Options for the course of COVID-19

Authors: Golukhova E.Z., Rybka M.M., Klyuchnikov I.V., Mamalyga M.L., Slivneva I.V., Zhelihazheva M.V., Ramnenok T.V.

Company: 1 Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, 121552, Russian Federation
2 Federal Service for Surveillance in Healthcare in Moscow and the Moscow Region, Moscow, 127206, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2021-15-1-32-47

For citation: Golukhova E.Z., Rybka M.M., Klyuchnikov I.V., Mamalyga M.L., Slivneva I.V., Zhelikhazheva M.V., Ramnenok T.V. Options for the course of COVID-19. Creative Cardiology. 2021; 15 (1): 32–47 (in Russ.). DOI: 10.24022/1997-3187-2021-15-1-32-47

Received / Accepted:  11.03.2021 / 16.03.2021

Keywords: COVID-19 C-reactive protein D-dimer systemic inflammatory response hypercoagulation

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Abstract

Introduction. Currently it is well-recognized that tissue markers allow to classify the process of different infectious diseases and help to identify patients' to subclasses and endotypes for clarifying the prognosis and therapy effectiveness. Objective. To detect different COVID-19 course types according to pathophysiological mechanisms, and evaluate clinical, lab and instrumental features of each clinical course.

Material and methods. 108 first COVID-19 patients were admitted at special hospital based on Bakoulev National Medical Research Center for Cardiovascular Surgery. The average age of patients was 57.4 ± 2.3 years, 54.6% of women, the degree of lung damage was 36.2 ± 2.3%. All patients were identified with C-reactive protein (CRP) and D-dimer.

Results. The patients were divided in 4 groups depending on the degree of main pathophysiological process of system inflammatory response (SIR) and hypercoagulation: with inflammatory (1group) (n = 22), coagulation (2 group) (n = 8), inflammatory-coagulation (3 group) (n = 71) and affectless (4 group) (n = 7) types of disease progression. All the 4 groups of the discharged patients were equal in pulmonic parenchymatous tissue damage degree. The level of lactate dehydrogenase (LDH) was significantly higher in patients of group 3 (334.2 ± 20.6 U/L) compared with LDH in groups 1, 2 and 4 (respectively 264.2 ± 21.5, 231 ± 14.2, 206.3 ± 32.2 U/L, p < 0.01), which indicates more severe damage to the pulmonary parenchyma. In groups 1 and 3, the level of lymphocytes was lower than in groups 2 and 4. In terms of the D-dimer level, the 3rd and 2nd groups did not differ (1537.4 ± 126.7 and 1682.5 ± 394.2, respectively, p > 0.05), but its level was significantly higher in the 3rd group compared with the 1st and 4th (359 ± 32.9 and 309.3 ± 50.8, p < 0.01). Over the course of staying in hospital the features of each type of disease progression kept preserved.

Conclusions. It is possible to accentuate 4 possible development scenario of the COVID-19: the inflammatory one (with SVR manifestation without hypercoagulation), the hypercoagulation one (without SVR activation), the inflammatory-coagulation (active SVR together with hypercoagulation) and affectless type (without SVR and hypercoagulation). The most prevalent type of COVID-19 disease progression is inflammatory-coagulation scenario which is manifested at 65% of patients.

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About Authors

  • Elena Z. Golukhova, Dr. Med. Sc., Professor, Academician of RAS, Director, ORCID
  • Mikhail M. Rybka, Dr. Med. Sc., Head of Department, Associate Director for Anesthesiology and Intensive Care, Professor of the Department, ORCID
  • Ivan V. Klyuchnikov, Dr. Med. Sc., Professor, Chief Researcher, ORCID
  • Maksim L. Mamalyga, Dr. Med. Sc., Senior Researcher, ORCID
  • Inessa V. Slivneva, Cand. Med. Sc., Researcher, Associate Professor, Ultrasonic Diagnostician, ORCID
  • Madina V. Zhelikhazheva, Dr. Med. Sc., Senior Researcher, ORCID
  • Tat’yana V. Ramnenok, Cand. Med. Sc., Senior State Inspector of the Department of Quality Control and Safety of Medical Activities, ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery