StopCOVID cohort : An observational study of 3,480 patients admitted to the Sechenov University hospital network in Moscow city for suspected COVID-19 infection

© 2020 Oxford University Press. This is a pre-copyedited, author-produced PDF of an article accepted for publication in Clinical Infectious Diseases following peer review. The version of record is available online at: https://doi.org/10.1093/cid/ciaa1535.BACKGROUND: The epidemiology, clinical course, and outcomes of COVID-19 patients in the Russian population are unknown. Information on the differences between laboratory-confirmed and clinically-diagnosed COVID-19 in real-life settings is lacking. METHODS: We extracted data from the medical records of adult patients who were consecutively admitted for suspected COVID-19 infection in Moscow, between April 8 and May 28, 2020. RESULTS: Of the 4261 patients hospitalised for suspected COVID-19, outcomes were available for 3480 patients (median age 56 years (interquartile range 45-66). The commonest comorbidities were hypertension, obesity, chronic cardiac disease and diabetes. Half of the patients (n=1728) had a positive RT-PCR while 1748 were negative on RT-PCR but had clinical symptoms and characteristic CT signs suggestive of COVID-19 infection.No significant differences in frequency of symptoms, laboratory test results and risk factors for in-hospital mortality were found between those exclusively clinically diagnosed or with positive SARS-CoV-2 RT-PCR.In a multivariable logistic regression model the following were associated with in-hospital mortality; older age (per 1 year increase) odds ratio [OR] 1.05 (95% confidence interval (CI) 1.03 - 1.06); male sex (OR 1.71, 1.24 - 2.37); chronic kidney disease (OR 2.99, 1.89 - 4.64); diabetes (OR 2.1, 1.46 - 2.99); chronic cardiac disease (OR 1.78, 1.24 - 2.57) and dementia (OR 2.73, 1.34 - 5.47). CONCLUSIONS: Age, male sex, and chronic comorbidities were risk factors for in-hospital mortality. The combination of clinical features were sufficient to diagnoseCOVID-19 infection indicating that laboratory testing is not critical in real-life clinical practice.Peer reviewe

Постковидное состояние у взрослых и детей

Despite the impressive progress in diagnosis and management of acute COVID-19, data regarding the consequences of this infection are just emerging. The World Health Organization has proposed the term post-COVID condition (PCC) to describe the wide range of sequelae of acute COVID-19. With more than 200 million confirmed cases of COVID-19, PCC may develop into a major problem for many years to come for the millions of COVID-19 survivors worldwide. Few studies were conducted in primary care, and very few studies have focused exclusively on children and adolescents.Objective. To review existing data on PCC. Analysis of manuscripts published in peer-reviewed journals and clinical protocols. PCC is characterized by a wide range of systemic, cardio-pulmonary, gastrointestinal, neurological, and psychosocial symptoms.Conclusion. Although PCC prevalence is difficult to estimate due to methodological limitations of the existing studies, there is no doubt that this problem is a significant healthcare burden. There is a need for further observational and interventional studies to establish optimal PCC prevention and management strategies.Несмотря на впечатляющий прогресс в диагностике и лечении острой фазы COVID-19, первые данные, касающиеся последствий перенесенной инфекции, только появляются в научной литературе. Для описания широкого спектра проявлений перенесенного острого COVID-19 Всемирной организацией здравоохранения предложен термин «постковидное состояние» (ПКС). При наличии > 200 млн подтвержденных случаев COVID-19 ПКС рискует стать проблемой на многие годы для миллионов людей, переживших COVID-19 во всем мире. Сравнительно небольшое число исследований проводилось по данным первичного звена здравоохранения, крайне малочислены работы, посвященные исключительно детям и подросткам.Целью исследования явилось формирование представления основных данных о ПКС. По результатам анализа статей, опубликованных в международных рецензируемых журналах, а также клинических протоколов, установлено, что ПКС характеризуется крайне большим разнообразием системных, сердечно-легочных, желудочно-кишечных, неврологических и психосоциальных симптомов.Заключение. Несмотря на то, что представить распространенность ПКС на сегодняшний день невозможно в связи с методологическими недостатками существующих исследований, данная проблема, без сомнений, важна для здравоохранения, при этом для выявления оптимальных подходов к профилактике и лечению ПКС необходимы дополнительные обсервационные и интервенционные исследования

DOPPLER SONOGRAPHY OF DIGITAL ARTERIES BY LENGTHENING OF FINGER PHALANGES WITH MINIFIXATORS

The study of peripheral hemodynamics in the arteries and veins of the posttraumatic hand stumps of 67 patients was performed before and during traction of the tissues with a mini-fixator using electrothermometry and Doppler sonography.Digital arteries before treatment in the conditions of reduced finger stumps motor activity show that all Doppler sonography recordings are decreased relative to the values of the unaffected fingers in the intact limb.During transverse traction intended for skin stock growing in the interdigital webspaces there was no significant dynamics of the recorded Doppler sonography values in the digital arteries. The compensatory vascular response to metabolic query and oxygen need is registered in the lengthened tissue by longitudinal traction effect on the finger phalanges when the tissue can be grown by more than 100% of the initial stock, that results in a 1.5–2 fold increase of the linear and volumetric systolic blood flow velocity in the digital arteries and skin capillaries that is associated with the changes in the artery viscoelastisity which is of a vasoconstriction type

StopCOVID cohort: an observational study of 3,480 patients admitted to the Sechenov University hospital network in Moscow city for suspected COVID-19 infection

Background The epidemiology, clinical course, and outcomes of patients with coronavirus disease 2019 (COVID-19) in the Russian population are unknown. Information on the differences between laboratory-confirmed and clinically diagnosed COVID-19 in real-life settings is lacking. Methods We extracted data from the medical records of adult patients who were consecutively admitted for suspected COVID-19 infection in Moscow between 8 April and 28 May 2020. Results Of the 4261 patients hospitalized for suspected COVID-19, outcomes were available for 3480 patients (median age, 56 years; interquartile range, 45–66). The most common comorbidities were hypertension, obesity, chronic cardiovascular disease, and diabetes. Half of the patients (n = 1728) had a positive reverse transcriptase–polymerase chain reaction (RT-PCR), while 1748 had a negative RT-PCR but had clinical symptoms and characteristic computed tomography signs suggestive of COVID-19. No significant differences in frequency of symptoms, laboratory test results, and risk factors for in-hospital mortality were found between those exclusively clinically diagnosed or with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR. In a multivariable logistic regression model the following were associated with in-hospital mortality: older age (per 1-year increase; odds ratio, 1.05; 95% confidence interval, 1.03–1.06), male sex (1.71; 1.24–2.37), chronic kidney disease (2.99; 1.89–4.64), diabetes (2.1; 1.46–2.99), chronic cardiovascular disease (1.78; 1.24–2.57), and dementia (2.73; 1.34–5.47). Conclusions Age, male sex, and chronic comorbidities were risk factors for in-hospital mortality. The combination of clinical features was sufficient to diagnose COVID-19 infection, indicating that laboratory testing is not critical in real-life clinical practice

Incidence and risk factors for persistent symptoms in adults previously hospitalised for COVID-19

Background: The long-term sequalae of COVID-19 remain poorly characterized. We assessed persistent symptoms in previously hospitalized patients with COVID-19 and assessed potential risk factors. Methods: Data were collected from patients discharged from 4 hospitals in Moscow, Russia between 8 April and 10 July 2020. Participants were interviewed via telephone using an ISARIC Long-term Follow-up Study questionnaire. Results: 2,649 of 4755 (56%) discharged patients were successfully evaluated, at median 218 (IQR 200, 236) days post-discharge. COVID-19 diagnosis was clinical in 1291 and molecular in 1358. Most cases were mild, but 902 (34%) required supplemental oxygen and 68 (2.6%) needed ventilatory support. Median age was 56 years (IQR 46, 66) and 1,353 (51.1%) were women. Persistent symptoms were reported by 1247 (47.1%) participants, with fatigue (21.2%), shortness of breath (14.5%) and forgetfulness (9.1%) the most common symptoms and chronic fatigue (25%) and respiratory (17.2%) the most common symptom categories. Female sex was associated with any persistent symptom category OR 1.83 (95% CI 1.55 to 2.17) with association being strongest for dermatological (3.26, 2.36 to 4.57) symptoms. Asthma and chronic pulmonary disease were not associated with persistent symptoms overall, but asthma was associated with neurological (1.95, 1.25 to 2.98) and mood and behavioural changes (2.02, 1.24 to 3.18), and chronic pulmonary disease was associated with chronic fatigue (1.68, 1.21 to 2.32). Conclusions: Almost half of adults admitted to hospital due to COVID-19 reported persistent symptoms 6 to 8 months after discharge. Fatigue and respiratory symptoms were most common, and female sex was associated with persistent symptoms.</p

Risk factors for long covid in previously hospitalised children using the ISARIC Global follow-up protocol: A prospective cohort study

Background The long-term sequelae of coronavirus disease 2019 (Covid-19) in children remain poorly characterised. This study aimed to assess long-term outcomes in children previously hospitalised with Covid-19 and associated risk factors. Methods This is a prospective cohort study of children (≤18 years old) admitted with confirmed Covid-19. Children admitted to the hospital between April 2, 2020 and August 26, 2020, were included. Telephone interview using the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) Covid-19 Health and Wellbeing paediatric follow-up survey. Persistent symptoms (&lt;5 months) were further categorised by system(s) involved. Findings 518 of 853 (61%) of eligible children were available for the follow-up assessment and included in the study. Median age was 10.4 years (IQR, 3-15.2) and 270 (52.1%) were girls; median follow-up since hospital discharge was 256 (223-271) days. At the time of the follow-up interview 126 (24.3%) participants reported persistent symptoms among which fatigue (53, 10.7%), sleep disturbance (36, 6.9%,) and sensory problems (29, 5.6%) were the most common. Multiple symptoms were experienced by 44 (8.4%) participants. Risk factors for persistent symptoms were: Older age "6-11 years" (odds ratio 2.74 (95% confidence interval 1.37 to 5.75) and "12-18 years" (2.68, 1.41 to 5.4); and a history of allergic diseases (1.67, 1.04 to 2.67). Interpretation A quarter of children experienced persistent symptoms months after hospitalization with acute covid-19 infection, with almost one in ten experiencing multi-system involvement. Older age and allergic diseases were associated with higher risk of persistent symptoms at follow-up

Prevalence and risk factors of post-COVID-19 condition in adults and children at 6 and 12 months after hospital discharge: a prospective, cohort study in Moscow (StopCOVID)

Background Previous studies assessing the prevalence of COVID-19 sequelae in adults and children were performed in the absence of an agreed definition. We investigated prevalence of post-COVID-19 condition (PCC) (WHO definition), at 6- and 12-months follow-up, amongst previously hospitalised adults and children and assessed risk factors. Methods Prospective cohort study of children and adults with confirmed COVID-19 in Moscow, hospitalised between April and August, 2020. Two follow-up telephone interviews, using the International Severe Acute Respiratory and Emerging Infection Consortium survey, were performed at 6 and 12 months after discharge. Results One thousand thirteen of 2509 (40%) of adults and 360 of 849 (42%) of children discharged participated in both the 6- and 12-month follow-ups. PCC prevalence was 50% (95% CI 47–53) in adults and 20% (95% CI 16–24) in children at 6 months, with decline to 34% (95% CI 31–37) and 11% (95% CI 8–14), respectively, at 12 months. In adults, female sex was associated with PCC at 6- and 12-month follow-up (OR 2.04, 95% CI 1.57 to 2.65) and (OR 2.04, 1.54 to 2.69), respectively. Pre-existing hypertension (OR 1.42, 1.04 to 1.94) was associated with post-COVID-19 condition at 12 months. In children, neurological comorbidities were associated with PCC both at 6 months (OR 4.38, 1.36 to 15.67) and 12 months (OR 8.96, 2.55 to 34.82) while allergic respiratory diseases were associated at 12 months (OR 2.66, 1.04 to 6.47). Conclusions Although prevalence of PCC declined one year after discharge, one in three adults and one in ten children experienced ongoing sequelae. In adults, females and persons with pre-existing hypertension, and in children, persons with neurological comorbidities or allergic respiratory diseases are at higher risk of PCC