Patterns of the pneumonia course caused by SARS-CoV-2 on inpatient basis: clinical experience in St. Petersburg
Background: one of the typical manifestations of a new coronavirus infection (COVID-19) is pneumonia. Aim: to evaluate the patterns of pneumonia course in patients with COVID-19 and analyze the results of treatment depending on its type. Patients and Methods: the medical documents of hospitalized patients with pneumonia caused by SARS-CoV-2 (n=229) were studied. Three groups were formed: I group (n=86) - patients who were discharged with clinical improvement and were not observed in the intensive care unit (ICU); II group (n=55) - patients who were discharged but were in the ICU during treatment; III group (n=88) - cases with a fatal outcome. Results: patients from group III were older compared to groups I and II (p<0.001), and suffered from at least one concomitant pathology, mainly cardiological or neuropsychiatric. Groups II and III compared to group I were characterized by a more pronounced decrease in oxygen saturation on the day of hospitalization (p<0.001), as well as by the increase in the neutrophil-lymphocyte ratio in peripheral blood (p<0.001), the rate of erythrocyte sedimentation (p=0.045 for I/II and p=0.019 for I/III) and C-reactive protein concentration (p<0.001). Subgroups that received or did not receive umifenovir significantly differed in relation to the need for artificial lung ventilation (ALV) (p=0.013) and the number of cases with fatal outcome (p=0.002). This was more the case for patients who needed treatment in ICU. The use of lopinavir/ritonavir in the subgroup of patients who required ALV was associated with a decrease in the number of fatal outcomes, p=0.044. Conclusions: the probability of a fatal outcome in patients with pneumonia caused by SARS-CoV-2 increased with ageing and underlying cardiological and neuropsychiatric pathology. Predictors of severe pneumonia were significant laboratory signs on the day of hospitalization. The downward trend towards mortality in the subgroups of patients with severe COVID-19 prescribed with lopinavir/ritonavir and umifenovir requires further study.