Ulyanovsk Medico-biological Journal

CLINICAL MEDICINE

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DOI 10.34014/2227-1848-2021-3-19-26

 

CHARACTERISTICS OF PURULONECROTIC LESIONS IN COVID-19 PATIENTS

A.N. Belyaev, I.S. Pol'kina

Ogarev Mordovia State University, Saransk, Russia

 

The COVID-19 pandemic has changed not only our social life, but also the course of many diseases, including purulent-inflammatory diseases of the lower extremities.

The aim of the paper is to assess the influence of COVID-19 on purulonecrotic lesions of the lower extremities.

Materials and Methods. We analyzed the results of treatment of 65 patients with purulonecrotic lesions of the lower extremities. All the patients were divided into 2 groups: Group 1 – 32 Non-COVID-19 patients, Group 2 – 33 COVID-19 patients. We studied laboratory blood parameters, hemostatic systems, performed lungs computed tomography (CT), and color-coded duplex scanning (CDS) of veins.

Results. COVID-19 is more likely to affect patients aged 60–69 (51.5 %) and females (66.7 %). In Group 2 the level of leukocytes was higher than in Group 1 (11.2×109 and 13.9 109, respectively, p<0.05). Patients in both groups showed a tendency to hypercoagulability during anticoagulant therapy. In Group 2 patients, the percentage of transfemoral amputations was higher than in Group 1 patients (58 % and 18.8 % respectively). Arterial embolism of the lower limbs in Group 2 was observed in 6 % of patients. There were no deaths in Group 1, but in Group 2 mortality rate was 33.3 %.

Conclusion. COVID-19 increases the number of arterial and venous thrombosis, often complicated by acute limb ischemia. Ischemic purulonecrotic processes complicated by COVID-19 are more severe, often lead to major limb amputation and are an important aggravating factor leading to death.

Key words: COVID-19, purulonecrotic complications, coagulation, amputation.

Conflict of interest. The authors declare no conflict of interest.

 

References

  1. Lippi G., Plebani M. Laboratory abnormalities in patients with COVID-2019 infection. Clin. Chem. Lab. Med. 2020; 58 (7): 1131–1134. DOI: 10.1515/cclm-2020-0198.

  2. Hussain A., Bhowmik B., do Vale Moreira N.C. COVID-19 and diabetes: Knowledge in progress. Diabetes Res. Clin. Pract. 2020; 162: 108142. DOI: 10.1016/j.diabres.2020.108142.

  3. Williams R., Karuranga S., Malanda B., Saeedi P., Basit A., Besançon S. Global and regional estimates and projections of diabetes-related health expenditure: results from the International Diabetes Federation Diabetes Atlas. Diabetes Res. Clin. Pract. 2020; 162. DOI: 10.1016/j.diabres.2020.108072.

  4. Cantador E., Núñez A., Sobrino P., Espejo V., Fabia L., Vela L., de Benito L., Botas J. Incidence and consequences of systemic arterial thrombotic events in COVID-19 patients. J. Thromb. Thrombolysis. 2020; 50 (3): 543–547. DOI: 10.1007/s11239-020-02176-7.

  5. Wang J.S., Pasieka H.B., Petronic-Rosic V., Sharif-Askary B., Evans K.K. Digital Gangrene as a Sign of Catastrophic Coronavirus Disease 2019-related Microangiopathy. Plast. Reconstr. Surg. Glob. Open. 2020; 8 (7): e3025. DOI: 10.1097/GOX.0000000000003025.

  6. Liu Y., Chen P., Mutar M., Hung M., Shao Z., Han Y., Tong W., Liu Y. Ischemic Necrosis of Lower Extremity in COVID-19: A Case Report. J. Atheroscler. Thromb. 2021; 28 (1): 90–95. DOI: 10.5551/jat.57950.

  7. Makhoul K., Shukha Y., Hanna L.A., Nitecki S., Leiderman M., Hayek T., Hamoud S. A case of rapidly progressive upper limb ischemic necrosis in a patient with COVID-19. Int. J. Infect. Dis. 2021; 106: 401–404. DOI: 10.1016/j.ijid.2021.04.023.

  8. Wang J.S., Pasieka H.B., Petronic-Rosic V., Sharif-Askary B., Evans K.K. Digital Gangrene as a Sign of Catastrophic Coronavirus Disease 2019-related Microangiopathy. Plast. Reconstr. Surg. Glob. Open. 2020; 8 (7): e3025. DOI: 10.1097/GOX.000000000000302.

  9. Tang N., Li D., Wang X., Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J. Thromb. Haemost. 2020; 18 (4): 844–847. DOI: 10.1111/jth.14768.

  10. Novara E., Molinaro E., Benedetti I., Bonometti R., Lauritano E.C., Boverio R. Severe acute dried gangrene in COVID-19 infection: a case report. Eur. Rev. Med. Pharmacol. Sci. 2020; 24 (10): 5769–5771. DOI: 10.26355/eurrev_202005_21369.

  11. Mackman N. The role of tissue factor and factor VIIa in hemostasis. Anesth. Analg. 2009; 108 (5): 1447–1452.

  12. Branchford B.R., Carpenter S.L. The role of inflammation in venous thromboembolism. Front. Pediatr. 2018; 6: 142.

  13. Avila J., Long B., Holladay D., Gottlieb M. Thrombotic complications of COVID-19. Am. J. Emerg. Med. 2021; 39: 213–218. DOI: 10.1016/j.ajem.2020.09.065.

  14. Gottlieb M., Long B. Dermatologic manifestations and complications of COVID-19. Am. J. Emerg. Med. 2020; 38 (9): 1715–1721. DOI: 10.1016/j.ajem.2020.06.011.

  15. Zhang Y., Cao W., Xiao M. Clinical and coagulation characteristics of 7 patients with critical COVID-2019 pneumonia and acro-ischemia. Zhonghua Xue Ye Xue Za Zhi. 2020; 41. DOI: 10.3760/cma.j.issn.0253-2727.2020.0006.

  16. Griffin D.O., Jensen A., Khan M. Arterial thromboembolic complications in COVID-19 in low-risk patients despite prophylaxis [published online ahead of print, 2020 May 6]. Br. J. Haematol. 2020; 190 (1). DOI: 10.1111/bjh.16792.

  17. Kashi M., Jacquin A., Dakhil B. Severe arterial thrombosis associated with Covid-19 infection. Thromb. Res. 2020; 192: 75–77. DOI: 10.1016/j.thromres.2020.05.025.

  18. Sena G., Gallelli G. An increased severity of peripheral arterial disease in the COVID-19 era. J. Vasc. Surg. 2020; 72 (2): 758. DOI: 10.1016/j.jvs.2020.04.489.

  19. Nahum J., Morichau-Beauchant T., Daviaud F. Venous thrombosis among critically III patients with Coronavirus disease 2019 (COVID-19). JAMA Network Open. 2020; 3 (5): e2010478. DOI: 10.1001/jamanetworkopen.2020.10478.

Received June 22, 2021; accepted July 16, 2021.

 

Information about the authors

Belyaev Aleksandr Nazarovich, Doctor of Science (Medicine), Professor, Head of the Chair of General Surgery named after professor N.I. Atyasov, Ogarev Mordovia State University. 430005, Russia, Saransk, Bol'shevistskaya St., 68; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-0698-3007

Pol'kina Irina Sergeevna, 6th year student, Medical Institute, Ogarev Mordovia State University. 430005, Russia, Saransk, Bol'shevistskaya St., 68; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0001-6012-3617

 

For citation

Belyaev A.N., Pol'kina I.S. Osobennosti techeniya gnoyno-nekroticheskikh porazheniy u bol'nykh s COVID-19 [Characteristics of purulonecrotic lesions in COVID-19 patients]. Ul'yanovskiy mediko-biologicheskiy zhurnal. 2021; 3: 19–26. DOI: 10.34014/2227-1848-2021-3-19-26 (in Russian).

 

 

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УДК 617-089

DOI 10.34014/2227-1848-2021-3-19-26

 

ОСОБЕННОСТИ ТЕЧЕНИЯ ГНОЙНО-НЕКРОТИЧЕСКИХ ПОРАЖЕНИЙ У БОЛЬНЫХ С COVID-19

А.Н. Беляев, И.С. Полькина

ФГБОУ ВО «Национальный исследовательский Мордовский государственный университет им. Н.П. Огарева», г. Саранск, Россия

 

Пандемия COVID-19 не только внесла коррективы в социальную жизнь, но и изменила течение многих заболеваний, в т.ч. и гнойно-воспалительных поражений нижних конечностей.

Цель. Оценить влияние коронавирусной инфекции на течение гнойно-некротических поражений нижних конечностей.

Материалы и методы. Проведен анализ результатов лечения 65 больных с гнойно-некротическими поражениями нижних конечностей. Пациенты были разделены на 2 группы: 1-я группа – 32 больных без COVID-19, 2-я группа – 33 больных с COVID-19. Исследовались лабораторные показатели крови, системы гемостаза, проводились компьютерная томография легких, цветное дуплексное сканирование вен, анализировались результаты лечения.

Результаты. COVID-19 чаще поражаются пациенты в возрасте 60–69 лет (51,5 %) и лица женского пола (66,7 %). У больных 2-й группы уровень лейкоцитов был выше, чем в 1-й группе (11,2×109/л и 13,9 ×109/л соответственно, р<0,05). На фоне антикоагулянтной терапии у больных обеих групп отмечалась тенденция к гиперкоагуляции. У больных 2-й группы ампутации на уровне бедра достигли 58 %, что более чем в 2 раза больше, чем у больных 1-й группы (18,8 %). Тромбоэмболии артерий конечностей во 2-й группе составили 6 %. Летальности в первой группе не было, во 2-й группе – 33,3 %.

Выводы. Коронавирусная инфекция способствует возрастанию количества артериальных и венозных тромбозов, нередко осложняющихся острой ишемией конечностей. Ишемические гнойно-некротические процессы на фоне COVID-19 имеют более тяжелое течение, часто приводят к высокой ампутации конечности и являются важным отягощающим фактором, приводящим к летальному исходу.

Ключевые слова: COVID-19, гнойно-некротические осложнения, коагуляция, ампутация.

 

Литература

  1. Lippi G., Plebani M. Laboratory abnormalities in patients with COVID-2019 infection. Clin. Chem. Lab. Med. 2020; 58 (7): 1131–1134. DOI: 10.1515/cclm-2020-0198.

  2. Hussain A., Bhowmik B., do Vale Moreira N.C. COVID-19 and diabetes: Knowledge in progress. Diabetes Res. Clin. Pract. 2020; 162: 108142. DOI: 10.1016/j.diabres.2020.108142.

  3. Williams R., Karuranga S., Malanda B., Saeedi P., Basit A., Besançon S. Global and regional estimates and projections of diabetes-related health expenditure: results from the International Diabetes Federation Diabetes Atlas. Diabetes Res. Clin. Pract. 2020; 162. DOI: 10.1016/j.diabres.2020.108072.

  4. Cantador E., Núñez A., Sobrino P., Espejo V., Fabia L., Vela L., de Benito L., Botas J. Incidence and consequences of systemic arterial thrombotic events in COVID-19 patients. J. Thromb. Thrombolysis. 2020; 50 (3): 543–547. DOI: 10.1007/s11239-020-02176-7.

  5. Wang J.S., Pasieka H.B., Petronic-Rosic V., Sharif-Askary B., Evans K.K. Digital Gangrene as a Sign of Catastrophic Coronavirus Disease 2019-related Microangiopathy. Plast. Reconstr. Surg. Glob. Open. 2020; 8 (7): e3025. DOI: 10.1097/GOX.0000000000003025.

  6. Liu Y., Chen P., Mutar M., Hung M., Shao Z., Han Y., Tong W., Liu Y. Ischemic Necrosis of Lower Extremity in COVID-19: A Case Report. J. Atheroscler. Thromb. 2021; 28 (1): 90–95. DOI: 10.5551/jat.57950.

  7. Makhoul K., Shukha Y., Hanna L.A., Nitecki S., Leiderman M., Hayek T., Hamoud S. A case of rapidly progressive upper limb ischemic necrosis in a patient with COVID-19. Int. J. Infect. Dis. 2021; 106: 401–404. DOI: 10.1016/j.ijid.2021.04.023.

  8. Wang J.S., Pasieka H.B., Petronic-Rosic V., Sharif-Askary B., Evans K.K. Digital Gangrene as a Sign of Catastrophic Coronavirus Disease 2019-related Microangiopathy. Plast. Reconstr. Surg. Glob. Open. 2020; 8 (7): e3025. DOI: 10.1097/GOX.000000000000302.

  9. Tang N., Li D., Wang X., Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J. Thromb. Haemost. 2020; 18 (4): 844–847. DOI: 10.1111/jth.14768.

  10. Novara E., Molinaro E., Benedetti I., Bonometti R., Lauritano E.C., Boverio R. Severe acute dried gangrene in COVID-19 infection: a case report. Eur. Rev. Med. Pharmacol. Sci. 2020; 24 (10): 5769–5771. DOI: 10.26355/eurrev_202005_21369.

  11. Mackman N. The role of tissue factor and factor VIIa in hemostasis. Anesth. Analg. 2009; 108 (5): 1447–1452.

  12. Branchford B.R., Carpenter S.L. The role of inflammation in venous thromboembolism. Front. Pediatr. 2018; 6: 142.

  13. Avila J., Long B., Holladay D., Gottlieb M. Thrombotic complications of COVID-19. Am. J. Emerg. Med. 2021; 39: 213–218. DOI: 10.1016/j.ajem.2020.09.065.

  14. Gottlieb M., Long B. Dermatologic manifestations and complications of COVID-19. Am. J. Emerg. Med. 2020; 38 (9): 1715–1721. DOI: 10.1016/j.ajem.2020.06.011.

  15. Zhang Y., Cao W., Xiao M. Clinical and coagulation characteristics of 7 patients with critical COVID-2019 pneumonia and acro-ischemia. Zhonghua Xue Ye Xue Za Zhi. 2020; 41. DOI: 10.3760/cma.j.issn.0253-2727.2020.0006.

  16. Griffin D.O., Jensen A., Khan M. Arterial thromboembolic complications in COVID-19 in low-risk patients despite prophylaxis [published online ahead of print, 2020 May 6]. Br. J. Haematol. 2020; 190 (1). DOI: 10.1111/bjh.16792.

  17. Kashi M., Jacquin A., Dakhil B. Severe arterial thrombosis associated with Covid-19 infection. Thromb. Res. 2020; 192: 75–77. DOI: 10.1016/j.thromres.2020.05.025.

  18. Sena G., Gallelli G. An increased severity of peripheral arterial disease in the COVID-19 era. J. Vasc. Surg. 2020; 72 (2): 758. DOI: 10.1016/j.jvs.2020.04.489.

  19. Nahum J., Morichau-Beauchant T., Daviaud F. Venous thrombosis among critically III patients with Coronavirus disease 2019 (COVID-19). JAMA Network Open. 2020; 3 (5): e2010478. DOI: 10.1001/jamanetworkopen.2020.10478.

Поступила в редакцию 22.06.2021; принята 16.07.2021.

 

Авторский коллектив

Беляев Александр Назарович – доктор медицинских наук, профессор, заведующий кафедрой общей хирургии им. проф. Н.И. Атясова, ФГБОУ ВО «Национальный исследовательский Мордовский государственный университет им. Н.П. Огарева». 430005, Россия, г. Саранск, ул. Большевистская, 68; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-0698-3007

Полькина Ирина Сергеевна – студентка 6 курса медицинского института ФГБОУ ВО «Национальный исследовательский Мордовский государственный университет им. Н.П. Огарева». 430005, Россия, г. Саранск, ул. Большевистская, 68; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0001-6012-3617

 

Образец цитирования

Беляев А.Н., Полькина И.С. Особенности течения гнойно-некротических поражений у больных с COVID-19. Ульяновский медико-биологический журнал. 2021; 3: 19–26. DOI: 10.34014/2227-1848-2021-3-19-26.