| Abstract | Ciljevi: Cilj istraživanja je bio retrospektivno istražiti glavne kriterije u kliničkoj slici i laboratorijskim nalazima za uvođenje remdesivira u terapiju u bolesnika s COVID 19 infekcijom sa srednje teškim i teškim oblikom bolesti, učinak remdesivira na sniženje tjelesne temperature, smanjenje smrtnosti i potrebe za primjenom mehaničke ventilacije.
Materijali i metode: Analizom povijesti bolesti iz Klinike za infektologiju KBC-a Split zabilježeno je ukupno 60 bolesnika s COVID 19 infekcijom sa srednje teškim i teškim oblikom bolesti. Prikupljeni su sljedeći podatci: dob, spol, trajanje temperature prije i nakon primjene lijeka, leukociti, trombociti, AST, ALT, GGT, LDH, CK, D dimeri, CRP, ureja, kreatinin, ABS, SpO2, RTG pluća, stanje svijesti bolesnika te krvni tlak i srčana frekvencija. Također, prikupljeni su i epidemiološki i demografski podatci o mjestu stanovanja, ukupnom broju ukućana kao i broju zaraženih ukućana.
Rezultati: U istraživanju je sudjelovalo ukupno 60 bolesnika, od koji su 48 bili muškog spola (80%). Medijan životne dobi bolesnika iznosi 64 godine. Od ukupnog broja bolesnika, njih 60% je bilo iz grada, dok su ostali bili sa manjih naselja i sela. Kod 48 bolesnika nitko drugi nije bio bolestan od ukućana, kod 10 bolesnika je samo još jedan ukućan bio bolestan, a kod 2 bolesnika su svi ukućani bili bolesni. U remdesivir skupini je temperatura trajala značajno dulje prije primjene lijeka, te su bolesnici imali višu razinu leukocita, viši LDH i pCO₂ u odnosu na kontrolnu skupinu, kao i srednje vrijednosti CRP-a, CK i D dimera. U skupini pacijenata s remdesivirom, temperatura je trajala značajno kraće u odnosu na kontrolnu skupinu. Vrijednosti jetrenih transaminaza (ALT i GGT) blago su povišene u remdesivir skupini u odnosu na kontrolnu skupinu. Vrijednosti uree i kreatinina nešto su više kod remdesivir skupine. Ne postoji značajna razlika u vrijednostima sistoličkih i dijastoličkih tlakova između skupina, srčana frekvencija nešto je viša u kontrolnoj skupini. U obje skupine bolesnici su bili u respiracijskoj alkalozi i imali su snižene vrijednosti pO₂. Bolesnici liječeni remdesivirom imali su niži SpO₂. Na RTG-u pluća u remdesivir skupini u 90% bolesnika su zabilježena obostrana upalna zasjenjenja tipičnog izgleda za COVID 19 infekciju, dominantno u srednjim i donjim plućnim poljima.
Zaključci: Budući da je riječ o bolesnicima s težom kliničkom slikom i povišenim laboratorijskim upalnim parametrima, kod odluke o uvođenju remdesivira kraće trajanje temperature u toj skupini bolesnika ukazuje na dobrobit primjene lijeka. Iako učinak remdesivira prema dobivenim rezultatima istraživanja smanjuje broj premještaja u JIL, istraživanje nije pokazalo da primjena remdesivira smanjuje broj smrtnih slučajeva. |
| Abstract (english) | Objectives: The aim of the study was to retrospectively investigate the main criteria in the clinical picture and laboratory findings for the introduction of remdesivir into therapy in patients with COVID 19 infection with moderate to severe disease, the effect of remdesivir on lowering body temperature, reducing mortality and the need for mehanical ventilation.
Materials and methods: The analysis of the medical history from the Clinic for Infectious Diseases of the University Hospital of Split recorded a total of 60 patients with COVID 19 infection with moderate to severe disease. The following data were collected: age, sex, duration of body temperature before and after drug administration, levels of leukocytes, platelets, AST, ALT, GGT, LDH, CK, D dimers, CRP, urea, creatinine, ABS, SpO₂, lung X-ray, state of consciousness of patients, blood pressure and heart rate. Also, epidemiological and demographic data on the place of residence, total number of households as well as the number of infected households were collected.
Results: In the study participated 60 patients, of which 48 were male (80%). The median age is 64 years. Of the total number of patients, 60% were from the city, while the rest were from smaller settlements and villages. In 48 patients no one else was ill from the household, in 10 patients only one more household member was ill, and in 2 patients all family members were ill. In the remdesivir group, the temperature lasted significantly longer before drug administration, and patients had higher leukocyte levels, higher LDH and pCO₂ compared to the control group, as well as mean values of CRP, CK and D dimers. In the remdesivir group, the temperature was significantly shorter after drug administration than in the control group. Hepatic transaminases (ALT and GGT) in the remdesivir group compared to the control group. Urea and creatinine values are slightly higher in the remdesivir group. There is no significant difference in the values of the systolic and diastolic pressure between the groups, the heart rate is slightly higher in the control group. In both groups patients were in respiratory alkalosis and had decreased pO₂ values. Patients treated with remdesivir had lower SpO₂. On the chest radiography in the remdesivir group, bilateral inflammatory infiltrates typical of COVID 19 infection were observed in 90% of patients, predominantly in the middle and lower lung fields.
Conclusions: Seeing they were patients with a more severe clinical picture and elevated laboratory inflammatory parameters, shorter duration of fever in this group of patients indicates the benefit of remdesivir. Although the effect of remdesivir according to the obtained research results reduces the number of accommodation in the ICU, research has not shown that the use of remdesivir reduces the number of deaths. |
