The optimization of pharmacological treatment of community-acquired pneumonia associated with COVID-19 in the presence of concomitant arterial hypertension by adding statins to the basic treatment is proposed in the dissertation. Also, the discriminating and predictive properties of certain laboratory parameters regarding the severity and hospital mortality were established, the risk factors of severe/critical course and lethal outcome in hospitalized patients with community-acquired pneumonia associated with COVID-19 were studied, and a new scale for prediction of the severity and hospital mortality in such patients was developed. 135 patients were examined, of which 106 had arterial hypertension. Statin therapy was prescribed to 29 patients with arterial hypertension. Statin therapy for community-acquired pneumonia associated with COVID-19 and concomitant hypertension is associated with less degree of pulmonary dysfunction in patients aged ≥65 years and overweight/obese. On the background of taking statins, SрO2 less often decreased to the level of <93% during inpatient treatment among patients aged ≥65 years (p=0.03) and with a body mass index ≥25.0 kg/m2 (p=0.02). Also, the level of soluble IL-2 receptors in patients who received statins was 27.7% lower than in patients who did not use these drugs. Serum ferritin level and ferritin-hemoglobin ratio at the time of hospitalization are reliable predictors of in-hospital mortality in patients with community-acquired pneumonia associated with COVID-19 and concomitant hypertension. If the ferritin level at the time of hospital admission exceeds 438.0 ng/mL, and the ferritin-hemoglobin ratio exceeds 37.64, hospital mortality increases 12 times. However, ferritin and ferritin-hemoglobin ratio appeared to be weak predictors of severe/critical course. This study did not support the use of IL-6 as a predictor of severe/critical course, but this biomarker may be used as a predictor of in-hospital mortality. Risk factors for severe/critical course of community-acquired pneumonia associated with COVID-19 in th presence of conocomitant arterial hypertension include body mass index >25.6 kg/m2, >1 point on the CURB65 scale, >23 points on the CAP-Sym questionnaire, presence of diabetes history, leukocyte count >7.1×109/L, segmented neutrophils >64%, fasting blood glucose >6.2 mmol/L, aspartate aminotransferase >19.1 U/L, alanine aminotransferase >24.5 U/L, activated partial thromboplastin time >24.2 s, ferritin levels >402.0 ng/mL, soluble IL-2 receptors >7.5 ng/mL, IL-6 >62.5 pg/mL. According to logistic regression, body mass index and fasting glucose level were independent risk factors for severe/critical course of community-acquired pneumonia associated with COVID-19 in the presence of concomitant arterial hypertension. An increase in body mass index for every 1 kg/m2 is associated with a 10.9% increase in the probability of a severe/critical condition, and an increase in glucose level for every 1 mmol/L is accompanied by a 22.9% increase in the probability of a severe/critical condition. Risk factors for fatal outcome at the inpatient stage of treatment include age >71 years, body mass index >30.1 kg/m2, history of diabetes mellitus, shortness of breath at the time of hospitalization, >1 point on the CURB-65 scale, >25 points on by the CAP-Sym questionnaire, >81 points on the PSI scale (pneumonia severity index), as well as laboratory parameters such as erythrocyte sedimentation rate >44 mm/h, fasting blood glucose >7.8 mmol/L, creatinine >105.7 μmol/L, urea >7.4 mmol/L, activated partial thromboplastin time >28.5 s, prothrombin index <93.8%, ferritin >438 ng/mL, IL-6 >91.0 pg/mL. Body mass index was found to be an independent risk factor for in-hospital mortality due to COVID-19 in patients with arterial hypertension. An increase in body mass index for every 1 kg/m2 is associated with a 24.1% increase in the probability of a fatal outcome. After analyzing the main risk factors for a severe/critical course and hospital mortality, the BIFOCALED score was developed. It was established that the optimal threshold value for predicting a severe/critical condition is 2 points, and for in-hospital mortality it’s 5 points. In the presence of >2 points according to the BIFOCALED score, the probability of a severe/critical condition was 71.8%, in the presence of ≤2 points it was 22.0% (OR=9.01 [3.97–20.44], p<0.001). In patients who scored >5 points according to the BIFOCALED score, in-hospital mortality was 52.9%, and in patients who scored ≤5 points according to this score, it was 4.2% (OR=25.43 [6.88–93.99], p<0.001).
Key words: pneumonia, coronavirus disease, COVID-19, arterial hypertension, hypertension, blood pressure, statins, inflammation, IL-6, ferritin, soluble IL-2 receptors, predictors, long-term consequences, biomarkers, comorbidity. Branch – medicine.
