Method for predicting pneumonia complications occurrence

FIELD: medicine.

SUBSTANCE: method involves asking questions, evaluating five anamnesis parameters in 5-level scale with following calculation of pneumonia complications occurrence probability from equation of POP = 0.27+0.06xX1+0.05xX2+0.019xX3+0.021xX4+0.02xX5, where POP is the pneumonia complications occurrence probability; 0.27 is the free term; X1 is the time from disease manifestation to asking for medical care in points: 1 point - asking for medical care during the first hours of disease; 2 points - during the first 8 h; 3 points - during the first 8-12 h; 4 points - during the first 12-24 h; 5 points - longer than 1 day after the disease occurrence; X2 is the smoking time in points: 1 point - no smoking takes place; 2 points - smoking during 3 years; 3 points - 4-8 years; 4 points - 9-12 years; 5 points - longer than 12 years;. X3 is the time spent in hospital and acute respiratory virus infections in points: 1 point - no hospital in anamnesis; 2 points - hospitalization not related to bronchopulmonary diseases; 3 points - acute respiratory virus infections frequency is greater than 4 times a year; 4 points - frequently occurred bronchopulmonary diseases; 5 points - pneumonia or bronchitis occurred during the last year; X4 is the available chronic foci of respiratory virus infection in upper air passages, oral cavity, herpetic infection in points: 1 point - no chronic foci available; 2 points - chronic diseases of respiratory virus infection in upper air passages, oral cavity, herpetic infection w remission period longer than 1 year; 3 points - remission period is 6 months long; 4 points - exacerbation during the last 3 months available; 5 points - exacerbation available in current time; X5 is the concomitant diseases in points: 1 point - no concomitant diseases available; 2 points - concomitant bile duct dyskinesia, chronic gastritis, duodenitis, dysmetabolic nephropathy, urolithiasis; 3 points - chronic cholecystitis, pyelonephritis, prostatitis, adnexitis, cardiac ischemia disease, essential hypertension, helminthiasis; 4 points - chronic hepatitis, glomerulonephritis, myocardial dystrophy, lymphoadenopathy, tuberculosis infection; 5 points - mycotic lesions on skin and mucous membrane, acute respiratory virus infections, chronic concomitant diseases exacerbation at examination period. The POP value being <0.97 low risk is predicted; from 0.98 to 1.31 moderate risk degree; POP>1.32 - high risk of complications development.

EFFECT: high accuracy of diagnosis.

2 tbl

 

The invention relates to medicine, namely to pulmonology.

Pneumonia (P) remains one of the most widespread infectious diseases of man with a serious prognosis [1, 6]. Now P is considered as a state with certain systemic manifestations that translates local inflammatory lesion of the lung tissue into the category of infectious diseases. According to the statistics, about 26% of patients with pneumonia admitted to the intensive care unit, die from complications such as septic shock and acute respiratory distress syndrome [8]. Complicated pneumonia was observed in nearly half of all cases, while it is customary to divide the complications of pulmonary and extrapulmonary. To include pulmonary acute respiratory failure (ARF), respiratory distress syndrome, parapneumonic effusion, empyema, lung abscess; extrapulmonary - metastatic infection, phlebitis, sepsis, toxic or infectious shock, a syndrome of multiple organ failure (myocarditis, pericarditis, endocarditis, hepatitis, nephritis) [5]. The main reasons for the complicated course, in the opinion of some authors, are late hospitalization of patients, the underestimation of the risk of complications to the patient that entails delayed launch of the inadequacy of intensive care, ventilation support - all this contributes not only to a longer stay of patients in hospital, but also significantly increases the cost of treatment of patients [3, 4, 7]. Therefore an adequate assessment of the patient, timely prediction of complications of the disease acquires in this situation is of the utmost importance.

As of similar used one of the most common scales to assess the severity of pneumonia in clinical practice - 2-step scale proposed by M. Fine in 1997 [10]. At the first stage identify patients with a very low mortality rate: age younger than 50 years, the absence of comorbidities and organ disorders. The second stage consists of calculating scores using data on the age, concomitant diseases and organ disorders, epidemiological, laboratory, gasometrical and x-ray examinations performed stratification of patients into risk classes possible fatal outcome of pneumonia. Counting systems on this scale is available online (http: // ncemi.org, www.emedhomom.com).

The disadvantages of this method: determined by the risk of death P; for the implementation of the forecast requires drawing blood from the patient and gasometrical study. To determine the parameters is possible only in a specialized medical institution, a forecasting is necessary as the presence of a feature at the current level of laboratory services and the time waiting for the result.

In our invention, unlike the prototype for 15 minutes estimated 5 parameters history with consequent calculation of the predictive probability of complications in the multiple regression equation and determination of the degree of risk of complications, which allows early to predict the development of complications and to determine an appropriate strategy of further management of the patient with pneumonia.

The purpose of the invention: forecast risk of complications in a patient with community-acquired pneumonia (RR) using informative non-invasive parameters of history to determine further tactics of treatment of the patient.

This goal is achieved by asking the patient with pneumonia, evaluating each of the 5 parameters of history in points, calculation on the developed equation probabilistic risk of complications (VRO) and the risk of complications.

Surveyed 457 patients. In the initial examination of the patient EAP specified data of the anamnesis of life. With the help of factor analysis were selected most significant informative signs: of the 11 parameters were chosen 5 (where k is the load index ≥0,75) [9]. It was further held the ranking data for the development of the TES 5-point scale, each parameter was qualitatively rated on the importance of influence on the development of complications of pneumonia: 1 - no effect 2 - little effect, 3 - moderate, 4 - significant impact, 5 - strong influence.

Then using regression analysis to determine the impact of factor settings on the development of complications in a patient P, was derived prognostic equation of the probability of complications of pneumonia [2]:

VRO=0,27+0,06×X1+0,05×x2+0,019×X3+0,021×X4+0,02×X5, where

VRO - predictive probability of complications of pneumonia;

0,27 - free member;

X1-X5 - studied parameters of the patient in points. X1 - the time from the onset of illness before seeking care in points: 1 point - contacting the patient's care in the first hours of the disease; 2 points in the first 8 hours; 3 credits for 8-12 hours; 4 units in 12-24 hours; 5 credits - more days of onset;

X2 - the experience of Smoking in points: 1 point - no Smoking history; 2 points - experience area up to 3 years; 3 credits 4-8 years; 4 points - 9-12 years; 5 points - more than 12 years;

X3 is the frequency of hospitalizations and acute respiratory viral infections (ARVI) in points: 1 point - no hospitalizations in history; 2 points for history of hospitalization for diseases not bronchopulmonary system; 3 credits ARVI more than 4 times a year; 4 points - neo is mocratie diseases of the bronchopulmonary system in history; 5 points - moved pneumonia, bronchitis in the past year;

X4 - the presence of chronic foci of infection of the upper respiratory tract (TTP), oral herpes infection in points: 1 point - the absence of chronic foci of infection SDT, oral herpes infection; 2 points - chronic diseases of the SDT, oral herpes infection with remission for more than 1 year; 3 credits remission of disease - 6 months; 4 points - exacerbation within the last 3 months; 5 points - exacerbation at the time of treatment;

X5 - related diseases in points: 1 point - related diseases are absent; 2 points - related biliary dyskinesia, chronic gastritis, duodenitis, dysmetabolic nephropathy, kidney stones; 3 points - chronic cholecystitis, pyelonephritis, prostatitis, adnexitis, coronary heart disease, hypertension, helminthiasis; 4 points - chronic hepatitis, glomerulonephritis, myocardial, lymphadenopathy, tuboperitoneal; 5 points - fungal skin and mucous membranes, respiratory infection, exacerbation of chronic comorbidities at the time of inspection.

Because the distribution of the aggregate score corresponded to normal, we used the rule of one Sigma and average. If the value of VRO<097, it is, in our opinion, indicates a low risk of complications; from 0.98 to 1.31 - moderate risk; value VRO exceeding 1.32 to about high risk of complications.

So, we have developed the method is as follows. In the initial examination of the patient survey. With the appropriate clinical picture characteristic of pneumonia, revealed the following data: patient smokes or not; the experience of Smoking in years; the episodes and severity of respiratory diseases during the previous disease, presence of comorbidities (for example, lymphoadenopathy, tuboperitoneal, fungal skin and mucous membranes, coronary heart disease, hypertension, myocardial, chronic gastritis, duodenitis, hepatitis, cholecystitis, pyelonephritis, glomerulonephritis, prostate, adnexitis, dysmetabolic nephropathy, kidney stones, biliary dyskinesia, helminthiasis, ARI), the presence and frequency of exacerbations of chronic foci of infection var (for example, chronic sinusitis, ethmoiditis, tonsillitis, pharyngitis, otitis, polypose), oral cavity (stomatitis, tooth decay), herpes infection. Next on the table for each of the 5 options is determined by the corresponding score, which is then entered in the prognostic equation of veroia the activity of complications (VRO) and counts, and then according to the scheme shown in the drawing, assessment of results: if the value of VRO <0,97, forecast low of 0.98 to 1.31 - moderate >1.32 to - high risk of developing complications P.

Example 1: the Patient, 20 years of age was admitted to the hospital research Institute MCVL 20.01.05 year. Upon receipt complained of productive cough with the Department of Muco-purulent sputum, pain in the right half of the chest, aggravated by coughing and deep breathing, shortness of breath on mild exertion, body temperature rise up to 38°C, General weakness, headache. From medical history: acutely ill 3 days ago (have a runny nose, headache, muscle pain, increased body temperature to 38.5° (C)associates the disease with hypothermia. Immediately sought medical assistance, diagnosis: ARI, received symptomatic treatment on an outpatient basis. The day before hospitalization felt deterioration joined the above complaints (at the time of inspection antibacterially drugs are not accepted). From the anamnesis of life: growing and developing according to age. Ari is sick 2 times a year. Has the disease: chronic tonsillitis (last exacerbation 2 months ago, outpatient treatment). Six months ago she was hospitalized for acute bronchitis. Smokes 1/2 pack of cigarettes in ECENA 5 years. Alcohol takes 1 time per month. At objective inspection: a state of moderate severity. Pale skin, wet clean. Height - 176 cm, weight - 65 kg Percutere: marked shortening of lung sound over the lower lobes on the right, auscultatory - weakened vesicular breathing in the lower lobe on the right, there is crepitus. BH=21 min, HR=85 per minute, AD=105/70 mm Hg On other organs and systems without pathological features. In clinical analysis of blood leukocytes 23,2·109g/l, p-I - 7, I - 63, ESR 25 mm/h In the biochemical analysis of blood - sugar 4.1 mmol/l, urea - 7.8 mmol/l On the radiograph: the infiltration of lung tissue the mean intensity of the right lower lobe. The patient is diagnosed with Community-acquired pneumonia in the lower lobe of the right lung, mild currents. NAM 1 tbsp.

When evaluating the most frequently used by doctors scale Fine amount of balls in a given patient was 30 (i.e. less than 70), which corresponds to class II mortality risk (low level) and the patient is to be sent for treatment in a therapeutic (treatment) Department of the hospital.

Using the developed method, we forecast the risk of developing complications of the disease, as developed by the authors of the scheme. According to the table defined points corresponding to each indicator (the time from manif the habitats of disease before seeking care in this patient more days which is 5 points; the experience of Smoking 5 years - 3 points; 6 months ago she was hospitalized for acute bronchitis - 5 points; the patient has chronic tonsillitis (last exacerbation 2 months ago) - 4 points; the presence of SARS at the time of inspection - 5 points), substitute the indices of points in the prognostic equation of the probability of complications of pneumonia:

VRO=0,27+(0,06×5+0,05×3+0,019×5+0,021×4+0,02×5)=0.99,and

further, according to the scheme shown in the drawing, the estimated result: the resulting value VRO exceeds 0,98 that, according to our criteria, is forecasting a moderate risk of developing complications of P. in this patient. Thus, the patient should have been sent to the intensive care unit and to obtain adequate supervision and treatment. Retrospective analysis of the medical history revealed the development of complications in a patient, toxic myocarditis, hepatitis, which contributed to the increase in the duration of a patient's hospital for 8 days.

Therefore, the chosen method allows for the treatment of a patient for medical aid in time to predict the risk of complications, thereby to determine an appropriate tactics for reduction of terms of treatment and considerably reduce the financial burden on an individual who CSOs patient.

Table
The ranking data of patients with pneumonia on a five-point rating scale
Significant factorsPoints12345
Time from manifestatie illness before seeking carethe first hoursup to 8 hours8-12 hours12-24 hoursthe more days
Experience areanoup to 3 years4-8 years9-12 yearsmore than 12 years
Hospitalization and acute respiratory viral infections (ARVI)nohospitalization for diseases not bronchopulmonary systemARVI more than 4 times per yearnumerous diseases of the bronchopulmonary system historypneumonia, bronchitis during the preceding disease year
The presence of chronic foci of infection of the upper respiratory tract (TTP), oral herpes infectionnothe absence of exacerbations of chronic diseases of the SDT, mouth, gerp the political infection more than 1 year the absence of exacerbations of chronic diseases of the SDT, oral herpes infection in the past 6 monthsexacerbation of chronic diseases of the SDT, oral herpes infection in the past 3 monthsexacerbation of chronic otitis media, tonsillitis, pharyngitis, sinusitis, ethmoiditis, polypose, herpes infection, dental caries, stomatitis at the time
Comorbiditiesnochronic gastritis, duodenitis, dyskinesia of the biliary tract, dysmetabolic nephropathy, kidney stoneschronic cholecystitis, pyelonephritis, prostatitis, adnexitis, coronary heart disease, hypertension, helminthiasischronic hepatitis, glomerulonephritis, myocardial, lymphadenopathy, tuboperitonealfungal skin and mucous membranes, respiratory infection, exacerbation of chronic comorbidities at the time of inspection

Sources of information

1. Alexanian L.A. risk Factors for fatal outcome of community-acquired pneumonia /Laulainen //Antibiotics and chemotherapy. 2001. No. 1. P.18-21.

2. Borovikov VP of Statistical analysis and data processing in the Windows environment. /Vporoticov, Ippolitov. M: Information and publishing house "the Yichang", 1997. 608 S.

3. Butler LN. Community-acquired pneumonia heavy flow. Modern possibilities of antibacterial therapy /Londorossi //Pulmonology. 2003. No. 3. P.123-127.

4. Dosotojna mortality in hospital in community-acquired pneumonia /Alaverdi, Avenuenew, EIO, Laulainen etc. //Clinical Microbiology and antimicrobial chemotherapy. 2003. V.5. No. 4. S-388.

5. Landyshev Userhost on pulmonology /Userdev, Avensis. Blagoveshchensk: RIO, 2003. 184 C.

6. Novikov VE Pneumonia: a complex and unresolved issues of diagnosis and treatment /Weenicon //Rusmet. Journe. 2004. Vol.12. No. 1. S-1232.

7. Chuchalin A.G. Diagnosis and treatment of pneumonia with positions medicine evidence /Aguchi, Annoy, Row //Consilium Medicum. 2002. No. 12. S-452.

8. Szczerba J.V. Community-acquired pneumonia in the aspect of the global process of the emergence of new and recurrent infections: new etiological, epidemiological, and clinical characteristics, acquisition category system infectious diseases /Uwire, Iphonehow [serial on the Internet] 2004 March [date cited] URL: http://www.infectology.ru/publik/stat49.asp.

9. Cadets V.I. Mathematical-statistical processing of data for medical research /Vigneron, Seggregated. SPb., 2002. 266 C.

10. Fine M. A prediction rule to identify lowrisk patients with community-acquired pneumonia /M.Fine, T.Auble, D.Yealy //N. Engl. Med. 1997. N1. P.336.

The way the forecast again in the development of complications of pneumonia, includes a survey of patient and characterized in that no laboratory tests are evaluated 5 parameters anamnesis on a 5-point scale with the subsequent calculation of the predictive probability of complications of pneumonia by the equation

VRO=0,27+0,06·X1+0,05·x2+0,019·X3+0,021·X4+0,02·X5

where VRO is the predictive probability of complications of pneumonia;

0,27 - free member;

X1 - the time from the onset of illness before seeking care in points: 1 point - contacting the patient's care in the first hours of the disease; 2 points in the first 8 hours; 3 credits for 8-12 hours; 4 units in 12-24 hours; 5 credits - more days of onset;

X2 - the experience of Smoking in points: 1 point - no Smoking history; 2 points - experience area up to 3 years; 3 credits 4-8 years; 4 points - 9-12 years; 5 points - more than 12 years;

X3 is the frequency of hospitalizations and acute respiratory viral infections (ARVI) in points: 1 point - no hospitalizations in history; 2 points for history of hospitalization for diseases not bronchopulmonary system; 3 credits ARVI more than 4 times a year; 4 points - numerous diseases of bronchopulmonary system in history; 5 points - moved pneumonia, bronchitis in the past year;

X4 - the presence of chronic foci of infection upper dyatel who's ways (TTP), oral herpes infection in points: 1 point - the absence of chronic foci of infection SDT, oral herpes infection; 2 points - chronic diseases of the SDT, oral herpes infection with remission for more than 1 year; 3 credits remission of disease - 6 months; 4 points - exacerbation within the last 3 months; 5 points - exacerbation at the time of treatment;

X5 - related diseases in points: 1 point - related diseases are absent; 2 points - related biliary dyskinesia, chronic gastritis, duodenitis, dysmetabolic nephropathy, kidney stones; 3 points - chronic cholecystitis, pyelonephritis, prostatitis, adnexitis, coronary heart disease, hypertension, helminthiasis; 4 points - chronic hepatitis, glomerulonephritis, myocardial, lymphadenopathy, tuboperitoneal; 5 points - fungal skin and mucous membranes, respiratory infection, exacerbation of chronic comorbidities at the time of inspection,

and when the value VRO<0,97 - predict low; from 0.98 to 1.31 - moderate; VRO>1.32 to - high risk of complications.



 

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