MULTIVARIATE RISK ANALYSIS OF HIGH MORTALITY FROM HEART FAILURE IN PATIENTS WITH ARTERIAL HYPERTENSION AND SARS-COV-2 PNEUMONIA

Objective: To identify risk factors for high mortality from heart failure in patients with arterial hypertension (AH) against the background of SARS-CoV-2 pneumonia. Design and method: 90 patients with pneumonia confirmed by PCR and computed tomography (CT) with determination of the volume of lung damage (VLD). Ferritin, lymphocytes, platelets, D-dimer, fibrinogen and procalcitonin were determined. Saturation (SPO2) was measured; oxygenation index (PaO2/Fi02) was calculated to assess respiratory failure (RF). ECG was performed, pulmonary hypertension (PH), TAPSE index, left ventricular ejection fraction (LVEF) were determined. 77 of 90 patients (85.5%) died (group 1), 13 recovered (group 2). Patients of 1 were hospitalized on day 3.4 (2-5) from the onset of pneumonia; 2 - on day 4.5 (3-7). Patients in 1 were older (71 years, 56-86) than in 2 (54 years, 36-62) (p=0.02). AH was 100% in 1 versus 30.8% in 2; the incidence of CVD was 83.1% and 0%; the incidence of type 2 diabetes was 28.6% and 0%. Obesity in 1 (33.7%); in 2, 30.8% (p=0.03). Results: The VLD in 2 was 69.2% (51-88), which was higher than in 1 (55.8%, 20-90) (p=0.045), but the SPO2 (78%, 70-84) and PaO2/Fi02 (86 mmHg) indicated severe RF in 1 with the development of acute respiratory distress syndrome (ARDS). Persistent PH with PA to 60 mmHg (42-78); the TAPSE 14 mm (12-17), LVEF to 44% (40-57). Inflammation was indicated by the concentration of blood ferritin (1053 mg/L, 321-1984); lymphopenia (0.69 x10∗9/l, 0.2-0.9); procalcitonin level (4.1 ng/ml, 0.8-6.3). At autopsy, non-coronary infarctions, hemorrhages, alveolar edema, microatelectasis, air cysts were found in the organs. Histological examination revealed stasis, microaggregates of formed elements of the blood, fibrin deposits inside the vessels and under the endothelium. D-dimer (4972 ng/ml, 1375-15770), fibrinogen (7.5 g/l; 6.7-8.8) and thrombocytopenia (65x10∗9/l; 20-146). Conclusions: Mortality from ARDS in SARS-CoV-2 pneumonia in patients with hypertension increases with age and reaches 85.5%. Hypoxemia and the degree of decrease in the oxygenation index against the background of persistent PH and right ventricular dysfunction such as acute pulmonary heart disease are one of the main predictors of an unfavorable outcome.