Features of the course of COVID-19 in patients with chronic viral hepatitis
Authors:   Tashkent Medical Academy, Tashkent, Uzbekistan, Akhmedova M.D. , Imamova I.A. ,   Tashkent Medical Academy, Tashkent, Uzbekistan
Published: September 2024

Objective. To study the features of clinical picture and levels of proinflammatory cytokines (interleukin-1 and -6) and tumor necrosis factor-alpha in COVID-19 patients with CVH. Patients and Methods. A prospective case-control study included 222 patients admitted between 2020 and 2024 with a diagnosis of COVID-19 presenting with CVH at Zangiota Multidisciplinary Infectious Disease Clinic No. 1. The diagnosis of COVID-19 in all patients was verified either by polymerase chain reaction revealing SARS-CoV-2 ribonucleic acid (nasopharyngeal swabs) or by specific immunoglobulins of class M to coronavirus detected by enzyme immunoassay. The severity of the course of the disease was determined in accordance with the temporary methodological recommendations of the Republic of Uzbekistan “Prevention, diagnosis and treatment of new coronavirus infection (COVID-19 Group I included 103 (46.39%) patients with chronic viral hepatitis C (CVHC), Group II included 104 (46.85%) patients with chronic viral hepatitis B (CVHB), and Group III included 15(6.76%) patients with mixt-hepatitis. The examination included: history taking; clinical examination of patients; standard clinical and biochemical blood tests; multispiral computed tomography and/or lung radiography. Serum levels of TNF-alpha and interleukins (hereinafter referred to as IL) -1, and -6 were determined using diagnostic test systems manufactured by VECTOR-BEST LLC (Novosibirsk, Russia) according to the attached instructions. Statistical processing of the obtained results was performed using Statstica.12 program. Methods of descriptive and variation statistics were used; Fisher's criterion and Pearson's linear correlation coefficient were calculated. Differences were considered reliable at p < 0.05. Results. In groups I and II, the moderately severe form of COVID-19 was significantly (p < 0.05) redominant; in the whole sample, as well as in the moderately severe course of the disease, women were significantly (p < 0.05) predominant; 9 out of 10 patients who died were men. The later a patient was admitted to the hospital, the more often severe COVID-19 was diagnosed. In all groups, men were hospitalized significantly (p < 0.05) later than women. In 12(5,41%) patients the diagnosis of “CVH” was detected for the first time in hospital by ELISA method: in 11 cases – CVHC, in another 1 – CVHB. Thirtysix(16.21%) patients had diabetes mellitus, 17 of them had moderate COVID-19, and 19 had severe COVID-19. There was a significant (p < 0.05) predominance of type 2 diabetes mellitus in patients from group I (25.2% vs. 3.6:% in group II, and 13.3% in group III, respectively). In 26 patients with diabetes mellitus from group I, the level of IL-6 was significantly (p < 0.05) higher (59.45 ± 18.15 pg/mL, versus 30.61 ± 4.24 and 31.0 pg/mL for groups II and III, respectively). The level of C-reactive protein in the general group amounted to 41.21 ± 1.68 IU/mL; the dynamics of this index had a wave-like character, increasing with aggravation of the condition and decreasing with increasing saturation and decreasing intoxication syndrome. In 78 (35.13%) patients at hospital discharge the level of CRP remained elevated (24.03 ± 1.47 mg/L). Conclusion. Timely detection of disorders in the systems of cytokine regulation and hemostasis in patients with the combination of COVID-19 and CVH will allow increasing the effectiveness of treatment (hepatoprotectors, anticoagulants) both in hospital and in the rehabilitation period. Key words: COVID-19, diagnosis, proinflammatory cytokines, tumor necrosis factor-alpha, chronic viral hepatitis