[Risk factors for adverse outcomes in elderly patients with asthma and severe COVID-19 at the hospital and early post-hospital stages].

BACKGROUND: Mortality and COVID-19 related factors are thoroughly analyzed. Given the large number of hospitalized patients, the potential short- and long-term COVID-19 related complications, further research is needed on the possible consequences of hospitalization, especially in higher-risk patients, after prolonged hospitalization and intensive care admission. AIM: To study the clinical course and outcomes of severe COVID-19 in elderly patients with asthma at the hospital and early post-hospital stages. MATERIALS AND METHODS: The study included 131 elderly patients (WHO, 2020) >60 years old, n=131 with asthma, hospitalized for severe COVID-19. Of these, 86 (65.6%) patients survived, 30 (22.9%) died in the hospital, and 15 (14.9%) patients died after discharge from the hospital (in the 90-day post-hospital period). COVID-19 was confirmed by laboratory tests (SARS-CoV-2 PCR RNA test) and/or clinically and radiologically. All patients had a documented history of asthma. Patients were followed up during the hospital stay and for 90 days after discharge. RESULTS: Comparison of outcomes showed that in the groups of patients with a fatal outcome (regardless of the stage), the Charlson comorbidity index, respiratory rate, extent of lung damage assessed by computed tomography, the absolute leukocyte and neutrophil number and the ratio of neutrophils to lymphocytes were statistically significantly higher. The absolute number of eosinophils was lower in these groups. In the group of patients who died during hospitalization, severe (IV-V) asthma (p=0.03), steroid use during the previous year (p=0.02), chronic heart failure with a reduced ejection fraction (p=0.009) were more common, and atopic asthma phenotype was less common (p=0.02). In those who died after discharge, more common were non-invasive ventilation and diabetes mellitus (p<0.001). The multivariate regression analysis model revealed the most significant predictors of mortality at the hospital and early post-hospital stages. CONCLUSION: Adverse outcomes of severe COVID-19 in elderly patients with asthma include hospital and post-hospital mortality. The most significant predictors of mortality are the comorbidity index and low eosinophil count. Hospital mortality is associated with a higher ratio of neutrophils to lymphocytes and lower total protein levels; early (90-day) post-hospital mortality is associated with extensive lung damage shown by computed tomography and diabetes mellitus.

Analysis of severity and evaluation of prognosis in elderly patients with bronchial asthma and severe COVID-19

Introduction. The role of comorbid conditions in susceptibility to SARS-CoV-2 infection and the severity of associated COVID-19 disease has been an area of ongoing research since the pandemic began. Objective. To evaluate the impact of elderly asthma on the clinical course and outcomes of severe COVID-19. Materials and methods. Elderly patients (WHO, 2020) (> 60 years, n = 131) with bronchial asthma (BA) hospitalized for severe COVID-19 were included in the study. The presence of COVID-19 was confirmed by laboratory tests (PCR smear) and/or clinical and radiological examinations. All patients had a history of a confirmed diagnosis of bronchial asthma (GINA, 2020). Follow-up was performed at the hospital stage and for 90 days after discharge from the hospital. Results. In the groups of patients with lethal outcome (regardless of the stage) there were statistically significantly higher Charlson index, respiratory rate, CT lung lesion volume, leukocyte, neutrophil and neutrophil to lymphocyte ratios, lower absolute eosinophil count. In the group of patients who died during hospitalization, severe (IV–V) asthma (p = 0.03), steroid use during the previous year (p = 0.02), chronic heart failure (p = 0.009), and the atopic asthma phenotype was less common (p = 0.02). Those who died in the 90-day posthospital period had greater lung lesion volume on CT scan, and diabetes mellitus was more common (p < 0.001). The most significant predictors of mortality were identified. Conclusion. The common most significant predictors of hospital and 90-day posthospital mortality in older patients with bronchial asthma were comorbidity index and lower eosinophil levels. Hospital mortality is further characterized by a higher neutrophil to lymphocyte ratio and lower total protein;90-day posthospital mortality by the amount of lung damage on CT scan and the presence of diabetes mellitus. © 2022, Remedium Group Ltd. All rights reserved.

Analysis of severity and evaluation of prognosis in elderly patients with bronchial asthma and severe COVID-19

Introduction. The role of comorbid conditions in susceptibility to SARS-CoV-2 infection and the severity of associated COVID-19 disease has been an area of ongoing research since the pandemic began. Objective. To evaluate the impact of elderly asthma on the clinical course and outcomes of severe COVID-19. Materials and methods. Elderly patients (WHO, 2020) (> 60 years, n = 131) with bronchial asthma (BA) hospitalized for severe COVID-19 were included in the study. The presence of COVID-19 was confirmed by laboratory tests (PCR smear) and/or clinical and radiological examinations. All patients had a history of a confirmed diagnosis of bronchial asthma (GINA, 2020). Follow-up was performed at the hospital stage and for 90 days after discharge from the hospital. Results. In the groups of patients with lethal outcome (regardless of the stage) there were statistically significantly higher Charlson index, respiratory rate, CT lung lesion volume, leukocyte, neutrophil and neutrophil to lymphocyte ratios, lower absolute eosinophil count. In the group of patients who died during hospitalization, severe (IV–V) asthma (p = 0.03), steroid use during the previous year (p = 0.02), chronic heart failure (p = 0.009), and the atopic asthma phenotype was less common (p = 0.02). Those who died in the 90-day posthospital period had greater lung lesion volume on CT scan, and diabetes mellitus was more common (p < 0.001). The most significant predictors of mortality were identified. Conclusion. The common most significant predictors of hospital and 90-day posthospital mortality in older patients with bronchial asthma were comorbidity index and lower eosinophil levels. Hospital mortality is further characterized by a higher neutrophil to lymphocyte ratio and lower total protein;90-day posthospital mortality by the amount of lung damage on CT scan and the presence of diabetes mellitus. © 2022, Remedium Group Ltd. All rights reserved.

Asthma and COVID-19 in the elderly: course, survival, predictors of mortality

Bronchial asthma occurs in 0.9 - 17% of patients hospitalized with COVID-19. However, it is not clear whether asthma is a risk factor for the development and severity of COVID-19. Studies have shown that patients with asthma appear to be more susceptible to COVID-19 infection, but severe disease progression is not related to medication use, including asthma biologics, but rather to older age and comorbidities. Aim. To evaluate the clinical course of SARS-CoV-2 infection in elderly patients with asthma, to examine the effect of asthma and comorbidities on COVID-19-related outcomes, and to determine predictors of mortality. Methods. Elderly patients [WHO, 2020] (> 60 years, n = 131, median age 74 (67;80) years;59 men, 72 women) with asthma hospitalized for COVID-19 were included in the study. COVID-19 was confirmed by laboratory tests (PCR smear) and/or clinical and radiological examinations. All patients had a history of a documented diagnosis of asthma (GINA, 2020). Results. Out of 131 patients, 30 (22.9%) died in the hospital, and 15 (14.9%) died after discharge from the hospital (within 90 days). The group of patients with lethal outcome showed the following differences from those who recovered: values of Charlson index, respiration rate, degree of lung damage on CT scan, absolute number of leukocytes, neutrophils and neutrophils-to-lymphocytes ratio, C-reactive protein on the 5th day of hospitalization, and LDH were statistically significantly higher, while absolute number of eosinophils, total protein content, SpO2 and SpO2/FiO2 levels were lower;steroid intake during the year and non-atopic asthma were more common. Multivariate and ROC analysis revealed the most significant predictors of hospital mortality and their thresholds: Charlson comorbidity index ≥ 6 points, neutrophil/lymphocyte ratio ≥ 4.5, total protein ≤ 60 g/l, eosinophil level ≤ 100 cells/μL. Conclusion. The most significant predictors of hospital mortality in elderly patients with severe COVID-19 against asthma are Charlson comorbidity, neutrophil/lymphocyte ratio;lower eosinophil and total protein levels. Survival time of patients has an inverse correlation with the number of mortality risk factors present.

N-acetylcysteine as a part of complex treatment of moderate COVID-associated pneumonia

The need for safe and effective treatment is becoming increasingly urgent due to the high COVID-19 mortality rates observed worldwide. The choice of drug products for COVID-19 treatment regimens is based on the efficacy and safety data, the mechanism of action, and potential interactions. N-acetylcysteine's (NAC) pharmacological activity and its potential to suppress the progression of COVID-19 make it a promising therapeutic agent for COVID-19. Aim of the study was to evaluate the efficacy of NAC in the complex treatment of moderate COVID-associated pneumonia. Methods. The study included adult patients (n = 46) with moderate COVID-associated (the 2nd degree on CT) pneumonia (age 57 (51;71) years, body mass index – 30 (27.1;32.3) kg/m2, duration of the disease before hospitalization – 7 (6;8) days, body temperature at the admission – 37.5 (37.1;37.8)°С). The patients were randomized into two study groups. The 1st group (n = 22) received standard COVID-19 treatment [1]. The 2nd group (n = 24) additionally received NAC 1,200 – 1,500 mg/day intravenously. Treatment with NAC was started together with the standard therapy. Results. Our study showed that the inclusion of NAC in the complex treatment of moderate COVID-associated pneumonia led to a statistically significant increase in blood oxygen saturation, oxygenation index, the difference in delta increase in oxygenation index, a quicker reduction in the volume of lung damage, and the difference between the groups in delta reduction of this index. Also, the rate of reduction of C-reactive protein and reduction of the duration of hospitalization in the group of patients who received NAC was statistically significantly more profound than in the standard treatment group. Conclusion. The study confirmed the effectiveness of NAC as a part of the complex treatment of moderate COVID-associated pneumonia. © 2021 Medical Education. All rights reserved.

[Risk factors for the early development of septic shock in patients with severe COVID-19].

AIM: In a retrospective study, we evaluated factors associated with the early development of septic shock in patients with severe COVID-19. MATERIALS AND METHODS: We collected medical records of the intensive care unit patients submitted by the local COVID-19 hospitals across Russia to the Federal Center for the Critical Care at the Sechenov First Moscow State Medical University (Sechenov University). Septic shock in crticially ill patients requiring mechanical ventilation was defined as a need in vasopressors to maintain blood pressure. RESULTS: We studied 1078 patients with severe COVID-19 who were admitted to the intensive care units for respiratory support. There were 611 males and 467 females. The mean age was 61.013.7 years. Five hundred twenty five medical records (48.7%) were received from the Moscow hospitals, 159 (14.7%) from the Moscow region, and 394 (36.5%) from the hospitals located in 58 regions of the Russian Federation. In 613 (56.9%) patients, diagnosis of SARS-CoV-2 infection was confirmed by PCR, and in the other cases it was established on the basis of the clinical picture and the results of the chest CT scan. Septic shock developed in 214 (19.9%) of 1078 patients. In the logistic regression model, the risk of septic shock in patients older than 50 years was higher than in patients of a younger age (OR 2.34; 95% CI 1.533.67; p0.0001). In patients with more severe SARS-CoV-2 infection, there was an increase in the prevalence of cardiovascular diseases, including coronary heart disease and atrial fibrillation, type 2 diabetes and malignant tumors. The risk of septic shock in patients with three or more concomitant diseases was higher than in patients without any concomitant chronic diseases (OR 1.76; 95% CI 1.762.70). CONCLUSION: The risk of septic shock in patients with acute respiratory distress syndrome induced by SARS-CoV-2 is higher in patients older than 50 years with concomitant diseases, although a severe course of the disease is also possible in younger patients without any concomitant disorders.