Increased Kynurenine Indicates a Fatal Course of COVID-19.

Актуальность: Коронавирусная инфекция — болезнь, вызывающая дыхательную недостаточность и осложнения у определенных групп людей, приводящие к смерти. Факторы, ассоциированные с тяжелым течением COVID-19, к текущему моменту достаточно хорошо изучены, в связи с чем, на современном этапе необходим их поиск и изучение в отдельных группах лиц, отличающихся по возрасту, полу, этнической принадлежности, наличию фоновых заболеваний и т.д. для разработки более персонализированных подходов к профилактике тяжелого течения. Цель исследования: провести сравнительный анализ факторов, ассоциированных с тяжелым течением COVID-19 у лиц до 60 лет и старше 60 лет и оценить их прогностическую значимость при комбинации факторов. Материалы и методы исследования: был проведен ретроспективный анализ клинических и лабораторных показателей 812 больных. Для идентификации факторов, ассоциированных с развитием тяжелого течения COVID-19, использовался множественный логистический регрессионный анализ. Для оценки прогностической значимости совокупности выявленных статистически значимых факторов в развитии тяжелого течения COVID-19 был проведен ROC-анализ. Результаты исследования: Многофакторный логистический регресионный анализ показал, что у больных до 60 лет диагноз сахарного диабета в анамнезе (OR=2,561, р=0,048), лимфопения (OR=2,133, p=0,030), наличие пневмонии при поступлении (OR=2,556, p=0,011), учащенное дыхание (OR=3,497, p=0,001), низкая сатурация (OR=4,076, p=0,006) были достоверно связаны с развитием тяжелого течения COVID-19. У больных старше 60 лет наличие сахарного диабета (OR=1,899, р=0,029), учащенное дыхание (OR=2,338, p=0,007) и низкая сатурация (OR = 4,248, p <0,0001) были достоверно связаны с развитием тяжелого течения COVID-19. В группах до 60 лет и старше 60 лет прогностическое значение комбинации всех соответствующих группам статистически значимых факторов было равно среднему уровню (AUC=0,760 и AUC=0,709 соответственно). Заключение: Факторы, ассоциированные с развитием тяжелого течения COVID-19, у лиц пожилого и среднего возраста имеют некоторые отличия, связанные с особенностями патогенеза заболевания. Для лиц до 60 лет факторами, ассоциированными с тяжелым течением COVID-19, являются сахарный диабет, наличие пневмонии при поступлении, одышка, низкая сатурация и лимфопения. Для лиц старше 60 лет факторами, ассоциированными с тяжелым течением COVID-19, являются наличие сахарного диабета, одышка и низкая сатурация. Совокупность всех изученных факторов значительно повышает риск формирования тяжелого течения COVID-19 в обеих возрастных группах. Introduction: Coronavirus infection is a disease that causes respiratory failure and complications in certain groups of people, leading to death. The factors associated with the severe course of COVID-19 have been fairly well studied by now; at the present stage, it is necessary to search for and study them in separate groups of people that differ in age, gender, ethnicity, the presence of background diseases, etc. to develop more personalized approaches to severe disease prevention. Objective: To conduct a comparative analysis of the factors associated with the severe course of COVID-19 in people under and over 60 years of age and evaluate their prognostic significance in combination of factors. Materials and methods: A retrospective analysis of the clinical and laboratory parameters of 812 COVID-19 patients was carried out. Multiple logistic regression analysis was used to identify factors associated with the development of severe COVID-19. ROC analysis was performed to assess the prognostic significance of the set of identified statistically significant factors in the development of a severe course of COVID-19. Results: Multivariate logistic regression analysis showed that patients under 60 diabetes mellitus (OR=2,561, p=0,048), lymphopenia (OR=2,133, p=0,030), and pneumonia at admission (OR=2,556, p=0,011), rapid breathing (OR=3,497, p=0,001), low saturation (OR=4,076, p=0,006) were significantly associated with the development of severe COVID-19. At the same time, in patients older than 60 years, the presence of diabetes mellitus (OR=1,899, p=0,029), rapid breathing (OR=2,338, p=0,007) and low saturation (OR=4,248, p<0,0001) were significantly associated with the development of a severe course of COVID-19. In groups under 60 and over 60 years of age, the prognostic value of the combination of all statistically significant factors corresponding to the groups was equal to the average level (AUC=0,760 and AUC=0,709, respectively) Conclusion: Factors associated with the development of a severe course of COVID-19 in elderly and middle-aged people have some differences related to the pathogenesis of the disease. For individuals under 60 years of age, factors associated with severe COVID-19 are diabetes mellitus, the presence of pneumonia on admission, dyspnea, low oxygen saturation, and lymphopenia. For individuals over 60 years of age, factors associated with severe COVID-19 are the presence of diabetes mellitus, shortness of breath, and low saturation. The combination of all the studied factors significantly increases the risk of developing a severe course of COVID-19 in both age groups. Кіріспе: Коронавирустық инфекция - бұл адамдардың белгілі бір топтарында тыныс алу жеткіліксіздігі мен асқынуларды тудыратын, өлімге әкелетін ауру. Қазіргі уақыттаCOVID-19 ауыр ағымына байланысты факторлар жеткілікті түрде зерттелді, осы кезеңде оларды жасы, жынысы, этникалық құрамы, фондық аурулар бойынша ерекшеленетін адамдардың жекелеген топтарында іздеу және зерттеу аурудың ауыр ағымының алдын алудағы жекелендірілген тәсілдерін әзірлеуге қажет. Зерттеу мақсаты: 60 жасқа дейінгі және 60 жастан асқан адамдардаCOVID-19 ауыр ағымымен байланысты факторларға салыстырмалы талдау жүргізу және факторлардың жиынтығымен олардың болжамдық маңыздылығын бағалау. Зерттеудің материалдары мен әдістері: 812 науқастың клиникалық және зертханалық көрсеткіштеріне ретроспективті талдау жасалды. Ауыр COVID-19 дамуына байланысты факторларды анықтау үшін бірнеше логистикалық регрессиялық талдау қолданылды. COVID-19 ауыр ағымының дамуындағы анықталған статистикалық маңызды факторлар жиынтығының болжамдық маңыздылығын бағалау үшінROC талдауы жүргізілді. Зерттеу нәтижелері: Көп нұсқалы логистикалық регрессиялық талдау60 жасқа дейінгі пациенттерде қант диабеті(OR=2,561, p=0,048), лимфопения (OR=2,133, p=0,030) және қабылдау кезінде пневмония (OR=2,556, p=0,011) болғанын көрсетті. жылдам тыныс алу(OR=3,497, p=0,001), төмен қанықтылық (OR=4,076, p=0,006) ауыр COVID-19 дамуымен айтарлықтай байланысты болды. 60 жастан асқан емделушілерде қант диабетінің болуы (OR=1,899, p=0,029), жылдам тыныс алу(OR=2,338, p=0,007) және қанығу деңгейінің төмендігі(OR=4,248, p<0,0001) айтарлықтай дәрежеде байланысты болды. COVID-19 ауыр ағымының дамуы. 60 жастан кіші және60 жастан асқан топтарда топтарға сәйкес келетін барлық статистикалық маңызды факторлардың комбинациясының болжамдық мәні орташа деңгейге тең болды (тиісіншеAUC=0,760 және AUC=0,709). Қорытынды: Егде және орта жастағы адамдарда COVID-19 ауыр ағымының дамуына байланысты факторлар аурудың патогенезіне байланысты кейбір айырмашылықтарға ие. 60 жасқа толмаған адамдар үшін ауыр COVID-19-мен байланысты факторлар қант диабеті, қабылдау кезінде пневмонияның болуы, ентігу, оттегімен қанығудың төмендігі және лимфопения болып табылады. 60 жастан асқан адамдар үшін ауырCOVID-19-мен байланысты факторлар қант диабетінің болуы, ентігу және қанықтылықтың төмендігі болып табылады. Барлық зерттелген факторлардың қосындысы екі жас тобында да COVID-19 ауыр ағымының даму қаупін айтарлықтай арттырады.

The long-term course of protection against severe COVID-19 courses by vaccine-induced or hybrid immunity in Germany is unclear. We studied 146 457 cases aged 60-99 years in the German federal state of Bavaria who were immunized against COVID-19 and tested positive for it from February 2022 to January 2023. We calculated adjusted hazard ratios for a severe course (hospitalization or death due to COVID-19) for different intervals between the onset of full primary or booster immunity and the date of the infection. 3342 (2.3%) severe courses of COVID-19 were observed in the first 60 days after the infection. The risk of a severe course rose with the interval between the onset of immune protection and the infection (adjusted hazard ratios and 95% confidence intervals at 6, 9, 12, and 15 months: 1.14 [1.08; 1.20]; 1.33 [1.24; 1.42]; 1.39 [1.25; 1.54]; 1.61 [1.35; 1.93]). The risk rose more slowly when mRNA-based vaccines were used exclusively. In a previous study, we observed 82% initial efficacy in cases aged 60 and above who received a booster vaccination (compared to unvaccinated cases) and an absolute risk reduction of 2.1%. If one extrapolates these findings to the current study, the residual efficacy and absolute risk reduction are found to be approximately 71% and 1.8% (respectively) at 6 months, and 32% and 0.8% at 15 months. These results indicate that, during the Omicron wave, the protection of older persons against a severe COVID-19 course gradually declined from six months after vaccination onward. The limitations of this study include confounders that could not be taken into account, possible misclassification of the cause of death, and selection bias due to missing information about vaccination status and severe COVID-19 courses.

BackgroundBiologic treatments are inherently associated with an increased risk of infections, and recipients are intuitively considered at-risk for a more severe course of COVID-19. However, the actual risks are not fully described, neither are the appropriate adjustments needed to mitigate such risks. MethodsNation-wide registry was set up by Israeli IBD Section, to characterize course of COVID-19 in IBD patients who contacted SARS-CoV-2 infection while on biologics. We prospectively collected demographic and clinical data, and analyzed COVID-19 outcomes with regard to the specific treatments.ResultsBetween Apr and Oct 2020, 144 patients with an established IBD diagnosis and confirmed COVID-19 were enrolled at 20 IBD referral centers. The majority of patients was under the age of 40 (113, 78%), 9 (6%) were younger than 18, only 4 patients (3%) over the age of 70.94 patients received biologics, as monotherapy (76, 52.8%), combined with immunomodulators (9, 10%) or concomitant corticosteroids (9, 10%).37 patients (26%) were reported with moderate and severe COVID-19 course, third of them (13) on biologics. 24 patents (17%) were admitted for hospitalization, the rest managed in home setting (114, 79%) and hotels converted into makeshift healthcare facilities (6, 4%). Fifteen patients (10%) required non-invasive ventilation and oxygen support, 3 patients (2%) went on mechanical ventilation. All patients recovered uneventfully, with no mortalities reported.Age was the most significant factor associated with moderate and severe disease. We found no correlation between bowel disease activity and the severity of COVID-19 course.The rate of serious COVID-19 for the 94 patients who had received biologics was significantly lower than that of 50 patients who were not treated with biologics (13/94 vs 24/50; RR 0.29 [95% CI, 0.161–0.515]; p < 0.0001). On adjusting for age, gender, comorbidities, IBD phenotype and activity, the surprising ameliorating effect associated with biologics was profound and significant (OR, 0.082 [95% CI 0.009-0.621], p =0.013) in all age categories. ConclusionOur results are reassuring and encouraging, and do not suggest that therapeutic immune suppression renders IBD patients particularly vulnerable for more severe course of the COVID-19. Adjusted odds for severe COVID-19 course actually decreased significantly in patients treated with biologics. It could be speculated that cytokine inhibition may mitigate progression of the infection to a devastating hyperinflammatory state. Continuing necessary maintenance immune suppression seems to be appropriate and safe approach, despite the COVID-19 pandemic.

Patients with obstructive sleep apnoea (OSA) are at increased risk of severe course of COVID-19. Vaccination remains to be the most effective prevention of complicated courses of infection. The best contemporary conservative treatment of OSA is continuous positive airway pressure (CPAP) therapy. To compare vaccination acceptance and outcomes of COVID-19 infection between OSA patients adhering to the CPAP therapy and those who rejected CPAP and surgical therapy. Subjects were divided into two groups: group A (N = 167) were individuals with sufficient CPAP adherence (more than 4 hours per night on average) over the last 10 years. Group B (N = 106) were individuals who did not use the CPAP therapy at all and had no indications to surgical therapy. Three patients in group B died, and one had a severe course of COVID-19. None of the patients in group A died or experienced a severe course of COVID-19. Group A had a significantly higher proportion of males (77.8% compared to 66% in group B) and all parameters of OSA severity. The vaccination status was similar among both groups, with a complete triple dose vaccination rate of 69.5% and 67.9% in groups A and B, respectively. The results show that the patients with OSA adherent to CPAP therapy were less likely to experience a severe course of COVID-19 or death than the OSA patients non-compliant with therapy, despite the former group having more severe OSA. This result underlines the importance of adherence to CPAP therapy in OSA.

The objective: to identify specific features of the COVID-19 course in HIV positive patients and risk factors for unfavourable outcomes in such patients.Subjects and Methods. Patients with COVID-19 regardless of their HIV status admitted to hospital were enrolled in a retrospective observational study.Results. HIV positive patients experienced a more severe course of COVID-19 including more extensive lung tissue damage and severe respiratory failure. Shortness of breath was more common of patients with HIV infection. Laboratory tests revealed adecreased antiviral immune response, signs of anemia and liver damage, and a tendency to develop blood clots. When developing a prognostic logistic regression model in patients with COVID-19 and HIV infection, it was revealed that the risk of an unfavorable outcome was associated with such factors as a decrease in the relative number of lymphocytes and level of total protein in peripheral blood at the moment of admission to hospital.Conclusions. Given the elevated risk of a severe course and unfavorable outcome of COVID-19 in case of concurrent HIV infection, it is necessary to monitor symptoms of respiratory failure in these patients, and if they appear, make a decision about hospitalization at an earlier stage of the disease.

BackgroundAs considerable evidence indicates viruses play an important role in the pathogenesis of inflammatory rheumatic diseases as environmental factors. The most prominent pathogenic viruses which have been proposed in the...

Background:COVID-19 has been reported in over 40million people globally with variable clinical outcomes. In this systematic review and meta-analysis, we assessed demographic, laboratory and clinical indicators as predictors for severe courses of COVID-19.Methods:We systematically searched multiple databases (PubMed, Web of Science Core Collection, MedRvix and bioRvix) for publications from December 2019 to May 31st 2020. Random-effects meta-analyses were used to calculate pooled odds ratios and differences of medians between (1) patients admitted to ICU versus non-ICU patients and (2) patients who died versus those who survived. We adapted an existing Cochrane risk-of-bias assessment tool for outcome studies.Results:Of 6,702 unique citations, we included 88 articles with 69,762 patients. There was concern for bias across all articles included. Age was strongly associated with mortality with a difference of medians (DoM) of 13.15 years (95% confidence interval (CI) 11.37 to 14.94) between those who died and those who survived. We found a clinically relevant difference between non-survivors and survivors for C-reactive protein (CRP; DoM 69.10, CI 50.43 to 87.77), lactate dehydrogenase (LDH; DoM 189.49, CI 155.00 to 223.98), cardiac troponin I (cTnI; DoM 21.88, CI 9.78 to 33.99) and D-Dimer (DoM 1.29mg/L, CI 0.9 – 1.69). Furthermore, cerebrovascular disease was the co-morbidity most strongly associated with mortality (Odds Ratio 3.45, CI 2.42 to 4.91) and ICU admission (Odds Ratio 5.88, CI 2.35 to 14.73).Discussion:This comprehensive meta-analysis found age, cerebrovascular disease, CRP, LDH and cTnI to be the most important risk-factors in predicting severe COVID-19 outcomes and will inform decision analytical tools to support clinical decision-making.

Aim. To study the association of the level of endothelial dysfunction marker sVCAM-1 with the severe course of COVID-19.Material and methods. The study included 100 patients with COVID-19, who were divided into 3 groups depending on the degree of lung damage based on the results of computed tomography (CT): group CT 1 – 29 patients, group CT 2 – 61 patients and the group CT 3 – 10 patients. In addition to the standard examination performed for coronavirus infection, all patients underwent carotid Doppler ultrasound, analysis of arterial stiffness indices (CAVI, ABI) using the VaSera device, and evaluation of the plasma sVCAM-1 concentration by ELISA.Results. The plasma sVCAM-1 concentration was significantly higher in the groups of patients with moderately severe (CT 2) and severe (CT 3) lung lesions than in patients with mild lesions (CT 1). In the general group of patients significant correlations were found between the plasma sVCAM-1 concentration and the level of oxygen saturation (r=-0.39, p=0.032), hospital length of stay (r=0.24, p=0.026), values of C-reactive protein (r=0.25, p=0.042), ferritin (r=0.38, p=0.021), LDH (r=0.52, p=0.015) , as well as the percentage of pulmonary involvement according to CT data at admission (r=0.41, p=0.019) and on the day of discharge (r=0.35, p=0.022). According to multivariate regression analysis, sVCAM-1 does not depend upon gender, age, body mass index (BMI), the presence of type 2 diabetes mellitus (T2DM) and hypertension, and is a marker associated with cytokine storm progression, intermediate negative dynamics according to CT data, and need for respiratory support. The presence of type 2 diabetes, as well as elevated sVCAM-1 concentrations, is associated with an increased risk of high-dose glucocorticosteroid therapy. The threshold levels of this marker were calculated for each of the above events. We revealed a correlation between the sVCAM-1 concentration and the carotid intimal medial thickness in the general group of patients (r=0.25, p=0.036).Conclusion. An increase in the plasma sVCAM-1 concentration reflects the progression of endothelial dysfunction, one of the key factors in the pathogenesis of COVID-19. The latter necessitates the need for endothelium protective therapy for these patients. The evaluation of sVCAM-1 in blood plasma is a promising diagnostic technique aimed at predicting the risk of a severe course of COVID-19 and its long-term health hazards.

Introduction: The relevance of the issue of human age-specific vulnerability to effects of environmental factors, especially biological agents, including viral infections, for public health is attributed to the aging of the population and the requirements for considering individual characteristics for a more accurate risk assessment. Objective: To establish age-specific patterns of the COVID-19 risk among healthcare and industrial workers. Materials and methods: We have analyzed the incidence and course of COVID-19 among 729 healthcare workers and 880 industrial workers in 2021–2022. The risk of mild, moderate and severe course of COVID-19 was determined in each age group. The age-specific dynamics of the COVID-19 risk was characterized by its change per year of age of the employees. Results: We established that the incidence of COVID-19 among healthcare workers was 1.6 times higher than among industrial workers. We also observed regularities of the age-specific dynamics of risk of COVID-19 of different severity among healthcare and industrial workers. For the mild course of the disease, the risk was approximated by the following regressions: healthcare Ri 1 (%) = –0.15 × (Age – 20, years) + 34.06; industry Ri 1 (%) = –0.24 × (Age – 20) + 27.21. For the moderate and severe course, the regressions were as follows: healthcare Ri 2,3 (%) = 0.23 × (Age – 20) + 2.46; industry Ri 2.3(%) = 0.14×(Age – 20) – 1.29. Conclusions: In different age groups, the relative risk of a mild course of COVID-19 in healthcare workers is 1.2–2.1 times higher than in industrial workers while that of a moderate and severe course is already 3 to 9 times higher. The direction of the age-specific COVID-19 risk depends on the disease severity. As for the mild course, a one-year increase in age is associated with a decrease in the disease risk by an average of 0.15 % in healthcare workers and 0.24 % in industrial workers. As for the moderate and severe courses, a one-year increase in age is associated with an increase in the COVID-19 risk by 0.23 % and 0.14 % in healthcare and industrial workers, respectively.

Risk of Severe Sars-Cov-2 Infections in COVID-19 Vaccinated Individuals with Hematologic Malignancies (SAVE HEM): A Nationwide Cohort Study in the Netherlands

Old age, obesity and vitamin D deficiency are considered as independent risk factors for severe courses of COVID-19. The aim of the review is to discuss common features of these risk factors and the impact of vitamin D. The recently discovered relationship between vitamin D and the infection pathway of the virus via the renin--angiotensin system (RAS) and the adipokines leptin and adiponectin play an important role. The frequency of studies showing a relationship between a low vitamin D status in comorbidities and severe COVID-19 courses makes an impact of vitamin D effects likely. There is a direct relationship between vitamin D, body fat and age in COVID-19 courses. With age, the ability of the skin to synthesize vitamin D decreases, and leads to vitamin D-deficits. If the skin is insufficiently exposed to sunlight, severe deficits can develop. As vitamin D plays an important role not only in the immune system but also in the RAS, and thus at the point where the virus attacks, a good vitamin D supply is an important basis for reducing the risk of severe COVID-19 processes. Treatment with vitamin D supplements should be based on severity of the vitamin D deficiency.

ABSTRACT. Among residents of Chernivtsi region, the main characteristics, frequency and peculiarities of the occurrence of long-term symptomatic and post-COVID-19 syndrome have not been sufficiently elucidated. The goal of the study was set: to evaluate the options for the course of the post-covid syndrome depending on age, gender, comorbidity and severity of the course of COVID-19. Material and methods. The following research methods were used: electronic questionnaire, epidemiological, clinical and anamnestic, analytical and statistical methods. The study included 214 adult patients who were infected with the SARS-CoV-2 virus (the diagnosis was confirmed by PCR) and who suffered from COVID- 19 of varying degrees of severity and were randomized into two groups: the 1st group (main) included – 112 people (ratio of men/women - 56.4 % (n = 63): 47.5 % (n = 49)), comparative (102 people) – patients with a mild and moderate course of COVID-19 who were consulted and were treated on an outpatient basis (male/female ratio – 45.5 % (n = 46): 54.5 % (n = 56)). Statistical processing of the data obtained during the research was carried out using the IBM SPSS Statistics v26.0 program. Results. It was found that among inpatients there was a significantly significant number of patients older than 60 years old (p &lt; 0.001), whereas among outpatients there were significantly more patients aged 18-29, which indicates a connection between the age of the respondents and the need for inpatient treatment presence of COVID-19. In the main group, the following symptoms occurred more frequently (p &lt; 0.05): cough OR = 2.023 [CI 1.105-3.703], fever OR = 6.916 [CI 2.061-23.204], difficulty breathing (dyspnea) OR = 4.421 [2.230 -8.764]. In the comparison group, the following prevailed: loss of smell OR = 0.147 [CI 0.077-0.281], fatigue OR = 0.456 [CI 0.226-0.920], increased temperature OR=2.023 [2.061- 23.204]. With a higher frequency, such diseases as: coronary heart disease (OR = 33.088 [CI 9.444-115.930]), arterial hypertension (OR = 13.641 [CI 6.547-28.422]), diabetes (OR = 4.755 [CI 1.915-11.803]), heart failure (OR = 18.504 [CI 8.200-41.752]), obesity (OR = 4.828 [CI 2.433-9.581]). Conclusions. 1. Among the patients who received inpatient treatment, the vast majority were people over 40 years old, younger men (from 40 years old) were more likely than women (over 60). 2. In persons with a severe course of COVID-19, the frequency of symptoms of shortness of breath, cough, difficulty breathing, chest pain is more likely to be registered, and in outpatients - loss of smell and fatigue. 3. With a greater frequency, such diseases as: coronary heart disease (37.5 %), arterial hypertension (57.4 %), diabetes (21.3 %), heart failure (54,1 %), obesity (41.1 %). Smoking and alcohol abuse did not show significant reliable differences. 4. The combination of 3 pathologies (hypertension, heart failure, obesity) was most common - in 11 people (10 %).

Concomitant pathology is a risk factor for severe COVID-19. Bilateral changes characteristic of sarcoidosis on CTscan can also occur with coronavirus infection. <b>The purpose of the study:</b> based on our own data to study the features of the course of a new coronavirus infection in patients with lung sarcoidosis. <b>Materials and methods:</b> 47 patients have been under observation which accounted for 22.4% of the total number of observed patients with sarcoidosis. Concomitant pathology: cardiovascular system - 24.9%, gastrointestinal tract pathology - 23.3%, COPD and bronchial asthma in 11.7%, diabetes mellitus in 5.25%. As a basic therapy, 74.5% received GCS, 5.2% - methotrexate, 16.2% - GCS +methotrexate. In addition, 32% took vitamin E and 19.8% - pentoxifylline. <b>Results and discussion:</b> The average age of patients is 37.2±3.4 (men 12, women 35). In 8 patients - pneumonia was not detected; in 21 patients (CT stage 1) SpO2 95.2± 2.4%, in 15 patients (CT stage 2) SpO2 86.0± 4.5%, in 4 patients (CT stage 3) COVID-19 had a severe SpO2 68.1± 7.3%, which required treatment in the intensive care unit. Blood parameters: IL-6 – 94.3±7.8 (N less than 3.4 ng/ml), CRP 103.4±8.9 (N 0-5 mg/L), ACE 82.3±7.3 (N 8-52 units/L), D-dimer 485±20.8 (N less than 442 ng/ml), ferritin 643.4±10.7 (N 28-365 ng/ml), GGT 104.5±3.7 (N 1-55 Units/L), procalcitonin 0.17 ± 0.01 (N less than 0.1ng/ml). <b>Conclusions:</b> based on the data obtained, a severe course of COVID-19 was noted in 6.38% of patients with sarcoidosis, the course of moderate severity in 32%. The factors contributing to the severe course include the use of cytostatics and GCS.

Introduction and purposeThe COVID-19 pandemic, which has been ongoing since early 2020, has significantly affected the health care system worldwide. SARS-CoV-2 virus being the etiological factor of the disease has a high affinity for the renal organ. The purpose of this study was to provide an overview of the current knowledge of the problem of frequent AKI in the course of coronavirus infection, the impact of COVID-19 disease in patients with chronic kidney disease and on renal replacement therapy or dialysis.Review methodIn the process of writing, we used available articles and scientific papers in Pubmed and Google Scholar databases based on keywords: COVID-19, SARS-CoV-2, AcuteKidneyInjury, ChronicKidneyDisease.State of knowledgeSARS-CoV-2 virus enters target cells through the ACE2 receptor. In the pathophysiology of AKI in the course of COVID-19, a key role is attributed to secondary damage mechanisms such as cytokine storm, hypoperfusion with hypoxia, endothelial dysfunction. The incidence of acute kidney injury ranges from 5.1% to 36.6%. The development of AKI, renal transplant status, the presence of chronic kidney disease or renal replacement therapy is associated with an increased risk of severe course and higher mortality on COVID-19. SummaryThe COVID-19 pandemic has posed new logistical and therapeutic challenges to the health care system. Due to the high tropism of SARS-CoV-2 to the kidneys and the frequent occurrence of AKI during the course of the infection, nephrology patients, those on renal replacement therapy and those awaiting transplantation should be placed under special surveillance. Patients in these groups are at particular risk for a severe course of COVID-19.

BACKGROUND: The new coronavirus infection (COVID-19) gained the pandemic status in 2020, and despite the fact that since then the virus has become less pathogenic, its virulence has increased by 2023. Well-vascularized organs and tissues, including the retina, represent the target for coronavirus. The etiopathogenesis of COVID-associated retinopathy, first described in 2021, still remains poorly understood, and its forms and occurrence frequency during different periods of the infectious process vary greatly. AIM: To identify the main characteristics of the COVID-associated retinopathy in patients with moderate and severe COVID-19 course during the acute period of the disease. MATERIALS AND METHODS: The study, conducted in 2021 (group 1) and 2023 (group 2), included patients with confirmed COVID-19 of moderate to severe course during the first 7 days from the onset of symptoms. Group 1 included 46 people, mean age 65.5 years, and group 2 included 55 people, mean age 69.3 years. The ophthalmologic examination was carried out in the “red zone” and intensive care unit, and included examination of the anterior segment of the eye, indirect ophthalmoscopy, and fundus photography using a portable hand-held digital fundus camera (Smartscope M5, Optomed, Finland). Hypertension, diabetes mellitus, volume of lung damage, invasive mechanical ventilation, and anticoagulant therapy were considered as conditions affecting retinal microcirculation. RESULTS: The observation groups were homogeneous in terms of gender, age, and concomitant diseases. The incidence of ophthalmoscopic findings in group 1 was 17.3%, and in group 2 — 12.7%. Most often, during the first 7 days of the disease, signs of angiopathy were observed: dilatation of blood vessels, irregularity of their diameter and tortuosity. Among focal changes, there were multiple retinal hemorrhages (6.5% and 3.6%) and cotton wool spots (4.3% and 5.4%). In patients with fundus changes, diabetes mellitus was significantly less common (in group 1, 25% vs. 39%, p 0.001; in group 2, 28% vs. 44%, p 0.001), as well as arterial hypertension (in group 1, 55% vs. 66%, p = 0.003; in group 2 28% vs. 83%, p 0.001). In group 1, there was a higher proportion of patients treated in intensive care unit, as in group 2 (37% vs. 17%, p 0.001), but in group 2, patients with identified retinal changes were more likely to receive therapeutic doses of anticoagulants (33% vs. 12%, p 0.001). CONCLUSION: The main characteristics of COVID-associated retinopathy in patients with moderate to severe COVID-19 during the acute period of the disease are dilatation and pathological tortuosity of the retinal arteries and veins, intraretinal hemorrhages and cotton wool spots. The connection between COVID-associated retinopathy and concomitant to the infectious process cardiovascular conditions has not been established. Retinopathy associated with coronavirus infection, with absolute similarity of clinical manifestations, was significantly more common in 2021 than in 2023.