RU2290075C1 - Method for predicting pneumonia complications occurrence - Google Patents

Abstract

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.

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Description

The invention relates to medicine, namely to pulmonology.

Pneumonia (P) is still one of the most widespread human infectious diseases with a serious prognosis [1, 6]. Currently, P is considered as a condition with certain systemic manifestations, which translates a local inflammatory lesion of the lung tissue into the category of infectious disease. According to statistics, about 26% of pneumonia patients hospitalized in the intensive care unit die from complications in the form of septic shock and acute respiratory distress syndrome [8]. A complicated course of pneumonia is observed in almost half of all cases of the disease, while it is customary to divide the complications into pulmonary and extrapulmonary. Pulmonary include acute respiratory failure (ARF), respiratory distress syndrome, parapneumonic effusion, pleural empyema, lung abscess; extrapulmonary - metastatic infections, phlebitis, sepsis, toxic and infectious shock, multiple organ failure syndrome (myocarditis, pericarditis, endocarditis, hepatitis, nephritis) [5]. The main causes of the complicated course, according to some authors, are late hospitalization of patients, underestimation of the risk of complications in a particular patient, which entails an untimely start of the conduct and inadequacy of intensive therapy, ventilation support - all this contributes not only to a longer stay of patients in hospital, but also significantly increases the cost of treating patients [3, 4, 7]. In this regard, an adequate assessment of the patient's condition, timely prediction of the development of complications of the disease becomes paramount in this situation.

As an analogue, one of the most common scales for assessing the severity of pneumonia in clinical practice was used — the 2-stage scale proposed by M. Fine in 1997 [10]. At the first stage, patients with a very low mortality rate are determined: age younger than 50 years, the absence of concomitant diseases and organ disorders. At the second stage, the total points are calculated using data on age, concomitant diseases and organ disorders, epidemiological, laboratory, gasometric and radiological studies, patients are stratified into risk classes for a possible fatal outcome of pneumonia. Counting systems on this scale are available on the Internet (http: // ncemi.org, www.emedhomom.com).

The disadvantages of this method: determines the risk of death P; to carry out the prognosis, blood sampling from the patient and a gasometric study are required. It is possible to determine the parameters only in a specialized medical institution, i.e. forecasting requires both the availability of a modern laboratory service and the waiting time for the result.

In our invention, in contrast to the prototype, 5 anamnesis parameters are evaluated within 15 minutes, followed by calculation of the prognostic probability of complications using the multiple regression equation and determining the degree of risk of complications, which allows predicting the development of complications in the early stages and determining the appropriate tactics for further management of the patient with pneumonia.

The purpose of the invention: prediction of the risk of complications in a patient with community-acquired pneumonia (CAP) using informative non-invasive medical history parameters to determine the subsequent management tactics of the patient.

The goal is achieved by interviewing a patient with pneumonia, evaluating each of the 5 parameters of the anamnesis in points, calculating, according to the developed equation, the probabilistic risk of complications (VRO) and determining the degree of risk of complications.

457 patients were examined. At the initial examination of a patient with VP, the data on the history of life were clarified. Using factor analysis, the most significant informative signs were selected: out of 11 parameters, 5 were selected (where k is the load index ≥0.75) [9]. Further, the data were ranked according to the developed 5-point rating scale, with each parameter being qualitatively ranked by the significance of the impact on the development of pneumonia complications: 1 - no effect, 2 - weak effect, 3 - moderate effect, 4 - significant effect, 5 - strong influence .

Then, using a regression analysis, we determined the influence of factor parameters on the development of complications in patient P, and derived the equation for the prognostic probability of developing pneumonia complications [2]:

VRO = 0.27 + 0.06 × X1 + 0.05 × X2 + 0.019 × X3 + 0.021 × X4 + 0.02 × X5, where

VRO - the prognostic probability of developing pneumonia complications;

0.27 - free member;

X1-X5 - the studied parameters of the patient in points. X1 - time from the manifestation of the disease to seeking medical help in points: 1 point - the patient's request for medical help in the first hours of the disease; 2 points - in the first 8 hours; 3 points - within 8-12 hours; 4 points - within 12-24 hours; 5 points - more than a day from the onset of the disease;

X2 - smoking experience in points: 1 point - lack of smoking experience; 2 points - smoking experience up to 3 years; 3 points - 4-8 years; 4 points - 9-12 years; 5 points - more than 12 years;

X3 - frequency of hospitalizations and acute respiratory viral infections (ARVI) in points: 1 point - the absence of hospitalizations in history; 2 points - in the history of hospitalization for diseases of the non-bronchopulmonary system; 3 points - ARVI more than 4 times a year; 4 points - a history of repeated diseases of the bronchopulmonary system; 5 points - transferred pneumonia, bronchitis during the last year;

X4 - the presence of chronic foci of infection of the upper respiratory tract (URTI), oral cavity, herpetic infection in points: 1 point - the absence of chronic foci of infection of the upper respiratory tract, oral cavity, herpetic infection; 2 points - chronic diseases of the airborne diseases, oral cavity, herpetic infection with a period of remission of more than 1 year; 3 points - the period of disease remission - 6 months; 4 points - exacerbation in the last 3 months; 5 points - exacerbation at the time of treatment;

X5 - concomitant diseases in points: 1 point - there are no concomitant diseases; 2 points - concomitant biliary dyskinesia, chronic gastritis, duodenitis, dysmetabolic nephropathy, urolithiasis; 3 points - chronic cholecystitis, pyelonephritis, prostatitis, adnexitis, coronary heart disease, hypertension, helminthiasis; 4 points - chronic hepatitis, glomerulonephritis, myocardial dystrophy, lymphadenopathy, tuberculosis; 5 points - fungal lesions of the skin and mucous membranes, acute respiratory viral infections, exacerbation of chronic concomitant diseases at the time of examination.

Since the distribution pattern of the totality of scores corresponded to normal, we used the rule of one sigma and the average value. If the value of BPO is <0.97, then this, in our opinion, indicates a low risk of complications; from 0.98 to 1.31 - about a moderate degree of risk; the value of BPO in excess of 1.32 - about a high degree of risk of complications.

So, the method developed by us is carried out as follows. At the initial examination of the patient, a survey is conducted. With the corresponding clinical picture characteristic of pneumonia, the following data are found out: the patient smokes or not; smoking experience in years; episodes and severity of respiratory diseases during the year preceding the disease; the presence of concomitant diseases (for example, lymphadenopathy, tuberculosis, fungal infections of the skin and mucous membranes, coronary heart disease, hypertension, myocardial dystrophy, chronic gastritis, duodenitis, hepatitis, cholecystitis, pyelonephritis, glomerulonephritis, prostatitis, adnexitis, and neurobiological disease) pathways, helminthiasis, acute respiratory viral infections), the presence and frequency of exacerbations of chronic foci of airborne infections (for example, chronic sinusitis, ethmoiditis, tonsillitis, pharyngitis, otitis media, llipoza), the mouth (stomatitis, caries), herpes infection. Next, according to the table, for each of the 5 parameters, the corresponding score is determined, which is then entered into the equation for the prognostic probability of complications (VRO) and calculated, and then, according to the diagram presented in the drawing, the results are evaluated: if the VRO value is <0.97, forecast low, 0.98-1.31 - moderate,> 1.32 - high degree of risk of P.'s complications

Example 1: Patient K, 20 years old, was admitted to the clinic of the Research Institute of MKVL 01/20/05. On admission, he complained of a productive cough with mucopurulent sputum, pain in the right side of the chest, aggravated by coughing and deep inspiration, difficulty breathing with moderate physical exertion, fever up to 38 ° C, general weakness, headache. From the anamnesis of the disease: he became ill sharply 3 days ago (a runny nose, headache, muscle pain appeared, body temperature increased to 38.5 ° C), he associates the disease with hypothermia. Immediately asked for medical help, diagnosed with SARS, received symptomatic treatment on an outpatient basis. The day before hospitalization I felt a worsening of the condition, the above complaints joined (at the time of the examination, I did not take any antibacterial drugs). From the anamnesis of life: grew and developed according to age. SARS is sick 2 times a year. Has the disease: chronic tonsillitis (last exacerbation 2 months ago, outpatient treatment). Six months ago I was in hospital for acute bronchitis. Smokes 1/2 pack of cigarettes for 5 years. Alcoholic beverages are taken once a month. An objective examination: a state of moderate severity. The skin is pale, moist, clean. Height - 176 cm, weight - 65 kg. Percussion: a shortening of the pulmonary sound above the lower lobe to the right is noted, auscultation - weakening of vesicular breathing in the lower lobe to the right, crepitation there. BH = 21 per minute, heart rate = 85 per minute, blood pressure = 105/70 mm Hg For other organs and systems without pathological features. In the clinical analysis of blood: leukocytes 23.2 · 10 ⁹ g / l, p-I - 7, s-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: infiltration of medium-intensity lung tissue on the right in the lower lobe. The patient was diagnosed with community-acquired pneumonia in the lower lobe of the right lung, mild course. DN 1 tbsp.

When assessed according to the Fine scale most often used by doctors, the total score for this patient was 30 (i.e., less than 70), which corresponds to the II mortality risk class (low level) and the patient should be referred for treatment to the therapeutic (if available, pulmonary) department the hospital.

Using the developed method, a risk forecast for the development of complications of the disease is made according to the scheme developed by the authors. The table determined the scores corresponding to each indicator (the time from the manifestation of the disease to seeking medical help for this patient is more than a day, which corresponds to 5 points; smoking experience of 5 years - 3 points; 6 months ago I was in hospital for acute bronchitis - 5 points ; the patient has chronic tonsillitis (last exacerbation 2 months ago) - 4 points; the presence of acute respiratory viral infections at the time of examination - 5 points), we substitute the score indicators into the equation for the prognostic probability of pneumonia complications:

VRO = 0.27 + (0.06 × 5 + 0.05 × 3 + 0.019 × 5 + 0.021 × 4 + 0.02 × 5) = 0.99,

further, according to the scheme presented in the drawing, we evaluate the result: the obtained value of BPO exceeds 0.98, which, according to our criteria, predicts a moderate risk of P.'s complications in this patient. Thus, the patient should have been referred to the intensive care unit and receive appropriate adequate supervision and treatment. A retrospective analysis of the medical history revealed the development of complications in the patient: toxic myocarditis, hepatitis, which contributed to an increase in the patient's hospital stay by 8 days.

Therefore, the selected method allows, when a patient seeks medical help, to predict the risk of complications in time, thereby determining adequate management tactics to reduce the treatment time of the patient and, accordingly, significantly reduce financial costs for a particular patient.

Table Ranking of data for pneumonia patients on a five-point rating scale Significant factors Points one 2 3 four 5 The time from the manifestation of the disease to seeking medical help first hours up to 8 hours 8-12 hours 12-24 hours more than a day Smoking experience no up to 3 years 4-8 years old 9-12 years old more than 12 years Hospitalizations and acute respiratory viral infections (ARVI) no hospitalization for diseases of the non-bronchopulmonary system ARVI more than 4 times a year repeated diseases of the bronchopulmonary system from history pneumonia, bronchitis during the previous year of the disease The presence of chronic foci of upper respiratory tract infection (UDT), oral cavity, herpetic infection no absence of exacerbations of chronic diseases of the airborne diseases, oral cavity, herpetic infection for more than 1 year the absence of exacerbations of chronic diseases of the airborne diseases, oral cavity, herpetic infection over the past 6 months exacerbation of chronic diseases of the UDT, oral cavity, herpetic infection over the past 3 months exacerbation of chronic otitis media, tonsillitis, sinusitis pharyngitis, ethmoiditis, polliposis, herpes infection, caries, stomatitis at the time of treatment Accompanying illnesses no chronic gastritis, duodenitis, biliary dyskinesia, dysmetabolic nephropathy, urolithiasis chronic cholecystitis, pyelonephritis, prostatitis, adnexitis, coronary heart disease, hypertension, helminthiasis chronic hepatitis, glomerulonephritis, myocardial dystrophy, lymphadenopathy, tuberculosis fungal lesions of the skin and mucous membranes, acute respiratory viral infections, exacerbation of chronic concomitant diseases at the time of examination

Information sources

1. Aleksanyan L.A. Risk factors for the lethal outcome of community-acquired pneumonia / L.A. Aleksanyan // Antibiotics and chemotherapy. 2001. No1. S.18-21.

2. Borovikov V.P. Statistical analysis and data processing in a Windows environment. / V.P. Borovikov, I.P. Borovikov. M .: Information and publishing house "Filin", 1997. 608 p.

3. Butler L.N. Community-acquired severe pneumonia. Modern possibilities of antibiotic therapy / L.N.Dvoretsky // Pulmonology. 2003. No3. S.123-127.

4. Round-the-clock mortality in a hospital with community-acquired pneumonia / A.L. Vertky, A.V. Naumov, E.I. Vovk, L.A. Aleksanyan, etc. // Clinical Microbiology and Antimicrobial Chemotherapy. 2003.V.5. Number 4. S.380-388.

5. Landyshev Yu.S. Guide to pulmonology / Yu.S. Landyshev, A.V. Lenshin. Blagoveshchensk: RIO, 2003.184 s.

6. Nonikov V.E. Pneumonia: complex and unresolved issues of diagnosis and treatment / V.E. Nonikov // Rus.med. journal 2004.V. 12. No. 1. S.1226-1232.

7. Chuchalin A.G. Diagnosis and treatment of pneumonia from the standpoint of evidence-based medicine / A.G. Chuchalin, A.N. Tsoi, V.V. Arkhipov // Consilium Medicum. 2002. No. 12. S.425-452.

8. Shcherba Yu.V. Community-acquired pneumonia in the aspect of the global process of the emergence of new and recurring infections: new etiological, epidemiological and clinical characteristics, the acquisition of a category of systemic infectious disease / Yu.V. Shcherba, IV Goncharova [serial on the Internet] 2004 March [date cited] URL : http://www.infectology.ru/publik/stat49.asp.

9. Yunkerov V.I. Mathematical and statistical processing of medical research data / V.I. Yunkerov, S.G. Grigoriev. St. Petersburg, 2002.266 s.

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

Claims (1)

A method for predicting the development of pneumonia complications, including a patient survey and characterized in that without a laboratory examination, 5 history parameters are evaluated on a 5-point scale, followed by calculation of the prognostic probability of pneumonia complications according to the equation VRO = 0.27 + 0.06 · X1 + 0.05 · X2 + 0.019 · X3 + 0.021 · X4 + 0.02 · X5, where VRO is the prognostic probability of developing pneumonia complications; 0.27 - free member; X1 - time from the manifestation of the disease to seeking medical help in points: 1 point - the patient's request for medical help in the first hours of the disease; 2 points - in the first 8 hours; 3 points - within 8-12 hours; 4 points - within 12-24 hours; 5 points - more than a day from the onset of the disease; X2 - smoking experience in points: 1 point - lack of smoking experience; 2 points - smoking experience up to 3 years; 3 points - 4-8 years; 4 points - 9-12 years; 5 points - more than 12 years; X3 - frequency of hospitalizations and acute respiratory viral infections (ARVI) in points: 1 point - the absence of hospitalizations in history; 2 points - in the history of hospitalization for diseases of the non-bronchopulmonary system; 3 points - ARVI more than 4 times a year; 4 points - a history of repeated diseases of the bronchopulmonary system; 5 points - transferred pneumonia, bronchitis during the last year; X4 - the presence of chronic foci of infection of the upper respiratory tract (URTI), oral cavity, herpetic infection in points: 1 point - the absence of chronic foci of infection of the upper respiratory tract, oral cavity, herpetic infection; 2 points - chronic diseases of the airborne diseases, oral cavity, herpetic infection with a period of remission of more than 1 year; 3 points - the period of disease remission - 6 months; 4 points - exacerbation in the last 3 months; 5 points - exacerbation at the time of treatment; X5 - concomitant diseases in points: 1 point - there are no concomitant diseases; 2 points - concomitant biliary dyskinesia, chronic gastritis, duodenitis, dysmetabolic nephropathy, urolithiasis; 3 points - chronic cholecystitis, pyelonephritis, prostatitis, adnexitis, coronary heart disease, hypertension, helminthiasis; 4 points - chronic hepatitis, glomerulonephritis, myocardial dystrophy, lymphadenopathy, tuberculosis; 5 points - fungal lesions of the skin and mucous membranes, acute respiratory viral infections, exacerbation of chronic concomitant diseases at the time of examination, and when the value of BPO <0.97 - predict low; from 0.98 to 1.31 - moderate; BPO> 1.32 - a high degree of risk of complications.

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