RU2472155C1 - Method for prediction of fatal outcome in patients with community-acquired pneumonia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: patient's immune status is examined to specify organ-specific pulmonary tissue components; the following indicators are to be considered for the purpose of estimating a risk of case fatality rate: IgM [mg/ml], IgG [mg/ml], circulating immune complexes units, AAT to BM LuM 01-230 [% of individual immune reactivity], AAT to CB LuS 06-300 [% of individual immune reactivity], AAT to CB LuS 06-80 [% of individual immune reactivity], erythrocytes [10*6/mcl], leukocytes [10*9/mcl], stab neutrophils [%], lymphocytes [%], monocytes [%], glucose [mmole/l], ACT [unit/l], respiration rate [motion/min], coughing rate [ranges]; then formula is used to calculate a case fatality rate function; if the function is more than zero, a fatal outcome is predicted, while the function less than zero enables predicting reconvalescence.

EFFECT: higher prediction accuracy ensured by specifying and considering the organ-specific pulmonary tissue damage indicators, simplifying the method for predicting the clinical outcome of community-acquired pneumonia in elderly and senile patients, enabling prediction of progression of the disease from the first days of admission to hospital.

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Description

The present invention relates to medicine, more specifically to therapy, clinical immunology and clinical pharmacology.

It is known that mortality in severe community-acquired pneumonia is 40% in Russia, the risk of mortality in hospitalized patients reaches 12%. Microbiological identification of the pathogen is possible only in 40-60% of cases of all pneumonia. Organ-specific inflammation (of the lungs), regardless of the etiological agent, leads to the destruction of the parenchyma and the release of a large number of organ-specific antigens [1].

A known method for assessing the severity of pneumonia on the basis of the PORT [2], CURB / 65 [3] scale, taking into account clinical and laboratory parameters without evaluating the organ-specific immune response. The method requires extensive biochemical research and certain skills of the clinician in interpreting the data. The disadvantages of the method are the lack of immunological criteria for a specific lesion of the lung tissue, the absence of a prognosis of a fatal outcome in patients of varying severity. And as a result, insufficient assessment of the contribution of the pulmonary component to the structure of mortality.

A known method for assessing the depth of lesion of the pulmonary parenchyma based on the level of pulmotropic autoantibodies (AAT) in the blood serum [4], we have confirmed its clinical significance in elderly and senile patients [5], an article has been published on immunopathogenesis of community-acquired pneumonia and an approximate assessment of the contribution immunological markers in mortality of community-acquired pneumonia.

A known method for predicting a fatal outcome in patients with community-acquired pneumonia, including the identification of various prognostic indicators, is as follows: assess consciousness, body temperature, leukocyte level in the blood, heart rate (HR), detect the absence or presence of decompensation, and take into account concomitant diseases ( cerebrovascular, CHF II-III stage, COPD), take into account the absence or presence of bleeding, measure the level of urea, the level of diastolic blood pressure [6]. With this approach, prognostic factors are taken into account in the order of their influence on mortality, starting with the more significant. However, like the previously known methods for predicting mortality, the above method does not take into account the immunological criteria for a specific lesion of the lung tissue. And as a result, there is an underestimation of the contribution of the pulmonary component to the structure of mortality.

The technical result of the claimed method is to increase the accuracy of prediction by identifying and accounting for organ-specific indicators of lung tissue lesion, simplifying the method of predicting the outcome of community-acquired pneumonia in elderly and senile patients, and the ability to predict the dynamics of the disease from the first day a patient enters a hospital.

A method for predicting mortality in patients with community-acquired pneumonia is as follows. Upon receipt of a patient with a preliminary diagnosis of community-acquired pneumonia, hematological, biochemical, immunological and clinical parameters are examined and evaluated [Table 1] in the following sequence, depending on the effect on mortality: IgM [mg / ml], IgG [mg / ml], CEC units, AAT for BM LuM 01-230 [% of individual immunoreactivity], AAT for CB LuS 06-300 [% of individual immunoreactivity], AAT for CB LuS 06-80 [% of individual immunoreactivity], erythrocytes [10 * 6 / μl], white blood cells [10 * 9 / μl], stab neutrophils [%], lymphocytes [%], monocytes [%], glucose [mmol / l], ACT [units / l], respiratory rate [movements / min], cough [ranks]. At the next stage, the significance of the functions of convalescence and lethal outcome is found by multiplying the variables by their coefficients, summing over the groups, adding constants and estimating the obtained values. If the function turned out to be greater than zero, then make a prediction of a fatal outcome, if less than zero - the forecast of convalescence.

Mortality function = -0.9005 × IgM + 0.0685 × IgG + 0.1673 × CEC-0.0273 × AAT for BM LuM 01-230 + 0.222 × AAT for CB LuS 06-300-0.0861 × AAT for CB LuS 06-80 + 4.8204 × RBC + 0.5492 × Leukocytes + 0.5257 × Band neutrophils + 0.0468 × Lymphocytes - 0.0678 × Monocytes - 0.7921 × Glucose + 0.069 × ACT + 0.0524 × Respiratory rate - 2.9582 × Cough - 38.9283

In the indicated rule, each variable corresponds to a certain coefficient.

A cough is evaluated as follows: 0 points - no cough; 1 point - mild (dry or wet), the patient notes coughing only when questioned; 2 points - moderate dry; 3 points - moderate moist, with sputum discharge; 4 points - moderate moist, with purulent sputum discharge; 5 points - pronounced dry, paroxysmal; 6 points - pronounced wet, with the discharge of light sputum; 7 points - pronounced wet, with the discharge of purulent sputum.

Table 1. The rule for predicting the death of VP for a specialist in clinical immunology. Fatal outcome is predicted when function values are greater than zero Discriminant Equation Variables Coefficients of Variables IgM [mg / ml] -0.9005 IgG [mg / ml] 0.0685 CEC [unit] 0.1673 AAT to BM LuM 01-230 [% of individual immunoreactivity] -0.0273 AAT to CB LuS 06-300 [% of individual immunoreactivity] 0.222 AAT to CB LuS 06-80 [% of individual immunoreactivity] -0.0861 Red blood cells [10 * 6 / μl] 4.8204 White blood cells [10 * 9 / μl] 0.5492 Band neutrophils [%] 0.5257 Lymphocytes [%] 0.0468 Monocytes [%] -0.0678 Glucose [mmol / L] -0.7921 ACT [u / l] 0.069 Respiratory rate [movements / min] 0.0524 Cough [Ranks] -2.9582 Constant -38.9283

The method has a percentage of correct prediction of mortality of 98% and a recovery of 95% (according to the sliding test). The method is intended for use by a specialist in the field of clinical immunology for immunocorrection.

The method can be used to predict the outcome and determine the need for advanced pharmacotherapy / immunotherapy for this type of disease.

Example 1

The patient, 74 years old, (IB No. 7312), was admitted to the hospital with complaints of cough with scanty white sputum, pain in the left half of the chest, aggravated by movement and deep breathing, discomfort of breathing at rest.

According to the patient, she fell ill acutely a few days ago after hypothermia, when she felt a sharp weakness, cough, noted an increase in temperature to 39 ° C, intense pain in the left side. Hospitalized.

From a life story: The fact of smoking and occupational hazards is denied.

Concomitant diseases: Hypertension. CHD: angina pectoris. Atrophic gastroduodenitis. Duodeno-gastric reflux. Kyphoscoliosis of the thoracic spine.

On examination in the department: an objective state of moderate severity. Body temperature 37.4 ° C. The skin is of normal color. Humidity of the skin is normal. Peripheral edema - no. Enlarged lymph nodes were not detected. The musculoskeletal system is kyphoscoliosis. Free breathing through the nose. The number of breaths is 20-22 per minute. The rhythm is correct. Percussion sound is clear pulmonary with a box tint. In the lungs, auscultation is hard breathing, moist finely bubbling rales are heard in the lower left. The area of the heart is not visually changed. Heart sounds are muffled. The rhythm is correct. Noises are not detected. Heart rate 95 per minute. HELL 120/80 mm Hg Pulse on peripheral arteries of satisfactory performance. Tongue overlaid, wet. The abdomen is of normal shape, soft, painless. Liver at the costal margin. The spleen is not palpable. The chair is normal.

The symptom of lumbar effusion is negative on both sides. Urination is free, painless, not frequent. Consciousness is clear. The patient is contact, adequate in behavior, oriented in place, time, self. Vision is reduced.

ECG: Sinus rhythm, heart rate-125, blockade PVLNPG, signs of hypertrophy of the right heart.

During ECHO-KG hypertrophy of the LV myocardium due to hypertrophy of the breast. Mitral valve calcification I-II Art. Mitral regurgitation of I-II Art. Signs of pulmonary hypertension I Art. LV diastolic dysfunction. PV = 68%.

On the x-ray in a direct and left lateral projection, heterogeneous infiltration in the basal parts of the left lung is noted. The pulmonary pattern is deformed due to pneumosclerosis. The roots are heavy, widened. Conclusion: left-side lower lobar pneumonia.

When conducting ultrasound of the lungs and pleural cavities, the infiltration sites in S 9.10 on the left, about 3 cm long. Diffuse pneumosclerosis. No fluid was found in the pleural cavities. The mobility of the pulmonary margins is somewhat limited.

Pneumonia in the lower lobe on the right. Emphysema. Diffuse pneumosclerosis.

Pulse oximetry indicators - heart rate - 82. SpО2 - 96%, which is normal and, given shortness of breath 22 min, the degree of respiratory failure is 1.

Laboratory indicators: White blood cells - 12.6 × 10 * 9 / μl, ESR - 28 mm / h, in the biochemical analysis of blood the level of urea and creatinine is normal, protein in the urine is 1 g / l.

The patient was diagnosed with community-acquired polysegmental pneumonia on the left, moderate severity. Complications of the main: DN 0-I stage. Intoxication.

Concomitant diseases: Hypertension of the III degree, 3 stages, risk 4. Hypertensive heart. CHD: angina pectoris II FC. Hypertensive nephropathy. Atrophic gastroduodenitis. Duodeno-gastric reflux. Kyphoscoliosis of the thoracic spine.

A study of the immune status was carried out and the following indicators of the organ-specific component were revealed: IgM - 2.23 mg / ml, IgG - 13.65 mg / ml, CEC - 35 units, AAT to BM LuM 01-230 - (-16%), AAT to CB LuS 06-300 - (- 13%), AAT to the Central Bank LuS 06-80 - 4.34%.

Assessed the risk of death:

Mortality function = -0.9005 × 2.23 + 0.0685 × 13.65 + 0.1673 × 35-0.0273 × (-16) + 0.222 × 2-0.0861 × (-13) + 4.8204 × 4.34 + 0.5492 × 12.6 + 0.5257 × 4 + 0.0468 × 16- 0.0678 × 2-0.7921 × 6.8 + 0.069 × 36 + 0.0524 × 21-2.9582 × 3-38.9283 = -12.27.

Mortality function less than zero, extremely low risk of death.

The patient was prescribed antibacterial, detoxification therapy, correction of concomitant diseases.

Against the background of the therapy, a positive dynamics on the left on the roentgenogram is a decrease in the number of infiltrative shadows, preservation of their insignificant amount. With repeated ultrasound, S 9 infiltration of the left lung is maintained. The dynamics of pneumonia.

In a clinical blood test, leukocytosis decreased to 11.1 × 10 * 9 / μl, ESR to 21 mm / h. After 2 weeks from the start of inpatient treatment, the patient was discharged with recovery.

Subsequently, an X-ray in the lungs without infiltrative changes preserves the reinforced pulmonary pattern S9-10 due to focal pneumosclerosis.

With repeated ultrasound, interstitial changes in the lower lobe on the left are residual pneumonia in the basal parts on the left. Plots of pneumosclerosis in both lungs. No infiltrative changes were detected.

In the clinical blood test, the number of leukocytes was normalized to 5.8 × 10 * 9 / μl, ESR decreased to 21 mm / h.

The patient was discharged with recovery after 12 days from the start of inpatient treatment.

Example 2

A patient, 87 years old, (IB No. 18376), was admitted to the hospital with complaints of weakness, sweating, coughing with a small amount of yellow sputum, fever up to 39 ° C, shortness of breath on exertion.

According to the patient, a runny nose, sore throat, an increase in body temperature up to 37.3 ° C, then a few days later 38 ° C appeared over the past 2 weeks. 3 days ago a cough appeared with a small amount of yellow sputum. He took aspirin, did not receive antibacterial therapy. The last 2 days, body temperature increased to 39 ° C, called the ambulance team, hospitalized.

From a life story: Smokes for more than 30 years, 1 pack per day. Concomitant diseases: Hypertension. COPD Chronic gastritis.

On examination in the department: an objective state of moderate severity. Body temperature 38 ° C. The skin is hyperemic. Humidity of the skin is increased. No peripheral edema. Enlarged lymph nodes are not detected. Musculoskeletal system without visible pathology. Free breathing through the nose. The number of breaths is 25 per minute. The rhythm is correct. Percussion sound with a box-like shade. In the lungs, auscultation of breathing is weakened in the lower parts of the right, single moist fine bubbling rales in the lower lobe to the right are heard.

The area of the heart is not visually changed. Heart sounds are muffled. The rhythm is correct. Noises are not detected. Heart rate 100 per minute. HELL 130/80 mm RT. Art. Pulse on peripheral arteries of satisfactory performance. The tongue is clean, moist. The abdomen is of normal shape, soft, painless. Liver at the costal margin. The spleen is not palpable. The chair is normal. The symptom of lumbar effusion is negative on both sides. Urination is free, painless, not frequent. Consciousness is clear. The patient is contactable, adequate in behavior. Oriented in place, time, self. Vision saved. Coordination tests are satisfactory.

On the radiograph on the right in the lower lobe, there is a thickening of the pulmonary pattern of a pneumonic nature. The pulmonary pattern is diffusely enriched, mainly in the basal departments, deformed due to pneumosclerosis. The roots of the lungs are compacted, heavy, not expanded, their structure is preserved. The diaphragm is usually located. Sinuses are traceable. The shadow of the heart is expanded to the left. The aorta is sealed. Pleuro-diaphragmatic commissures on the right. Conclusion: Pneumonia in the lower lobe on the right. Emphysema. Diffuse pneumosclerosis.

During ultrasound of the lungs and pleural cavities: During ultrasound scanning in S9 of the right lung, the area of infiltration is determined. The sinuses are free. The mobility of the pulmonary region is preserved. In the right lung, infiltrative and focal changes were not detected. The sinuses are free, the mobility of the pulmonary margin is sufficient. Over the entire surface of the lungs, areas of pneumosclerosis are determined.

Ultrasound picture of pneumonia in S9 of the right lung, diffuse pneumosclerosis.

On the ECG: Rhythm - Sinus. EOS deviation to the left. Focal pathology was not detected.

During ECHO-KG: LV myocardial hypertrophy. PV = 67.4%.

Pulse oximetry indicators - heart rate - 76 per min. SpО2 - 96%, which is normal and, given shortness of breath 22 min, the degree of respiratory failure is -1.

Laboratory indicators: White blood cells - 14.7 × 10 * 9 / μl, ESR - 32 mm / h, in the biochemical analysis of blood a slight increase in urea to 8.4 mmol / L, creatinine is normal, protein in the urine was not detected.

The patient was diagnosed with moderate COPD, with the organization of community-acquired pneumonia in S9 of the lower lobe on the right, of moderate severity. Complications of the main: DN-I. Concomitant diseases: Hypertension 2 degrees, 2 stages, risk 2. Chronic gastritis.

A study of the immune status was carried out and the following indicators of the organ-specific component were revealed: IgM - 1.56 mg / ml, IgG - 16.5 mg / ml, CEC - 67 units, AAT for BM LuM 01-230 - 40%, AAT for CB LuS 06-300 - 18, AAT to the Central Bank LuS 06-80 - 23%.

Assessed the risk of death:

Mortality function = -0.9005 × 1.56 + 0.0685 × 16.5 + 0.1673 × 67-0.0273 × 40 + 0.222 × 18-0.0861 × 23 + 4.8204 × 4.97 + 0.5492 × 14.7 + 0.5257 × 3 + 0.0468 × 6.7-0.0678 × 3.3-0.7921 × 4.5 + 0.069 × 32 + 0.0524 × 22-2.9582 × 4-38.9283 = -5.4.

Mortality function less than zero, low risk of death.

The patient was prescribed advanced antibacterial, detoxification therapy, correction of concomitant diseases.

Against the background of the therapy on the radiograph, the pulmonary fields are transparent, emphysematous. The pulmonary pattern is diffusely strengthened, deformed due to pneumosclerosis. With repeated ultrasound, infiltrative and focal changes were not detected. The sinuses are free. The mobility of the pulmonary margin is preserved on both sides. The sinuses are free. Over the entire surface of the lungs, areas of pneumosclerosis are determined.

In a clinical blood test, first decreased (11.8 × 10 * 9 / μl), then normalized (4.9 × 10 * 9 / μl) the number of leukocytes. ESR 15 mm / h. In the biochemical analysis of blood, the level of urea returned to normal.

The patient was discharged with recovery after 2 weeks from the start of inpatient treatment.

Example 3

Patient, 100 years old, (IS No. 18361). Upon admission to the clinic did not show complaints due to weakness and a decrease in mnestic-intellectual function.

The anamnesis is collected from the words of relatives. Deterioration during the week: there was a weakness, the patient refused to eat, periodically disturbed by a cough with sputum that was difficult to separate. Last days episodes of impaired consciousness (loss of orientation in the place and self). Relatives called the SMP team. The patient was hospitalized in ICU due to unstable hemodynamics (periodically occurring hypotension - 90/50 mm Hg, tachyarrhythmia - up to 150-170 beats per minute). Leukocytosis 30.8 × 10 * 9 / μl, low-grade body temperature. Against the background of the therapy, the hemodynamics stabilized (blood pressure - 110/60 mm Hg. Art., Heart rate - 88 per min), leukocytosis decreased to 15 × 10 * 9 / μl, and body temperature returned to normal. The patient was transferred to the general therapy department.

From a life story: Does not have disabilities, the fact of smoking and occupational hazards denies. A few years ago - a fracture of the lower third of the left thigh with osteomyelitis ?, about which was repeatedly operated. Concomitant diseases: COPD, IHD: a persistent form of atrial fibrillation. Hypertonic disease. Calcification AK and MK. AR III degree. CHF III FC. DEP.

When viewed in the therapeutic department: an objective state of moderate severity. Body temperature 36.7 ° C. The skin is pale. Humidity of the skin is normal. To the left in the frontotemporal region is a hematoma and abrasion with a diameter of about 6 cm. Pastosity of the legs, feet. No enlarged lymph nodes. Free breathing through the nose. The number of breaths in 22 minutes The rhythm is correct. Percussion sound with a boxy tint, dulling in n / a on both sides. In the lungs, auscultation of breathing is weakened n / a on both sides, on the left in the n / a moist small rales are heard in a small amount. The area of the heart is not visually changed. Heart sounds are muffled. The rhythm is wrong. Noises are not detected. Heart rate 90 per minute. HELL 130/80 mm RT. Art. Pulse on peripheral arteries of satisfactory performance. The tongue is clean, moist. The abdomen is of normal shape, soft, painless. Liver at the costal margin. The spleen is not palpable. The chair is normal. The symptom of lumbar effusion is negative on both sides. Urination is free, painless, not frequent. Consciousness is clear. Sick contact - responds to his own name. Oriented in place, time, self. Vision is reduced. The memory is down. Meningeal symptoms are absent.

On the radiograph: in the projection of the right pulmonary field infiltrative shadows. The pulmonary fields on the left are transparent, emphysematous. The pulmonary pattern is diffusely enriched, deformed due to pneumosclerosis. The shadow of the heart is expanded to the left. Conclusion: Pneumonia in the lower lobe on the right.

When conducting ultrasound of the lungs and pleural cavities: in S8 of the right lung, an infiltration site of 2 cm in length is visualized. There is no fluid in the pleural cavities. The mobility of the pulmonary margin is sharply limited on both sides. Ultrasound picture of pneumonia S8 of the right lung.

On the ECG: Rhythm - atrial fibrillation. EOS deviation to the left. BPNPG.

When conducting ECHO-KG: Calcification of the valves AK and MK, aortic and mitral regurgitation of 3 and 2 degrees, respectively. PV = 69%

Pulse oximetry indicators - heart rate - 114. SpO2 - 98%, which corresponds to the norm.

Laboratory indicators: White blood cells - 15 × 10 * 9 / μl, ESR - 40 mm / h, in the biochemical analysis of blood - an increase in the level of urea to 22.7 mmol / L, creatinine - up to 163 μmol / L, the level of bilirubin - 30.3 μmol / l, protein in the urine - 0.3 g / l.

The patient was diagnosed with COPD, moderate, with the organization of community-acquired pneumonia in the lower lobe on the right, severe course. Complications of the main diagnosis: DN-I. Concomitant diseases: CHD: a persistent form of atrial fibrillation. Hypertension 2 stages, 2 degrees, risk 4. Hypertensive heart. Calcification AK and MK. AR III degree. CHF III FC. DEP 3 degrees with cognitive impairment. Senile osteoporosis. Bruised frontotemporal area on the left.

The patient underwent antibacterial, detoxification therapy, correction of concomitant potology.

A study of the immune status was carried out and the following indicators of the organ-specific component were revealed: IgM -? IgG -? / Ml, CEC - 35 units, AAT to LuS 06-300 CB - (-16%), AAT to LuS 06-300 - (- 13%), AAT to LuS 06-80 - 4, 34%

Assessed the risk of death:

Mortality function = -0.9005 × 1.2 + 0.0685 × 7.05 + 0.1673 × 69-0.0273 × (-8) + 0.222 × (-6) -0.0861 × 3 + 4.8204 × 4.5 + 0.5492 × 30.9 + 0.5257 × 21 + 0.0468 × 4- 0.0678 × 1-0.7921 × 7.1 + 0.069 × 19 + 0.0524 × 21-2.9582 × 3-38.9283 = 8.38.

Mortality function greater than zero, high risk of death.

Despite the extended therapy, a week later the patient's condition worsened, weakness intensified, episodes of impaired consciousness appeared, refused to eat, body temperature increased to 37.6 ° C, a decrease in blood pressure to 90-100 / 60 mm Hg was noted. Art. On the roentgenogram - negative dynamics; in addition to infiltrative shadows on the right, there was an infiltration in the basal and basal parts on the left. Conclusion: bilateral lower lobar pneumonia. With repeated ultrasound, the infiltration site S8 was preserved on the right, the infiltration sites S10.9 of the left lung were visualized. Ultrasound picture of bilateral pneumonia in the lower lobes. In the clinical analysis of blood, no deterioration was observed: the number of leukocytes -11.5 × 10 * 9 / μl, ESR 32 mm / h. In the biochemical analysis of blood, elevated levels of urea (23 mmol / L), creatinine (167 μmol / L) and total bilirubin (30 μmol / L) remained. Oxygen saturation remained within the normal range (98%).

The patient died a day later with an increase in the effects of intoxication and multiple organ failure.

Example 4

Patient, 87 years old, (IS No. 3095). Upon admission to the clinic, she did not complain because of the severity of the condition and chronic cerebrovascular disease (HCV).

Anamnesis: Anamnesis is difficult to collect due to the severity of the condition and HCV. According to relatives, the last few days there was an increase in body temperature to 39 ° C, dry cough bothered. The patient refused to eat. The ambulance team was hospitalized in a hospital.

From the history of life: Disabled person 1 group. According to relatives, suffers from chronic cerebral ischemia.

When viewed in the therapeutic department: the objective condition is serious, in the mind, contact is not available. Body temperature 35.0 ° C. The skin is pale, acrocyanosis. Humidity of the skin is increased. No peripheral edema. There are no enlarged lymph nodes. Musculoskeletal system - scoliosis of the thoracic spine. The number of breaths 26 per min. The rhythm is correct. Percussion sound - dullness in the lower sections. In the lungs, auscultation breathing is carried out in all departments, weakened on the right, on the left above the whole surface, rales of various sizes. The area of the heart is not visually changed. Heart sounds are muffled. The rhythm is wrong. Noises are not detected. Heart rate 102 per minute. HELL 90/60 mm RT. Art. Pulse on peripheral arteries of satisfactory performance. The tongue is clean, moist. The abdomen is of normal shape, soft, painless. Peristalsis is not heard. Liver at the costal margin. The spleen is not palpable. The symptom of lumbar effusion is negative on both sides. Catheter urination. In the mind, not contact. Vision is reduced. Coordination tests are not performed.

On the radiograph:

Infiltrative changes in the lower lobe of the left lung, infiltration of the lower lobe of the right lung. Emphysema. Diffuse pneumosclerosis.

During ultrasound of the lungs and pleural cavities: During ultrasound scanning, infiltration of the lower lobe of the right lung is visualized. Foci of infiltration in the lower lobe of the left lung S8 1-2 cm long. Lower lobe right-sided pneumonia. Focal pneumonia S8 of the left lung. Cyst of the right kidney.

On the ECG: Rhythm - atrial fibrillation. EOS deviation to the left.

Pulse oximetry indicators - heart rate - 100 per min. SpO2 - 86%, which is below normal and given shortness of breath 26 min corresponds to respiratory failure of 2 degrees.

Laboratory indicators: White blood cells - 13.7 × 10 * 9 / μl, ESR - 34 mm / h. In the biochemical analysis of blood - a slight increase in the level of urea up to 13.2 mmol / L, creatinine - up to 118 μmol / L, protein in the urine - 3 g / L.

The patient was diagnosed with community-acquired, bilateral, lower-lobe pneumonia of severe course. Complications of the main: DN II Art. Concomitant diseases: Condition after stroke. Chronic cerebral ischemia.

A study of the immune status was carried out and the following indicators of the organ-specific component were revealed: IgM - 1.7 mg / ml, IgG - 25 mg / ml, CEC - 54 units, AAT for BM LuM 01-230 - 23%, AAT for CB LuS 06- 300 - 12%, AAT to the Central Bank LuS 06-80 - 4.15%.

Assessed the risk of death:

Mortality function = -0.9005 × 1.7 + 0.0685 × 25 + 0.1673 × 54-0.0273 × 23 + 0.222 × 35-0.0861 × 12 + 4.8204 × 4.15 + 0.5492 × 13.7 + 0.5257 × 1 + 0.0468 × 5.6-0.0678 × 0.3-0.7921 × 4.7 + 0.069 × 34 + 0.0524 × 27-2.9582 × 0-38.9283 = 4.73

Mortality function greater than zero, high risk of death.

The patient underwent antibacterial, detoxification therapy, correction of concomitant pathology.

However, despite the ongoing therapy, after 3 days the patient's condition worsened, weakness intensified, the patient became disoriented in the place and her own personality, refused to eat. A decrease in blood pressure to 80-90 / 50 mm Hg was noted. Art., BH increased to 28 per min. On the roentgenogram - negative dynamics - increased infiltration in the lower lobe of the left lung. With repeated ultrasound, infiltration in S 9-10 of the left lung is visualized, in the right lung, infiltration is in the same volume. Negative dynamics in the lower lobe on the left. In a clinical blood test, the number of leukocytes increased to 15.5 × 10 * 9 / μl, ESR to 37 mm / h. In the biochemical analysis of blood, an elevated level of urea (214 mmol / L) and creatinine (120 μmol / L) remained. Oxygen saturation dropped to 80%.

The patient died after 12 hours with an increase in the effects of intoxication and respiratory failure.

Information sources

1. Kosyakov P.N. Isoantigens and Isoantibodies of Man in the Norm and Pathology. 1974, Moscow: Meditsina. p.360.

2. Marras, T.K., C. Gutierrez, and C.K. Chan, Applying a prediction rule to identify low-risk patients with community-acquired pneumonia. Chest, 2000.118 (5): p. 1339-43.

3. Aydogdu, M., et al., Mortality prediction in community-acquired pneumonia requiring mechanical ventilation; values of pneumonia and intensive care unit severity scores. Tuberk Toraks, 2010.58 (1): p.25-34.

4. Poletaev A.B. Physiological immunology (natural autoantibodies and problems of nanomedicine). - Moscow: MIKLOSH. - 2010.

5. Skurydin S. V., Shirokhova N. M., Karabinenko A. A., Kupriyanov A. N., Clinical and diagnostic value of studying the content of pulmotropic autoantibodies in a model of community-acquired pneumonia in elderly and senile patients. \\ Russian immunological journal. - Volume 4 (13), No. 1. - 2010 .-- S.60-67.

6. Kostina S.A. Assessment of the severity and poor prognosis of community-acquired pneumonia in hospitalized patients. Abstract, Moscow, 2007.

Claims (1)

A method for predicting death in patients with community-acquired pneumonia by identifying and evaluating hematological, biochemical and clinical parameters, characterized in that the patient's immune status is examined, organ-specific lung tissue components are detected, and indicators for mortality risk are taken into account: IgM [mg / ml], IgG [mg / ml], CEC units, AAT to BM LuM 01-230 [% of individual immunoreactivity], AAT to CB LuS 06-300 [% of individual immunoreactivity], AAT to CB LuS 06-80 [% of individual immunoreactivity ], erythro tsitov [10 ⁶ / l], leukocytes [10 ⁹ / l], band neutrophils [%], lymphocytes [%], monocytes [%], glucose [mmol / l], ACT [u / l], respiratory rate [movements / min], coughing [ranks], then find the mortality function value according to the formula:
mortality function = (- 0.9005) IgM + 0.0685 IgG + 0.1673 CIK-0.0273 AAT for BM LuM 01-230 + 0.222 AAT for CB LuS 06-300-0.0861 AAT for CB LuS 06-80 + 4.8204 · erythrocytes + 0.5492 · leukocytes + 0.5257 · stab neutrophils + 0.0468 · lymphocytes - 0.0678 · monocytes - 0.7921 · glucose + 0.069 · AST + 0 0524 · respiratory rate - 2.9582 · cough - 38.9283, while cough is estimated as follows: 0 points - no cough; 1 point - mild dry or wet, the patient notes coughing only when questioned; 2 points - moderate dry; 3 points - moderate moist with discharge of sputum mucosa; 4 points - moderate moist with discharge of purulent sputum; 5 points - pronounced dry, paroxysmal; 6 points - pronounced wet with discharge of light sputum; 7 points - expressed wet with the discharge of purulent sputum, while if the function turned out to be more than zero, then make a prediction of a fatal outcome, if less than zero - the forecast of convalescence.