research work on the topic No. 122041200023-9 “Laboratory aspects of the manifestation of a systemic inflammatory response in patients with tuberculosis and various diseases of the bronchopulmonary system who have suffered an infection caused by SARS-COV-2”.

Conflict of interest. The authors declare no conflict of interest.

Contribution. The concept and design of the study – Abdullaev R.Yu.; collection and processing of material – Rybka M.M., Berezovskiy Yu.S., Greсov E.M., Semenova L.A.; statistical processing, text writing – Abdullaev R.Yu., Komissarova O.G.; editing, approval of the final version of the article – Komissarova O.G., Abdullaev R.Yu.

For citation: Abdullaev R.Yu., Komissarova O.G., Rybka M.M., Berezovskiy Yu.S., Grecov E.M., Semenova L.A. Clinical and laboratory manifestations and pathological anatomical picture of a severe course of a new coronavirus infection COVID-19 with a fatal outcome. Infektsionnye bolezni: novosti, mneniya, obuchenie [Infectious Diseases: News, Opinions, Training]. 2022; 11 (4): 30–7. DOI: https://doi.org/10.33029/2305-3496-2022-11-4-30-37

References

1. Abdullaev R., Komissarova O. Laboratory indicators of coronavirus infection COVID-19. Vrach [Physician]. 2020; 31 (5): 3–6. DOI: https://doi.org/10.29296/25877305-2020-05-01 (in Russian)

2. Glybochko P., Fomin V., Moiseev S., et al. Clinical outcomes of patients with COVID-19 admitted for respiratory support to the intensive care units in Russia. Klinicheskaya farmakologia i terapia [Clinical Pharmacology and Therapy]. 2020; 29 (3): 25–36. DOI: https://doi.org/10.32756/0869-54902020-3-25-36 (in Russian)

3. Guan W.J., Ni Z.Y., Hu Y., et al.; China Medical Treatment Expert Group for COVID-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020; 382 (18): 1708–20. DOI: https://doi.org/10.1056/NEJMoa2002032

4. Wang D., Hu B., Hu C., et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020; 323 (11): 1061–9. DOI: https://doi.org/10.1001/jama.2020.1585

5. Bhatraju P.K., Ghassemieh B.J., Nichols M., et al. COVID-19 in critically ill patients in the Seattle Region – Case Series. N Engl J Med. 2020; 382 (21): 2012–22. DOI: https://doi.org/10.1056/NEJMoa2004500

6. Martínez-Colón G.J., Ratnasiri K., Chen H., et al. SARS-CoV-2 infects human adipose tissue and elicits an inflammatory response consistent with severe COVID-19. bioRxiv. Preprint. 2021. DOI: https://doi.org/10.1101/2021.10.24.465626

7. Lippi G., Plebani M. Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chim Acta. 2020; 505: 190–1. DOI: https://doi.org/10.1016/j.cca.2020.03.004

8. Herold T., Jurinovic V., Arnreich C., et al. Elevated levels of interleukin-6 and CRP predict the need for mechanical ventilation in COVID-19. J Allergy Clin Immunol. 2020; 146 (1): 128–36.e4. DOI: https://doi.org/10.1016/j.jaci.2020.05.008

9. Chen H., Guo J., Wang C., et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020; 395 (10 226): 809–15. DOI: https://doi.org/10.1016/S0140-6736(20)30360-3

10. Zippi M., Fiorino S., Occhigrossi G., Hong W. Hypertransaminasemia in the course of infection with SARS-CoV-2: incidence and pathogenetic hypothesis. World J Clin Cases. 2020; 8 (8): 1385–90. DOI: https://doi.org/10.12998/wjcc.v8.i8.1385

11. Liu Y., Yang Y., Zhang C., et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci China Life Sci. 2020; 63 (3): 364–74. DOI: https://doi.org/10.1007/s11427-020-1643-8

12. Lippi G., Mattiuzzi C. Hemoglobin value may be decreased in patients with severe coronavirus disease 2019. Hematol Transfus Cell Ther. 2020; 42 (2): 116–7. DOI: https://doi.org/10.1016/j.htct.2020.03.001

13. Lippi G., Favaloro E.J. D-dimer is associated with severity of coronavirus disease 2019: a pooled analysis. Thromb Haemost. 2020; 120 (5): 876–8. DOI: https://doi.org/10.1055/s-0040-1709650

14. Tang N., Li D., Wang X., Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020; 18 (4): 844–7. DOI: https://doi.org/10.1111/jth.14768

15. Zhang J.J., Dong X., Cao Y.Y., Yuan Y.D., Yang Y.B., Yan Y.Q., et al. Clinical characteristics of 140 patients infected by SARS-CoV-2 in Wuhan, China. Allergy. 2020; 75 (7): 1730–41. DOI: https://doi.org/10.1111/all.14238

16. Lippi G., Plebani M., Henry B.M. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a meta-analysis. Clin Chim Acta. 2020; 506: 145–8. DOI: https://doi.org/10.1016/j.cca.2020.03.022

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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)

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