COVID-19: extrapulmonary impairments (own data of infection hospital of FSBI FSSCC FMBA of Russia) and experience of use different profile specialists to working in hospitals

Abstract

Relevance. The COVID-19 pandemic has once again shown how important it is to follow the principles of evidence-based medicine in etiopathogenetic therapy. Treatment of COVID-19 and its complications, carried out on the basis of individual publications, in fact, having the status of a series of clinical cases, as a rule, did not bring the desired result. Objective: to study the safety of transfusion of single-group hyperimmune plasma of convalescents containing a high titer of antibodies to the RBD domain of the S-protein SARS-CoV-2 in patients with moderate and severe forms of COVID-19 in the framework of a prospective comparative clinical study. Results. It was found that after plasma transfusion of convalescents to patients in a severe and extremely severe condition on the day of the start of mechanical ventilation or being on mechanical ventilation, the 30-day mortality rate was 60%, which did not differ from the lethality of the control group, which included 70 completed cases in which mechanical ventilation was performed. (57.9%). On the contrary, the mortality rate in moderate and severe patients who received plasma while on spontaneous breathing was significantly lower than the average hospital mortality in our hospital (4.3% and 6.73%, respectively), and also significantly lower than the mortality in the control group receiving non-immune plasma (10.0%). When transfusing anticoid plasma, the most frequently observed adverse events were allergic reactions in the form of urticaria and a febrile non-hemolytic reaction. A serious adverse event in the form of non-cardiogenic pulmonary edema has been reported once. Conclusions. 1. Convalescent plasma prescribed to patients with severe COVID-19 who are on mechanical ventilation does not affect the outcome of the disease. 2. Convalescent plasma prescribed to patients with moderate and severe COVID-19 who are on spontaneous respiration significantly reduces hospital mortality in these patients. 3. Transfusion of convalescent plasma can cause serious adverse events, therefore, when prescribing plasma therapy, it is necessary to weigh the risk of mortality from disease progression and the potential risks from plasma transfusion in each case.