ANALYSIS OF THE CAUSES OF LETHAL OUTCOMES AMONG PATIENTS WITH ACUTE PURULENT-DESTRUCTIVE LUNG DISEASES WITH COVID-19

Author(s):
Alisher Okhunov; Shokhista Bobokulova

Background:

COVID-19 is a rapidly evolving new disease first detected in China in December 2019

According to WHO, as of December 5, 2021, coronavirus was diagnosed in 265 million people, and in 5.2 million cases, the disease was fatal.

Since the discovery of SARS-CoV-2, purulent-destructive lung diseases have been described and diagnosed more and more throughout the world in patients who have fallen ill or have had COVID-19 pneumonia.

Hypothesis:

Target of our research was to identify the main causes of death in patients with acute purulent-destructive lung diseases who have undergone COVID-19.

Methods:

The autopsies of 42 deceased patients with acute purulent-destructive pulmonary diseases (PDPD) who had undergone COVID-19 were analyzed. The data of pathomorphological examination of internal organs were studied

Results:

Mortality among patients with PDPD who underwent COVID-19 was 17.6% (42 cases) and in the dynamics of treatment was distributed as follows. On the day of admission, 2 (0.84%) patients died, by the end of the first day – another 1 patient (0.42%). Subsequently, on days 2-3 of treatment, 4 patients (1.68%) died, 3-7 days – 9 patients (3.78%), 7-14 days – 10 patients (4.2%) and in the long term ( over 14 days and up to 3 months), another 16 (6.7%) patients died. Thus, the most dangerous were the first 14 days, during which 26 (61.9%) patients out of 42 died.

The most common causes of death among patients with PDPD who underwent COVID-19 were purulent-septic (70.9%), pleural (59.6%), cardiovascular (58.3%) and hepatic-renal (45, 4%) complications. Pulmonary bleeding was less common (1.1%). Such a high specific percentage of multiple organ “interest” prompted us to retrospectively study the pathomorphological changes in patients with a comparative analysis of lethal outcomes.

It was found that fatty and granular degeneration of liver cells was noted in 29 cases, cirrhosis of the liver – 9, amyloidosis – in 4. Kidney changes in 33 deaths were characterized by granular degeneration of the epithelium of the convoluted tubules and in 2 – by amyloidosis. Pathological changes in the muscle of the heart were found in 30 patients (no changes were found in 12). These changes were characterized by granular degeneration, combined in three patients with muscle fiber fragmentation.

Conclusions:

Thus, among the internal organs, the liver underwent the most profound changes, which, as is known, to a greater extent than other organs, is exposed to purulent intoxication. The revealed changes were characterized by granular degeneration of internal organs, combined in one patient with damage to several organs at once and the development of multiple organ failure.