An intermediate analysis of moderate and severe forms of COVID-19 treated in Craiova Infectious Disease Clinic

Abstract

Objective. Description and differentiation of moderate and severe forms of COVID-19 diagnosed and treated in Infectious Diseases Clinic, „Victor Babeş“ Infectious Diseases and Pneumology Hospital from Craiova. Material and method. Retrospective study (March 2020 – July 2020) of the first 300 hospitalized cases comparing the moderate and severe forms of COVID-19 from a clinical and biological point of view. Results. 56 moderate and 33 severe cases were recorded; between them there are a series of differences with statistical significance: age of patients (49.5 ± 16.13, p < 0.0001), number of obese patients (12 vs. 14, p = 0.06), with cardiovascular suffering, (8 vs. 18, p < 0.0001), diabetes (9 vs. 15, p = 0.005) or neoplasms (2 vs. 7, p = 0.02). Several severely ill patients have dyspnoea (14 vs. 24, p < 0.0001), pulmonary rales (8 vs. 13, p = 0.01), elevated systolic blood pressure (2 vs. 9, p = 0.01), coma (0 vs. 5, p = 0.01) or radiological image of bronchopneumonia (0 vs. 6, p = 0.004). Critically ill patients have a higher leukocyte count (6,176.07±2,512.05 vs. 8,666.67±4,565.88, p=0.01), higher ESR at 1 hour (43.05±18.09 vs. 71.18±30.8 mm, p < 0.0001), higher level of C-reactive protein (29.62±19.81 vs. 43.46±18.01 mg/l, p = 0.01), serum lactate (1.19±0.91 vs. 3.47±3.84 mEq/l, p = 0.006), blood glucose (112.5±25.01 vs. 304.45±273.58 mg/ dl, p < 0.0001), D dimers (518.7±455.32 vs. 1,314.22±1,347.54 µg/ml, p < 0.0001), troponin (1.8±4.02 vs. 90.81±202.08 mg/l, p < 0.0001); the neutrophil-to-lymphocyte ratio is higher in severe forms (3.66±1.2 vs. 6.21±4.21, p < 0.0001). Of the 33 patients with severe forms 16 (approximately 50% of them, respectively 5.33% of the 300 cases) died. Conclusions. Patients with severe forms of COVID-19 are much older and have more comorbidities (especially obesity, cardiovascular disease, diabetes or malignancies). For the early detection of severe forms, physicians should detect dyspnea, low oxygen saturation or the presence of pulmonary rales, more commonly encountered in severe forms. Tests for inflammation and procoagulant status are significantly better expressed in patients with severe forms. At the level of the studied group, the glycemic control was suboptimal for severe forms of the disease. Despite the intensive care support, about half of those admitted with severe forms (5.33% of all cases) died.

Keywords

• covid-19
• moderate/severe forms