Patients monitoring in the City Clinical Hospital No. 52 at the beginning and end of the pandemic

SARS-CoV-2 infection continues to circulate in the population and to play a role of immunological trigger. Polyserositis, described as a marker of immunoinflammatory diseases, today can often be found in patients who have had COVID-19, even irrespective of respiratory infection.

Objective: to study the incidence of pericardial and pleural effusion based on lung CT scans in patients with moderate to severe acute COVID-19 pneumonia and to compare findings with mortality rates.

Materials and methods. The incidence of exudation >5 mm according to data from a chest CT scan performed upon admission to a Covid hospital in patients with acute pneumonia from the database for the period from February 1 to April 30, 2020 and 2022. Criteria non-inclusion: presence of previous pericarditis or pleurisy, hydropericardium, hydrothorax, CHF with NYHA class ≥3, immunoinflammatory disease.

Results. Over the 3 months studied in 2020 and 2022, 390 cases were included, of which 58 ended in death. Pleural effusion visible on CT of the lungs in the group of survivors were recorded in 15%, in the group of deceased – in 50% of patients (OR 3.9; 95%CI 2.5–6.2), pericardial effusion – 12 and 57%, respectively (OR 5.6; 95%CI 3.6–8.9). The maximum thickness of the effusion was also twice as large in the second group: 13 vs 29 mm in the cavity pleura, 6 vs 11 mm in the pericardial cavity. When comparing the frequency of serous membranes involvement by year, in 2020 effusion into the pleural cavity was recorded in 16%, in 2022 – in 22%, in the pericardial cavity in 2020 – in 14%, in 2022 – in 20% respectively. At the same time the groups were comparable in age Me 59 [95%CI: 49 to 86] years in 2020 and 60 [95%CI: 49 to 87] years in 2022 (p = 0.6), as well as by the severity of pneumonia according to CT 1.65 ± 0.2 vs 1.55 ± 0.2 (p = 0.2) respectively.

Conclusions. 1/5 of inpatients with COVID-19 pneumonia have a small effusion in the serous cavities of the chest. The exudation into the pleural or pericardial cavities are associated with a 4- and 6-fold increased risk of death in these patients. The incidence of serous effusion >5 mm increased 1.5 times over 3 years, which may indicate patient sensitization.

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