Coronavirus pandemic: Experience of the first wave in the Nizhny Novgorod Region

Abstract

Aim. The aim of the study was to analyze the data from real clinical practice of diagnosis and treatment of a new coronavirus infection obtained during the first wave of the virus in Nizhny Novgorod Region. Material and methods. We analyzed 4,250 records in the regional register of patients with confirmed coronavirus infection. For detailed analysis, 184 medical records of inpatients of medical institutions in Nizhny Novgorod and Nizhny Novgorod region with a diagnosis of confirmed coronavirus infection of different course and outcome were randomly selected. Of these, we used as analyzed groups the patients discharged with improvement (recovered) (n1 = 86) and those who died (n2 = 98). All patients underwent medical examination according to the current temporary clinical guidelines for the diagnosis and treatment of COVID-19 new coronavirus infection. Statistical processing was performed using Microsoft Office software package (Excel), USA and Statistica 10.0 (Statsoft, USA). Results and discussion. Our data allowed us to conclude that the prognosis is favorably influenced by early hospitalization in the pulmonary stage of the disease, by early etiotropic and pathogenetic therapy, by the absence of concomitant disease, by adding systemic glucocorticosteroids on day 6-8 of hospitalization (which corresponds to the published data), and by tocilizumab. All patients received anticoagulants, but a more detailed analysis of the correlation of prescribed doses with prognosis is required to understand their impact on the outcome. Conclusion. Unfavorable prognostic factors were elderly age, cardiovascular and respiratory comorbidity, polymorbidity, late seeking medical care, 2 or more episodes of desaturation below 90% during treatment, increasing leukocytosis in the course of treatment, preservation of relative lymphopenia below 20% and monocytopenia in the course of treatment, preservation of high C-reactive protein, LDH and ferritin values despite the therapy.