fcmedicineФундаментальная и клиническая медицинаFundamental and Clinical Medicine2500-07642542-0941КемГМУ10.23946/2500-0764-2021-6-4-22-44fcmedicine-465Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL RESEARCHФакторы риска летального исхода у пациентов с тяжелым течением COVID-19 на этапе поступления/перевода в отделение реанимацииRisk factors for death in patients with severe COVID-19 admitted to an intensive care unithttps://orcid.org/0000-0002-5186-7873ОсяевН. Ю.OsyaevN. Yu.

Осяев Николай Юрьевич, лаборант-исследователь лаборатории фундаментальных аспектов атеросклероза отдела экспериментальной медицины; врач клинической лабораторной диагностики, врач-бактериолог

650002, г. Кемерово, Сосновый бульвар, д. 6,

650066, г. Кемерово, пр. Октябрьский, д. 22

Nikolay Yu. Osyaev, Dr. MD, Research Technician; Laboratory for Vascular Biology, Division of Experimental Medicine; Clinical Laboratory Scientist, Clinical Laboratory

6, Sosnovy Boulevard, Kemerovo, 650002,

22, Oktyabrskiy Prospekt, Kemerovo, 650066

osyaev.nikolai@mail.ruhttps://orcid.org/0000-0003-1127-8684ИванниковаН. В.IvannikovaN. V.

Иванникова Наталья Владимировна, заведующая экспресс-лабораторией

650066, г. Кемерово, пр. Октябрьский, д. 22

Natalia V. Ivannikova, Dr. MD, Head of the Express Laboratory

22, Oktyabrskiy Prospekt, Kemerovo, 650066

https://orcid.org/0000-0003-0179-0983ВавинГ. В.VavinG. V.

Вавин Григорий Валерьевич, кандидат медицинских наук, заместитель главного врача по клинико-диагностической службе

650066, г. Кемерово, пр. Октябрьский, д. 22

Grigory V. Vavin, Dr. MD, PhD, Deputy Chief Executive Officer

22, Oktyabrskiy Prospekt, Kemerovo, 650066

https://orcid.org/0000-0002-3269-9018МозесВ. Г.MosesV. G.

Мозес Вадим Гельевич, доктор медицинских наук, профессор, заместитель главного врача по науке

650066, г. Кемерово, пр. Октябрьский, д. 22

Vadim G. Moses, Prof. MD, DSc, Professor, Chief Scientific Officer

22, Oktyabrskiy Prospekt, Kemerovo, 650066

https://orcid.org/0000-0002-7780-829XГруздеваО. В.GruzdevaO. V.

Груздева Ольга Викторовна, доктор медицинских наук, заведующая лабораторией исследования гомеостаза отдела экспериментальной медицины

650002, г. Кемерово, Сосновый бульвар, д. 6

Olga V. Gruzdeva, Dr. MD, DSc, Head of the Laboratory for Homeostasis Research, Division of Experimental Medicine

6, Sosnovy Boulevard, Kemerovo, 650002

https://orcid.org/0000-0001-8679-4857КутихинА. Г.KutikhinA. G.

Кутихин Антон Геннадьевич, кандидат медицинских наук, заведующий лабораторией молекулярной, трансляционной и цифровой медицины

650002, г. Кемерово, Сосновый бульвар, д. 6

Anton G. Kutikhin, Dr. MD, PhD, Head of the Laboratory of Molecular, Translational, and Digital Medicine

6, Sosnovy Boulevard, Kemerovo, 650002

ФГБНУ «Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний»; ГАУЗ «Кузбасская областная клиническая больница» имени С.В. БеляеваРоссияResearch Institute for Complex Issues of Cardiovascular Diseases; Belyaev Kuzbass Clinical HospitalRussian FederationГАУЗ «Кузбасская областная клиническая больница» имени С.В. БеляеваРоссияBelyaev Kuzbass Clinical HospitalRussian FederationФГБНУ «Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний»РоссияResearch Institute for Complex Issues of Cardiovascular DiseasesRussian Federation202128122021642244Copyright © Осяев Н.Ю., Иванникова Н.В., Вавин Г.В., Мозес В.Г., Груздева О.В., Кутихин А.Г., 20212021Осяев Н.Ю., Иванникова Н.В., Вавин Г.В., Мозес В.Г., Груздева О.В., Кутихин А.Г.Osyaev N.Y., Ivannikova N.V., Vavin G.V., Moses V.G., Gruzdeva O.V., Kutikhin A.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://fcm.kemsmu.ru/jour/article/view/465Цель

Цель. Изучение факторов риска летального исхода у пациентов с тяжелым течением COVID-19 на этапе поступления/перевода в отделение реанимации.

Тяжелое течение COVID-19 сопровождается снижением насыщения крови кислородом, развитием системного воспалительного ответа и полиорганной недостаточностью, что в совокупности приводит к выраженным нарушениям гомеостаза и увеличивает риск летального исхода. Тем не менее, остается неясным, какие именно факторы риска ассоциированы с летальным исходом на этапе перевода пациентов в реанимационное отделение.

Материалы и методы

Материалы и методы. В исследование было включено 144 пациента с тяжелым течением COVID-19. Группы умерших и выживших пациентов были равны по численности (n = 72) и сопоставимы по полу (по 36 мужчин и женщин) и возрасту (медиана возраста 64 года, межквартильный интервал 58−69 лет в группе умерших и 56−70 лет в группе выживших). При поступлении в реанимационное отделение всем пациентам проводились: 1) общий анализ крови и мочи; 2) биохимическое исследование крови; 3) коагулограмма; 4) определение уровня IgM/IgG к SARS-CoV-2.

Результаты

Результаты. Факторами риска летального исхода при тяжелом течении COVID-19 на этапе поступления/перевода в отделение реанимации являлись сердечно-сосудистая коморбидность (артериальная гипертензия, хроническая сердечная недостаточность, атеросклероз аорты и периферических артерий), нарушения почечного гомеостаза (наличие в анамнезе хронической болезни почек 3−5 стадий, снижение скорости клубочковой фильтрации, повышение молярной концентрации креатинина и мочевины в крови, протеинурия у мужчин, гематурия), нарушения обмена веществ (повышение молярной концен- трации глюкозы крови натощак и лактата, повышенная молярная концентрация общего билирубина у мужчин), нейтрофилия (у мужчин), лимфопения (у женщин), повышенное соотношение нейтрофилов к лимфоцитам (у женщин), а также сниженный коэффициент позитивности в отношении IgM/IgG к SARS-CoV-2 (у женщин).

Заключение

Заключение. Проведенное исследование позволило предположить наличие как независимых, так и гендерно-специфичных факторов риска летального исхода при COVID-19.

Aim

Aim. Severe COVID-19 is accompanied by reduced blood oxygen saturation, systemic inflammatory response syndrome and multiple organ failure, all causing a significant deterioration of homeostasis associated with death. Here we aimed to study the risk factors for death in patients with severe COVID-19 who have been admitted to an intensive care unit.

Materials and Methods

Materials and Methods. The study included 144 consecutive patients with severe COVID-19 who have been admitted to an intensive care unit of Kuzbass Clinical Hospital from August to December 2020. Groups of survivors and non-survivors were equal in number (n = 72) and matched by gender (36 men and women) and age (median age 64 years, interquartile range 56-70 years in survivors and 58-69 years in non-survivors). Complete blood count, urinalysis, biochemical analysis, coagulation testing, and measurement of anti-SARS-CoV-2 IgM/IgG were carried out in all patients immediately upon the admission to intensive care unit.

Results

Results. Risk factors for death in severe COVID-19 at the admission to intensive care unit were arterial hypertension, chronic heart failure, peripheral atherosclerosis, impaired renal homeostasis (reduced glomerular filtration rate, elevated serum creatinine and urea, proteinuria, hematuria), augmented fasting blood glucose and lactate, neutrophilia (in men), lymphopenia and increased neutrophil-to-lymphocyte ratio (in women), and decreased IgM/IgG to SARS-CoV-2 (in women).

Conclusion

Conclusion. We found both independent and gender-specific risk factors for death due to COVID-19.

COVID-19SARS-CoV-2тяжелое течениелетальный исходфакторы рискагомеостазинтенсивная терапияCOVID-19SARS-CoV-2adverse outcomedeathrisk factorshomeostasisintensive care unitРабота выполнена при поддержке комплексной программы фундаментальных научных исследований СО РАН в рамках фундаментальной темы НИИ КПССЗ № 0419-2021-001 «Разработка новых фармакологических подходов к экспериментальной терапии атеросклероза и комплексных цифровых решений на основе искусственного интеллекта для автоматизированной диагностики патологий системы кровообращения и определения риска летального исхода» при финансовой поддержке Министерства науки и высшего образования Российской Федерации в рамках национального проекта "Наука и университеты".This study was supported by the Complex Program of Basic Research under the Siberian Branch of the Russian Academy of Sciences within the Basic Research Topic of Research Institute for Complex Issues of Cardiovascular Diseases № 0419-2021-001 «Novel anti-atherosclerotic therapies and machine learning solutions for automated diagnosis and prognostication of cardiovascular disease». 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The authors declare that there are no conflicts of interest present.