Severe community-acquired pneumonia in adults. Clinical recommendations from Russian Federation of Anaesthesiologists and Reanimatologists

Avdeev, S. N.; Белобородов, В Б; Belotserkovskiy, B.Z.; Грицан, А.И.; Дехнич, А В; Zaytsev, A. A.; Kirov, Mikhail Y.; Kozlov, Roman; Kuzkov, Vsevolod V.; Protsenko, D.N.; Rachina, Svetlana; Синопальников, А. И.; Yakovlev, S V; Yaroshetskiy, Andrey I.

doi:10.17116/anaesthesiology20220116

Cited by 16 publications

(1 citation statement)

References 265 publications

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“…Патогенез развития ССО у пациентов с ХСН и пневмонией обусловлен системной воспалительной реакцией, повреждением эндотелия и развитием протромботической активности. Поскольку ССО чаще возникают после тяжелого течения инфекции, можно полагать, что вирулентность возбудителя и иммунный ответ вносят определенный вклад в их развитие [5].…”

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Predictors of cardiovascular events in patients with heart failure and <i>Pseudomonas aeruginosa</i> pneumonia

Podzolkov,

Tarzimanova,

Ponomareva

et al. 2024

Russ J Cardiol

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Aim. To identify predictors of cardiovascular events (CVEs) in patients with heart failure (HF) and P. aeruginosa pneumonia.Material and methods. The study included 92 patients with HF with mildly reduced or reduced ejection fraction and nosocomial pneumonia. Based on sputum or bronchoalveolar lavage microbiological examination, patients were divided into 2 following groups: group I — 51 patients with HF and P. aeruginosa pneumonia, group II — 41 patients with HF and pneumonia caused by other pathogens (Staphylococcus aureus, Streptococcus pneumoniae). During the hospital stay, the following morbidities were assessed: cardiovascular death, acute coronary syndrome, non-fatal cerebrovascular accident, pulmonary embolism, lower extremity venous thrombosis.Results. CVEs were significantly more often observed in patients with HF and P. aeruginosa pneumonia — 30 (58,8%) than in patients with HF and pneumonia caused by S. aureus or S. pneumoniae — 5 (12,1%). Complete blood count in group I patients revealed a decrease in hemoglobin level to 114 [95; 133] g/l, when compared with patients in group II — 139 [118; 150] g/l (p<0,001) and an increase in white blood cell count (10,2×109/l and 6,96×109/l, respectively (p<0,001)). A biochemical blood test in group I patients revealed a significant increase in C-reactive protein (CRP) of 105 [60; 191] and 18 [14; 55,1] mg/l (p<0,001). Patients with P. aeruginosa pneumonia had more widespread lung involvement than patients with pneumonia of other etiologies.Conclusion. There are following most significant predictors of cardiovascular events in patients with HF and P. aeruginosa pneumonia: decreased LVEF <40% (relative risk (RR) 1,833; 95% confidence interval (CI) 1,188-3,400; p=0,005), white blood cell count >11×109/l (RR 2,412; 95% CI 1,399-4,158; p=0,048), CRP >133 mg/l (RR 3,115; 95% CI 1,611-6,025; p<0,001) and hypoproteinemia <57 g/l (RR 5,225; 95% CI 1,249-21,854; p=0,012).

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Section: ключевые моменты Key Messagesunclassified

Predictors of cardiovascular events in patients with heart failure and <i>Pseudomonas aeruginosa</i> pneumonia

Podzolkov,

Tarzimanova,

Ponomareva

et al. 2024

Russ J Cardiol

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Relationship Between Sepsis Phenotypes and Treatment Characteristics of Patients with Viral and Bacterial Pneumonia

Ruslyakova,

Shamsutdinova,

Gaikovaya

2024

Obŝaâ reanimatologiâ

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New subgroups of patients with severe community-acquired pneumonia (SCAP) are hardly predicted by the use of clinical covariates; clusterization may signiﬁcantly improve diagnostic approaches and facilitate the adaptation of speciﬁc treatment modalities to patient’s individual characteristics.The aim of the study. To identify linking the sepsis phenotype in patients with SCAP and preferable treatment option to forecasting the outcome and improve treatment results.Materials and methods. Case histories of 664 of intensive care unit (ICU) patients with sepsis (2016–2023) from I. I. Mechnikov Northwestern State Medical University were analyzed. The study included 568 (85.5%) patients with viral SCAP (SCAPv group) and 96 (14.5%) patients with bacterial SCAP (SCAPb group). Sepsis phenotypes were identiﬁed using algorithm proposed by Seymour C.W. et al. In SCAP cases associated with COVID-19 infection (n=293, 51.6%) patients received genetically engineered biological therapy (GIBT). The study compared two cohorts of patients: those who received GIBT and did not receive GIBT. Data were statistically processed using the Statistica 10.0 and SPSS software packages.Results. Analysis revealed 4 sepsis phenotypes: α- (N=323, 48.6%); β- (N=128, 19.3%); γ- (N=87, 13.1%); δ - (N=126, 19%). The majority of SCAPv group patients — 295 (51.9%) — had α-phenotype of sepsis, while δ -phenotype prevailed in the SCAPb group — 53 (55.2%). The proportion of patients receiving GIBT and exhibiting α- sepsis phenotype dominated over other sepsis phenotypes: 61.8% of patientspossesed α- phenotype, whereas β-, γ- and δ -phenotypes were determined in 16% , 12.6%, and 9.6% of GIBT patients, respectivelty (P<0.05). The best eﬀect of using monoclonal antibodies to interleukin-6 receptors as a GIBT was obtained in patients with the α-phenotype sepsis and COVID-19-associated SCAP: 87.5% favorable outcomes, P=0.0419. Rate of bacterial sepsis was signiﬁcantly lower in patients with α- and δ -phenotypes of sepsis receiving GIBT vs those who did not receive this therapy: 12.71% vs 23.2% of patients with α-phenotype, P=0.0131; 25.0% vs 70.41% of patients with δ -phenotype, P=0.0254, respectively.Conclusion. Diﬀerences in sepsis phenotype between patients with viral or bacterial SCAP may stratify patients for diﬀerent therapeutic management and more accurately predict potential complications and unfavorable outcome.

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Диагностика синдрома активации макрофагов в зависимости от исходного уровня IL-6 у пациентов с новой коронавирусной инфекцией, вызванной вирусом SARS-CoV-2

Popov

Маркелова

Комарова

et al. 2022

Russian Journal of Infection and Immunity

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The effect of the antiviral drug Kagocel on the levels of metalloproteinases MMP-8 and MMP-9 and their tissue inhibitors TIMP-1 and TIMP-2 in induced sputum in the treatment of community-acquired viral-bacterial pneumonia was analyzed. 60 adult patients with a confirmed diagnosis of community-acquired pneumonia and viral-bacterial etiology were included in the follow-up research work. Materials and methods. All patients were randomly divided into 2 groups: 1 group (comparison group) included 30 patients receiving Ceftriaxone monotherapy; in the 2nd group (main) - 30 people who were prescribed Ceftriaxone and the antiviral drug Kagocel as etiotropic treatment. Both groups were comparable in terms of gender, age and time of admission to the hospital. Results. During hospitalization, patients in both groups had elevated levels of MMP-8, MMP-9, TIMP-1 and TIMP-2 in induced sputum compared to the reference values. By 7 days of inpatient treatment, the level of MMP-8 continued to be significantly higher than the reference values in both groups, and in patients of the 2nd group there was a decrease compared to baseline values, and in patients in the 1st group at the same time. The activity of MMP-9 during hospitalization was also high in patients of both groups compared with the level of these enzymes in healthy people. By the 7th day of therapy various indicators' changes were recorded. The level of MMP-9 in patients of the 1st group increased, and in patients of the 2nd group - on the contrary - decreased. The level of TIMP-1 decreased in patients of the 1st group below the control value, and in patients of the 2nd group - reached the reference values. The level of TIMP-2 decreased in both groups and reached the level of control values. Conclusion. Inclusion in the standard antibacterial regimen of community-acquired viral-bacterial pneumonia of the antiviral drug Kagocel reduces the level of MMR-9 and reduces the severity of the imbalance in the MMP and TIMP system by 7 days of therapy, which leads to a faster clinical recovery of patients.

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Severe community-acquired pneumonia in adults. Clinical recommendations from Russian Federation of Anaesthesiologists and Reanimatologists

Cited by 16 publications

References 265 publications

Predictors of cardiovascular events in patients with heart failure and <i>Pseudomonas aeruginosa</i> pneumonia

Predictors of cardiovascular events in patients with heart failure and <i>Pseudomonas aeruginosa</i> pneumonia

Relationship Between Sepsis Phenotypes and Treatment Characteristics of Patients with Viral and Bacterial Pneumonia

Диагностика синдрома активации макрофагов в зависимости от исходного уровня IL-6 у пациентов с новой коронавирусной инфекцией, вызванной вирусом SARS-CoV-2

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