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Клинический портрет пациента с COVID-19. Опыт многопрофильной клиники
Клинический портрет пациента с COVID-19. Опыт многопрофильной клиники
Баймаканова Г.Е., Хатьков И.Е., Дудина Г.А., Чегодарь А.С., Румянцев К.А., Свиридов Ф.С., Осипова А.В., Данишевич А.М., Носкова К.К., Пинашина Е.С., Орлова Н.В., Слезингер В.М., Чернова М.Е., Товстыко К.А., Бодунова Н.А. Клинический портрет пациента с COVID-19. Опыт многопрофильной клиники. Терапевтический архив. 2021;93(11):1283–1289. DOI: 10.26442/00403660.2021.11.201191
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Аннотация
Цель. Оценка клинической картины у пациентов с подтвержденной новой коронавирусной инфекцией (COVID-19).
Материалы и методы. В статье представлены клинические и инструментальные данные 1169 больных, включенных в одноцентровое смешанное исследование. Пациентам проведены тестирование на COVID-19 методом полимеразной цепной реакции, компьютерная томография (КТ) органов грудной клетки, исследован уровень антител, собраны данные клинического анамнеза.
Результаты. У больных с подтвержденным COVID-19 поражение легких и положительный тест на антитела наблюдались в 75,5 и 45,2% случаев соответственно. Наиболее частые симптомы COVID-19: повышение температуры тела (73,2%), слабость (72,7%), кашель (62,8%) и одышка (55,4%). Пациенты с визуализируемым на КТ поражением легких чаще имели симптомы COVID-19 и повышенный уровень антител к вирусу SARS-CoV-2. Наличие хронических заболеваний эндокринной системы, системы кровообращения и органов дыхания коррелировали с более тяжелым течением болезни и выраженностью симптомов (КТ-1–4: 91,2–96,3%), чем у пациентов без хронических заболеваний (КТ-1–4: 85,1%).
Заключение. Составлен клинический портрет больных COVID-19, выделены наиболее значимые клинические характеристики, соответствующие более тяжелому течению болезни. Показано, что пациенты с хроническими заболеваниями требуют персонализированного подхода и разработки специальных критериев диагностики и лечения COVID-19.
Ключевые слова: коронавирус, COVID-19, SARS-CoV-2, клинические признаки, диагностика
Materials and methods. The article presents clinical and instrumental data of 1169 patients included in a single-center mixed study. Patients were tested for COVID-19 using polymerase chain reaction, computed tomography (CT), and antibody screening. Clinical history data were collected.
Results. In patients with confirmed COVID-19, lung damage and a positive test for antibodies were observed in 75.5 and 45.2% of cases, respectively. The most common symptoms of COVID-19 were: fever (73.2%), weakness, (72.7%) dry cough (62.8%) and shortness of breath (55.4%). Patients with CT-visualized lung lesions were more likely to have clinical symptoms and elevated levels of antibodies. Patients with chronic diseases of the endocrine system, circulatory system, and respiratory system had a more severe course of the disease (CT-1–4:
91.2–96.3%) than patients without chronic diseases (CT-1–4: 85,1%).
Conclusion. We have compiled a clinical profile of patients with COVID-19 and highlighted the most significant clinical characteristics corresponding to a more severe course of the disease. Our data showed that patients with chronic diseases require a personalized approach and the development of specific criteria for the diagnosis and treatment of COVID-19.
Keywords: сoronavirus, COVID-19, SARS-CoV-2, clinical features, diagnostics
Материалы и методы. В статье представлены клинические и инструментальные данные 1169 больных, включенных в одноцентровое смешанное исследование. Пациентам проведены тестирование на COVID-19 методом полимеразной цепной реакции, компьютерная томография (КТ) органов грудной клетки, исследован уровень антител, собраны данные клинического анамнеза.
Результаты. У больных с подтвержденным COVID-19 поражение легких и положительный тест на антитела наблюдались в 75,5 и 45,2% случаев соответственно. Наиболее частые симптомы COVID-19: повышение температуры тела (73,2%), слабость (72,7%), кашель (62,8%) и одышка (55,4%). Пациенты с визуализируемым на КТ поражением легких чаще имели симптомы COVID-19 и повышенный уровень антител к вирусу SARS-CoV-2. Наличие хронических заболеваний эндокринной системы, системы кровообращения и органов дыхания коррелировали с более тяжелым течением болезни и выраженностью симптомов (КТ-1–4: 91,2–96,3%), чем у пациентов без хронических заболеваний (КТ-1–4: 85,1%).
Заключение. Составлен клинический портрет больных COVID-19, выделены наиболее значимые клинические характеристики, соответствующие более тяжелому течению болезни. Показано, что пациенты с хроническими заболеваниями требуют персонализированного подхода и разработки специальных критериев диагностики и лечения COVID-19.
Ключевые слова: коронавирус, COVID-19, SARS-CoV-2, клинические признаки, диагностика
________________________________________________
Materials and methods. The article presents clinical and instrumental data of 1169 patients included in a single-center mixed study. Patients were tested for COVID-19 using polymerase chain reaction, computed tomography (CT), and antibody screening. Clinical history data were collected.
Results. In patients with confirmed COVID-19, lung damage and a positive test for antibodies were observed in 75.5 and 45.2% of cases, respectively. The most common symptoms of COVID-19 were: fever (73.2%), weakness, (72.7%) dry cough (62.8%) and shortness of breath (55.4%). Patients with CT-visualized lung lesions were more likely to have clinical symptoms and elevated levels of antibodies. Patients with chronic diseases of the endocrine system, circulatory system, and respiratory system had a more severe course of the disease (CT-1–4:
91.2–96.3%) than patients without chronic diseases (CT-1–4: 85,1%).
Conclusion. We have compiled a clinical profile of patients with COVID-19 and highlighted the most significant clinical characteristics corresponding to a more severe course of the disease. Our data showed that patients with chronic diseases require a personalized approach and the development of specific criteria for the diagnosis and treatment of COVID-19.
Keywords: сoronavirus, COVID-19, SARS-CoV-2, clinical features, diagnostics
Полный текст
Список литературы
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12. 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:10.1001/jama.2020.1585
13. Akbariqomi M, Hosseini MS, Rashidiani J, et al. Clinical characteristics and outcome of hospitalized COVID-19 patients with diabetes: A single-center, retrospective study in Iran. Diabetes Res Clin Pract. 2020;169:1-10. DOI:10.1016/j.diabres.2020.108467
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16. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes among 5700 Patients Hospitalized with COVID-19 in the New York City Area. JAMA. 2020;323(20):2052-9. DOI:10.1001/jama.2020.6775
17. Azarkar G, Osmani F. Clinical characteristics and risk factors for mortality in COVID-19 inpatients in Birjand, Iran: a single‑center retrospective study. Eur J Med Res. 2021;26(1):79. DOI:10.1186/s40001-021-00553-3
18. Pezzutti DL, Wadhwa V, Makary MS. COVID-19 imaging: Diagnostic approaches, challenges, and evolving advances. World J Radiol. 2021;13(6):171-91. DOI:10.4329/wjr.v13.i6.171
19. Luo L, Liu D, Liao X, et al. Contact Settings and Risk for Transmission in 3410 Close Contacts of Patients With COVID-19 in Guangzhou, China: A Prospective Cohort Study. Ann Intern Med. 2020;173(11):879‑87. DOI:10.7326/M20-2671
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2. Coronavirus disease 2019 (COVID-19). BMJ Best Practice. Last updated 22.07.2021. Available at: https://bestpractice.bmj.com/topics/en-gb/3000201/pdf/3000201/Coronavirus disease 2019 %28COVID-19%29.pdf. Accessed: 09.08.2021.
3. Chuchalin AG. COVID-19 and human security. Terapevticheskii Arkhiv (Ter. Arkh.). 2021;93(3):253-4 (in Russian). DOI:10.26442/00403660.2021.03.200717
4. Temporary guidelines. Prevention, diagnosis and treatment of coronavirus infection COVID-19 (version 6 of 28.04.2020). Ministry of Health of Russia. Available at: https://static-1.rosminzdrav.ru/system/attachments/attaches/000/050/116/original/28042020_%D0%9CR_CO.... Accessed: 09.08.2021 (in Russian).
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6. Bakharev SD, Baulo EV, Bykova SV, et al. COVID-19 and the small intestine. Terapevticheskii Arkhiv (Ter. Arkh.). 2021;93(3):343-7 (in Russian). DOI:10.26442/00403660.2021.03.200662
7. Perevesentsev OA, Cholodnaya TO, Samsonov AE, Burtsev DV. Methods of specific laboratory testing of new coronavirus infection. Medical Herald of the South of Russia. 2020;11(3):27-33 (in Russian). DOI:10.21886/2219-8075-2020-11-3-27-33
8. Sule WF, Oluwayelu DO. Real-time RT-PCR for COVID-19 diagnosis: challenges and prospects. Pan Afr Med J. 2020;35(Suppl. 2):121. DOI:10.11604/pamj.supp.2020.35.24258
9. Augustine R, Hasan A, Das S, et al. Loop-mediated isothermal amplification (LAMP): a rapid, sensitive, specific, and cost-effective point-of-care test for coronaviruses in the context of COVID-19 pandemic. Biology. 2020;9(8):1-17. DOI:10.3390/biology9080182
10. Ustyuzhanin DV, Belkind MB, Gaman S, et al. CT findings of coronavirus disease: results by experience of the COVID-center in the national medical research center of cardiology. Russian Electronic Journal of Radiology. 2020;10(2):27‑38 (in Russian). DOI:10.21569/2222-7415-2020-10-2-27-38
11. Fried MW, Crawford JM, Mospan AR, et al. Patient Characteristics and Outcomes of 11 721 Patients With Coronavirus Disease 2019 (COVID-19) Hospitalized Across the United States. Clin Infect Dis. 2021;72(10):e558-65. DOI:10.1093/cid/ciaa1268
12. 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:10.1001/jama.2020.1585
13. Akbariqomi M, Hosseini MS, Rashidiani J, et al. Clinical characteristics and outcome of hospitalized COVID-19 patients with diabetes: A single-center, retrospective study in Iran. Diabetes Res Clin Pract. 2020;169:1-10. DOI:10.1016/j.diabres.2020.108467
14. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
DOI:10.1016/S0140-6736(20)30183-5
15. Aggarwal S, Garcia-Telles N, Aggarwal G, et al. Clinical features, laboratory characteristics, and outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19): Early report from the United States. Diagnosis. 2020;7(2):91-6. DOI:10.1515/dx-2020-0046
16. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes among 5700 Patients Hospitalized with COVID-19 in the New York City Area. JAMA. 2020;323(20):2052-9. DOI:10.1001/jama.2020.6775
17. Azarkar G, Osmani F. Clinical characteristics and risk factors for mortality in COVID-19 inpatients in Birjand, Iran: a single‑center retrospective study. Eur J Med Res. 2021;26(1):79. DOI:10.1186/s40001-021-00553-3
18. Pezzutti DL, Wadhwa V, Makary MS. COVID-19 imaging: Diagnostic approaches, challenges, and evolving advances. World J Radiol. 2021;13(6):171-91. DOI:10.4329/wjr.v13.i6.171
19. Luo L, Liu D, Liao X, et al. Contact Settings and Risk for Transmission in 3410 Close Contacts of Patients With COVID-19 in Guangzhou, China: A Prospective Cohort Study. Ann Intern Med. 2020;173(11):879‑87. DOI:10.7326/M20-2671
20. Bundgaard H, Bundgaard JS, Raaschou-Pedersen DET, et al. Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers: A Randomized Controlled Trial. Ann Intern Med. 2021;174(3):335-43. DOI:10.7326/M20-6817
2. Coronavirus disease 2019 (COVID-19). BMJ Best Practice. Last updated 22.07.2021. Available at: https://bestpractice.bmj.com/topics/en-gb/3000201/pdf/3000201/Coronavirus disease 2019 %28COVID-19%29.pdf. Accessed: 09.08.2021.
3. Чучалин А.Г. COVID-19 и безопасность человека. Терапевтический архив. 2021;93(3):253-4 [Chuchalin AG. COVID-19 and human security. Terapevticheskii Arkhiv (Ter. Arkh.). 2021;93(3):253-4 (in Russian)]. DOI:10.26442/00403660.2021.03.200717
4. Временные методические рекомендации. Профилактика, диагностика и лечение новой коронавирусной инфекции COVID-19 (версия 6 от 28.04.2020). Минздрав России. Режим доступа: https://static-1.rosminzdrav.ru/system/attachments/attaches/000/050/116/original/28042020_%D0%9CR_CO.... Ссылка активна на 09.08.2021 [Temporary guidelines. Prevention, diagnosis and treatment of coronavirus infection COVID-19 (version 6 of 28.04.2020). Ministry of Health of Russia. Available at: https://static-1.rosminzdrav.ru/system/attachments/attaches/000/050/116/original/28042020_%D0%9CR_CO.... Accessed: 09.08.2021 (in Russian)].
5. Временные методические рекомендации. Профилактика, диагностика и лечение новой коронавирусной инфекции COVID-19 (версия 10 от 08.02.2021). Минздрав России. Режим доступа: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/054/588/original/%D0%92%D1%80%D0%B5.... Ссылка активна на 09.08.2021 [Temporary guidelines. Prevention, diagnosis and treatment of the new coronavirus infection COVID-19 (version 10 of 08.02.2021). Ministry of Health of Russia. Available at: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/054/588/original/%D0%92%D1%80%D0%B5.... Accessed: 09.08.2021 (in Russian)].
6. Бахарев С.Д., Бауло Е.В., Быкова С.В., и др. COVID-19 и тонкая кишка. Терапевтический архив. 2021;93(3):343-7 [Bakharev SD, Baulo EV, Bykova SV, et al. COVID-19 and the small intestine. Terapevticheskii Arkhiv (Ter. Arkh.). 2021;93(3):343-7 (in Russian)]. DOI:10.26442/00403660.2021.03.200662
7. Перевезенцев О.А., Холодная Т.О., Самсонов А.Е., Бурцев Д.В. Методы специфического лабораторного тестирования новой коронавирусной инфекции. Медицинский вестник Юга России. 2020;11(3):27-33 [Perevesentsev OA, Cholodnaya TO, Samsonov AE, Burtsev DV. Methods of specific laboratory testing of new coronavirus infection. Medical Herald of the South of Russia. 2020;11(3):27-33 (in Russian)]. DOI:10.21886/2219-8075-2020-11-3-27-33
8. Sule WF, Oluwayelu DO. Real-time RT-PCR for COVID-19 diagnosis: challenges and prospects. Pan Afr Med J. 2020;35(Suppl. 2):121. DOI:10.11604/pamj.supp.2020.35.24258
9. Augustine R, Hasan A, Das S, et al. Loop-mediated isothermal amplification (LAMP): a rapid, sensitive, specific, and cost-effective point-of-care test for coronaviruses in the context of COVID-19 pandemic. Biology. 2020;9(8):1-17. DOI:10.3390/biology9080182
10. Устюжанин Д.В., Белькинд М.Б., Гаман С.А., и др. КТ-картина коронавирусной болезни: результат по итогам работы COVID-центра на базе НМИЦ кардиологии. Российский электронный журнал лучевой диагностики. 2020;10(2):27-38 [Ustyuzhanin DV, Belkind MB, Gaman S, et al. CT findings of coronavirus disease: results by experience of the COVID-center in the national medical research center of cardiology. Russian Electronic Journal of Radiology. 2020;10(2):27‑38 (in Russian)].
DOI:10.21569/2222-7415-2020-10-2-27-38
11. Fried MW, Crawford JM, Mospan AR, et al. Patient Characteristics and Outcomes of 11 721 Patients With Coronavirus Disease 2019 (COVID-19) Hospitalized Across the United States. Clin Infect Dis. 2021;72(10):e558-65. DOI:10.1093/cid/ciaa1268
12. 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:10.1001/jama.2020.1585
13. Akbariqomi M, Hosseini MS, Rashidiani J, et al. Clinical characteristics and outcome of hospitalized COVID-19 patients with diabetes: A single-center, retrospective study in Iran. Diabetes Res Clin Pract. 2020;169:1-10. DOI:10.1016/j.diabres.2020.108467
14. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
DOI:10.1016/S0140-6736(20)30183-5
15. Aggarwal S, Garcia-Telles N, Aggarwal G, et al. Clinical features, laboratory characteristics, and outcomes of patients hospitalized with coronavirus disease 2019 (COVID-19): Early report from the United States. Diagnosis. 2020;7(2):91-6. DOI:10.1515/dx-2020-0046
16. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes among 5700 Patients Hospitalized with COVID-19 in the New York City Area. JAMA. 2020;323(20):2052-9. DOI:10.1001/jama.2020.6775
17. Azarkar G, Osmani F. Clinical characteristics and risk factors for mortality in COVID-19 inpatients in Birjand, Iran: a single‑center retrospective study. Eur J Med Res. 2021;26(1):79. DOI:10.1186/s40001-021-00553-3
18. Pezzutti DL, Wadhwa V, Makary MS. COVID-19 imaging: Diagnostic approaches, challenges, and evolving advances. World J Radiol. 2021;13(6):171-91. DOI:10.4329/wjr.v13.i6.171
19. Luo L, Liu D, Liao X, et al. Contact Settings and Risk for Transmission in 3410 Close Contacts of Patients With COVID-19 in Guangzhou, China: A Prospective Cohort Study. Ann Intern Med. 2020;173(11):879‑87. DOI:10.7326/M20-2671
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19. Luo L, Liu D, Liao X, et al. Contact Settings and Risk for Transmission in 3410 Close Contacts of Patients With COVID-19 in Guangzhou, China: A Prospective Cohort Study. Ann Intern Med. 2020;173(11):879‑87. DOI:10.7326/M20-2671
20. Bundgaard H, Bundgaard JS, Raaschou-Pedersen DET, et al. Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers: A Randomized Controlled Trial. Ann Intern Med. 2021;174(3):335-43. DOI:10.7326/M20-6817
Авторы
Г.Е. Баймаканова1, И.Е. Хатьков1, Г.А. Дудина1, А.С. Чегодарь1, К.А. Румянцев1, Ф.С. Свиридов1,2, А.В. Осипова1, А.М. Данишевич1, К.К. Носкова1, Е.С. Пинашина1, Н.В. Орлова1, В.М. Слезингер1, М.Е. Чернова1, К.А. Товстыко1, Н.А. Бодунова*1
1 ГБУЗ «Московский клинический научный центр им. А.С. Логинова» Департамента здравоохранения г. Москвы, Москва, Россия;
2 ФГБНУ «Медико-генетический научный центр им. акад. Н.П. Бочкова», Москва, Россия
*n.bodunova@mknc.ru
1 Loginov Moscow Clinical Scientific and Practical Center, Moscow, Russia;
2 Bochkov Research Centre for Medical Genetics, Moscow, Russia
*n.bodunova@mknc.ru
1 ГБУЗ «Московский клинический научный центр им. А.С. Логинова» Департамента здравоохранения г. Москвы, Москва, Россия;
2 ФГБНУ «Медико-генетический научный центр им. акад. Н.П. Бочкова», Москва, Россия
*n.bodunova@mknc.ru
________________________________________________
1 Loginov Moscow Clinical Scientific and Practical Center, Moscow, Russia;
2 Bochkov Research Centre for Medical Genetics, Moscow, Russia
*n.bodunova@mknc.ru
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