Rybalka K. Lung damage and predicting the severity of coronavirus disease (COVID-19)

The dissertation is devoted to the urgent task of pulmonology - expanding knowledge about lung lesions in COVID-19 in different periods (acute and post-acute (early, late, long-term)) and finding new opportunities to predict the severity of the disease. The main criteria for predicting the severity of the disease in the acute period, the degree and nature of respiratory system damage in both acute and post-acute periods of the disease (based on clinical, objective data, imaging (computed tomography – CT, lung ultrasound – LUS), functional (spirometry, bodyplethysmography – BPG, diffusion capacity) and laboratory parameters (KL-6)) were determined. The data from 132 “medical records of inpatients” were analysed to conduct a retrospective analysis and identify problematic issues in the management of patients with COVID-19 that need to be addressed. After setting the goal and objectives of the dissertation study, 170 people with a final diagnosis of COVID-19 with lung damage were included in the prospective stage and four subgroups were identified: subgroup 1 - patients in the acute period of the disease, subgroup 2 - patients in the early post-acute period, subgroup 3 - patients in the late post-acute period, subgroup 4 - patients with long-term COVID-19 who underwent laboratory, imaging and functional examination (except for the acute period). Depending on the severity of the disease, within the subgroups, patients were divided into those with severe and those with critical illness. Scientific novelty of the results obtained. For the first time, lung lesions in patients with COVID-19 in different periods of the pathological process (early, late, long-term) are described complexly (using clinical, functional and laboratory parameters). The correlations between the area of lung lesions according to CT scan and the degree of lung damage according to LUS in patients with COVID-19 were established. The optimal terms for the assessment of clinical and imaging parameters to predict the severity of COVID-19 were determined. The reference values of KL-6 in a non-Asian cohort of healthy individuals, as well as the diagnostic significance of KL-6 in patients with lung lesions in the setting of COVID-19 were determined. Criteria for indirectly determining the presence of decreased lung diffusing capacity by scoring lung ultrasound, according to the results of ROC analysis, are proposed. Practical significance of the results obtained. Prognostic criteria for the severity of the acute course of COVID-19 have been proposed for use in healthcare institutions. The high informativeness of lung ultrasound as a first-line test and at the stages of dynamic follow-up in patients with COVID-19 has been proven. Indications for the continuation or discontinuation of immunosuppressive (corticosteroid) therapy in patients with lung disease in the setting of COVID-19 have been formulated. The new provisions of the thesis were implemented in the scientific and pedagogical process at the Department of Internal Medicine 1 of Dnipro State Medical University and Sumy State University. The new practical provisions of the thesis have been implemented in the treatment process of the therapeutic department with pulmonary beds of the Municipal Non-Profit Enterprise "City Clinical Hospital №6" of the Dnipro City Council, the consultative and diagnostic department of the Municipal Non-Profit Enterprise "City Clinical Hospital №6" of the Dnipro City Council, the Therapeutic Expert Rehabilitation Department of the State Institution "Ukrainian State Research Institute of Medical and Social Problems of Disability, Ministry of Health of Ukraine, Pulmonology Department of the Sumy Regional Clinical Hospital.