LONG-TERM OUTCOMES OF PATIENTS WITH COVID-19-RELATED ARDS WITH AND WITHOUT INITIAL COMORBIDITIES

М.V. OSIKOV^¹,², V.N. ANTONOV^³, S.О. ZOTOV^¹,⁴

¹Department of Pathophysiology, South Ural State Medical University, Chelyabinsk, Russian Federation
²Chelyabinsk Regional Clinical Hospital, Chelyabinsk, Russian Federation
³Department of Therapy of the Institute of Additional Professional Education, South Ural State Medical University, Chelyabinsk, Russian Federation
⁴Chelyabinsk Regional Clinical Hospital № 3, Chelyabinsk, Russian Federation

Objective: To evaluate the complications, outcomes, and development of chronic diseases in patients following COVID-19-related acute respiratory distress syndrome (ARDS) with diffuse alveolar damage of varying severity in patients with and without initial comorbidities.

Methods: A retrospective analysis was conducted using a random sample of 158 medical records from patients at the Chelyabinsk Regional Clinical Hospital in Chelyabinsk, Russia. These patients, aged between 44 and 75 years, were hospitalized with bilateral viral pneumonia. The control group consisted of 111 patients who did not have COVID-19. Based on the extent of lung damage, the patients were divided into two groups: Group 1 included 90 patients with less than 50% involvement of the lung parenchyma. In contrast, Group 2 comprised 68 patients with more than 50% involvement of the lung parenchyma. Thirty-six months after their discharge from the hospital, both outpatient and inpatient medical visits were recorded using the medical information system "BARS. Healthcare". Every 12 months, the rate of complications was compared within and between the two groups.

Results: : In comparison with the control group, patients in Group 2 exhibited a significantly higher prevalence of nervous system diseases, hypertension (HT), coronary artery disease (CAD), and type 2 diabetes mellitus (T2DM) (p<0.05). Thyroid diseases were also notably more common in Group 2 (p<0.05). In Group 1, complications and outcomes of the studied diseases were recorded in 38.9% of cases, with fatalities occurring in 1.1% of cases. Complications were most prevalent in the first year, with HT, CAD, and T2DM complications observed in 42.9%, 61.5%, and 66.7% cases, respectively. Nervous system involvement was more frequently observed in the second year, accounting for 57.1% of cases. Conversely, in Group 2, complications and adverse outcomes were noted in 86.8% of cases, with a death rate of 10.3%. The most common complications included sequelae of CAD (30.6%), HT (23.4%), T2DM (19.4%), nervous system diseases (12.9%), thyroid diseases (6.5%), and kidney diseases (1.6%). Similar to Group 1, most complications in Group 2 appeared in the first year and included sequelae of CAD (49.2%), HT (41.4%), T2DM (75.0%), and thyroid disease (50.0%). Neurological diseases were exacerbated in the second year, accounting for 50.0% of cases. Compared with Group 1, the incidence of T2DM complications was 63.5% higher in Group 2 (p<0.05). In comparison, complications of CAD were 66.2% higher (p<0.05), and complications from HT increased by 51.7% (p<0.05). Neurological and thyroid disease complications were higher by 67.0% (p<0.05) and 87.5% (p<0.05), respectively. The remaining indicators did not show statistically significant differences due to the limited number of cases. Additionally, fatal outcomes were significantly more frequent in Group 2, occurring 85.3% more often (p<0.05) than in Group 1. Moreover, there were more frequent complications from T2DM and deaths within the first 12 months after COVID-19 among patients in Group 2.

Conclusion: We have observed the effects of COVID-19 severity on the structure and incidence of complications over three years after the event. This study may influence the management strategies for patients with comorbidities in severe and moderate COVID-19 cases.

Keywords: COVID-19, ARDS, comorbidities, complications, prognosis, model.

Download file:

References