Treatment of toxic hepatitis in COVID-19 patients

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Abstract

Background. The article reflects the clinical significance of the early diagnosis of toxic hepatitis in patients who have undergone a new coronavirus infection with the determination of clinical and laboratory predictors of the response to therapy. A dynamic analysis of the effectiveness of toxic hepatitis therapy in patients of three experimental groups and a control group is presented.

Aim. The aim of the present study is to increase the effectiveness of the treatment of toxic hepatitis in patients who have undergone COVID-19.

Materials and methods. On the basis of the newly created infection centers of the Central Clinical Hospital “RZhD-Medicine” and Vishnevsky 3-rd Central Military Clinical Hospital 996 patients with COVID-19, who had clinical and laboratory signs of toxic liver damage (cytolytic and/or cholestatic syndromes) against the background of COVID-19 therapy.

Results. On the 14th day from the start of therapy in group 3, there was a significant decrease in the clinical manifestations of jaundice in 163 (72.8%) patients, on the 21st day of treatment, this symptom was stopped in all patients. In groups 1 and 2, the decrease in clinical manifestations of jaundice was significantly lower – 122 (55.2%) and 134 (58.8%); p<0.05. At the end of therapy, no manifestations of jaundice were observed in all experimental groups, while in the control group, symptom reduction was achieved only in 47 (14.5%) patients.

Conclusion. The use of drugs with hepatoprotective effect in the form of monotherapy in groups 1 (UDCA) and 2 (ademethionine) showed a low therapeutic effect with positive dynamics of clinical and laboratory indicators of toxic hepatitis activity. The use of combined treatment in group 3 (UDCA and ademethionine) demonstrated the maximum therapeutic effect, pronounced positive dynamics in the form of normalization of clinical and laboratory indicators of toxic hepatitis activity.

About the authors

Igor V. Maev

Yevdokimov Moscow State University of Medicine and Dentistry

Email: aram_k@mail.ru
ORCID iD: 0000-0001-6114-564X

акад. РАН, д-р мед. наук, проф., зав. каф. пропедевтики внутренних болезней и гастроэнтерологии ФГБОУ ВО «МГМСУ им. А.И. Евдокимова»

Russian Federation, Moscow

Rafik I. Shaburov

Yevdokimov Moscow State University of Medicine and Dentistry; Central Clinical Hospital “RZhD-Medicine”

Email: aram_k@mail.ru
ORCID iD: 0000-0001-9741-0150

канд. мед. наук, доц. каф. пропедевтики внутренних болезней и гастроэнтерологии ФГБОУ ВО «МГМСУ им. А.И. Евдокимова», глав. врач ЧУЗ «ЦКБ “РЖД-Медицина”»

Russian Federation, Moscow; Moscow

Alexandr I. Pavlov

Vishnevsky 3-rd Central Military Clinical Hospital

Email: aram_k@mail.ru
ORCID iD: 0000-0003-1836-7946

д-р мед. наук, доц., зам. нач. госпиталя по медицинской части ФГБУ «3 ЦВКГ им. А.А. Вишневского»

Russian Federation, Krasnogorsk

Alevtina I. Molodova

Yevdokimov Moscow State University of Medicine and Dentistry

Email: aram_k@mail.ru
ORCID iD: 0000-0003-3302-6541

aссистент каф. пропедевтики внутренних болезней и гастроэнтерологии ФГБОУ ВО «МГМСУ им. А.И. Евдокимова»

Russian Federation, Moscow

Aram G. Karakozov

Yevdokimov Moscow State University of Medicine and Dentistry

Author for correspondence.
Email: aram_k@mail.ru
ORCID iD: 0000-0002-3196-4457

д-р мед. наук, проф. каф. пропедевтики внутренних болезней и гастроэнтерологии ФГБОУ ВО «МГМСУ им. А.И. Евдокимова»

Russian Federation, Moscow

Sergey P. Kazakov

Russian Medical Academy of Continuous Professional Education; Burdenko Main Military Clinical Hospital

Email: aram_k@mail.ru
ORCID iD: 0000-0001-6528-1059

д-р мед. наук, доц., зав. каф. медицинской биохимии и иммунопатологии ФГБОУ ДПО РМАНПО, нач. центра клинической лабораторной диагностики – главный лаборант ФГБУ «ГВКГ им. Н.Н. Бурденко»

Russian Federation, Moscow; Moscow

Ekaterina G. Lebedeva

Yevdokimov Moscow State University of Medicine and Dentistry

Email: aram_k@mail.ru
ORCID iD: 0000-0001-9572-1932

канд. мед. наук, доц. каф. пропедевтики внутренних болезней и гастроэнтерологии ФГБОУ ВО «МГМСУ им. А.И. Евдокимова»

Russian Federation, Moscow

Aleksandr F. Ivolgin

Vishnevsky 3-rd Central Military Clinical Hospital

Email: aram_k@mail.ru
ORCID iD: 0000-0002-8849-680X

нач. неврологического центра – главный невролог ФГБУ «3 ЦВКГ им. А.А. Вишневского»

Russian Federation, Krasnogorsk

Mikhail N. Eremin

Yevdokimov Moscow State University of Medicine and Dentistry

Email: aram_k@mail.ru
ORCID iD: 0000-0002-8798-5011

канд. мед. наук, ассистент каф. пропедевтики внутренних болезней и гастроэнтерологии ФГБОУ ВО «МГМСУ им. А.И. Евдокимова»

Russian Federation, Moscow

Olga B. Levchenko

Yevdokimov Moscow State University of Medicine and Dentistry

Email: aram_k@mail.ru
ORCID iD: 0000-0002-6594-7006

aссистент каф. пропедевтики внутренних болезней и гастроэнтерологии ФГБОУ ВО «МГМСУ им. А.И. Евдокимова»

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. Evolution of the Alanine aminotransferase by Group (Unit/L).

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3. Fig. 2. Evolution of the Aspartate aminotransferase by Group (Unit/L).

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4. Fig. 3. Evolution of γ-glutamyl transferase by group (Unit/L).

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5. Fig. 4. Evolution of Alkaline phosphatase by group (Unit/L).

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6. Fig. 5. Evolution of total bilirubin by group (umol/l).

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