Analytical, radiological and oxymetric follow-up of patients with COVID 19 as a guide for their therapeutic management

Seguimiento analítico, radiológico y oximétrico de los pacientes con COVID 19 como guía para su manejo terapéutico

Introduction: COVID-19 is an infectious disease that can manifest itself from a banal infection of the upper airway (60 to 70% of cases) to a mild, moderate or severe respiratory distress syndrome, as well as multisystem organ damage (40% of cases, 88% of which have one or more risk factors). The development of the so-called "cytokine storm" occurs on days 5 to 7 of the disease, and depends in turn on the presence or not of risk factors. Therefore, it is possible to create a predictive model of the development of such a cytokine storm and the likelihood of progression to severe pulmonary forms, to administer antiviral and anti-inflammatory treatment vigorously, at the times of the disease when they are most effective. 

Problem: The development of ARDS by the new coronavirus SARS COV-2 is difficult to manage and has a high morbidity / mortality. 

Objective: To propose a predictive model of risk of ARDS development by the new SARS COV-2 coronavirus from its initial phases, according to risk factors and analytical, clinical and radiological data, to administer antiviral and / or anti-inflammatory drugs at more opportune times, thus avoiding the passage to the advanced stages of the disease, such as ARDS or multisystem organ damage, instead of treating the patient once the damage has been installed.

Material and methods: Cohort of 796 patients, multicenter, seen from April 2019 to April 1, 2021, in a private tertiary hospital in the country, a public tertiary hospital and patients seen in the private clinic.

Results and discussion. Of the total patients, 56% had a mild clinical course, 29% had a mild cytokine storm, with the development of mild pneumonia, and 15% a moderate or severe cytokine storm, with the development of mild or moderate ARDS. There was a mortality of 0.36%. Patients with mild clinical course had no risk factors for poor progression and were treated symptomatically and on an outpatient basis. Patients with risk factors for poor progression were treated with remdesivir from diagnosis. Those who developed a mild cytokine storm were treated with glucocorticoids and anticoagulation at low to moderate doses. Patients with moderate or severe cytokine storm were treated with glucocortico at moderate or high doses, anticoagulation, with or without tocilizomab and remdesivir, depending on interleukin 6 values and detected viral load. None had serious side effects with treatment.  Conclusions: Initiating early and timely treatment in patients with risk factors and/or who develop a cytokine storm can prevent the development of respiratory distress and reduce its severity in patients with COVID-19, reducing the need for oxygen therapy in the short and long term, hospital stay, admission to the ICU, the need for mechanical ventilation and mortality and long-term sequelae.