Personalized approach to the management of a patient with COVID-19 with a complicated comorbid background
The new coronavirus infection COVID-19 continues to be a highly lethal disease. It should be noted that in the presence of chronic kidney disease (CKD) and type 2 diabetes mellitus, hospital mortality is 20.3-43%.
The aim of the work is to form the principles of a personalized approach to the management of patients with COVID-19 with a complicated comorbid background.
Material and methods. The article describes a clinical case of successful recovery of an 87-year-old patient from a new coronavirus infection COVID-19, complicated by pneumonia involving 36% of the lung parenchyma area. Along with age, the situation was aggravated by the comorbid status of the patient: the presence of chronic lymphocytic leukemia, hypertension, mechanical prostheses of the mitral and aortic valves, postinfarction cardiosclerosis, paroxysmal atrial fibrillation, type 2 diabetes mellitus, stage 4 CKD, anemic syndrome, and subclinical hypothyroidism.
Results. The C-reactive protein level at admission was 114.46 mg/L. The patient refused hospitalization. Baricitinib 4 mg, favipiravir according to the scheme, vitamin D 2000 units were prescribed for the previously taken therapy. Already after 3 days, C-reactive protein decreased by 4.6 times, and by the 8th day by 15.5 times and amounted to 7.38 mg/ml. The temperature returned to normal on day 2 from the start of baricitinib. In dynamics, a decrease in creatinine level to 177.0 µmol/l was noted, the glomerular filtration rate increased to 30 ml/min/1.73 m2, which corresponded to stage 3b of CKD (a pronounced decrease in glomerular filtration rate).
Conclusion. Despite the age of the patient, many comorbidities, each of which could be fatal, the timely use of baricitinib on an outpatient basis made it possible to stop the progressive course of the disease.
Keywords:new coronavirus infection COVID-19; baricitinib, favipiravir; comorbid patient
Funding. The study had no sponsorship.
Conflict of interest. The authors declare that there is no conflict of interest.
Contribution. The concept and design of the study – Chepurnenko S.A.; collection and processing of the material –Bulgakova N.M., Chepurnenko S.A., writing the text – Safonova A.V.; editing – Chepurnenko S.A., Shavkuta G.V.
For citation: Chepurnenko S.A., Shavkuta G.V., Bulgakova N.M., Safonova A.V. Personalized approach to the management of a patient with COVID-19 with a complicated comorbid background. Infektsionnye bolezni: novosti, mneniya, obuchenie [Infectious Diseases: News, Opinions, Training]. 2023; 12 (1): 116–22. DOI: https://doi.org/10.33029/2305-3496-2023-12-1-116-122 (in Russian)
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