RU2444017C1 - Method for prediction of developing complications in patients with community-acquired pneumonia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: blood serum is examined for procalcitonin (PCT, pg/ml), tumour necrosis factor-α (TNF-α pg/ml), and C-reactive protein (CRP, mg/l) values. These values are used to derive the value D: D=+12.444*PCT+0.13*CRP+2.589* TNF-α. If the value D exceeds 54.25, the complicated clinical course of community-acquired pneumonia is predicted.

EFFECT: invention provides higher preventive effectiveness in the complications in patients with community-acquired pneumonia due to the integral estimate of biochemical inflammation markers.

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Description

The invention relates to medicine, in particular to pulmonology, and can be used to predict the development of complications in patients with community-acquired pneumonia.

The prototype chose a method for predicting the development of pneumonia complications using an algorithm that includes risk factors (E.P. Kalinina, N.S. Zhuravskaya, A.P. Kuzmin. Method for predicting the development of pneumonia complications. Patent RU No. 2290075, December 27, 2006, Bull. No. 36). The method is based on determining the reactivity of immunocompetent cells with the identification of local and systemic cytokine profiles (IL-2.8, INF-γ, TNF-α). Prediction is based on an algorithm including measured parameters.

The known method has the following disadvantages.

1. The algorithm is designed for young men aged 18 to 21 years living in an organized team.

2. Does not take into account the essential role of modern biochemical markers of inflammation, reflecting the severity of the inflammatory process.

The purpose of the invention is to increase the efficiency of predicting the development of complications in patients with community-acquired pneumonia by integrally assessing levels of procalcitonin, tumor necrosis factor-α, and C-reactive protein.

The goal is achieved by assessing the severity of community-acquired pneumonia based on levels of procalcitonin, tumor necrosis factor-α, and C-reactive protein.

The claimed method has the following techniques:

a) using the solid-phase enzyme-linked immunosorbent assay determine the levels of tumor necrosis factor-α (TNF-α in pg / ml) and C-reactive protein in blood serum (CRP in mg / l);

b) using the immunochromatographic method using test systems determine the level of procalcitonin (PCT in PG / ml) in blood serum;

c) solve the discriminant equation:

D = + 12.444 * FCT + 0.13 * CRP + 2.589 * TNF-α,

where D is the discriminant function, the boundary value of which is 54.25.

With a D value greater than 54.25, it is possible to predict the development of complications in patients with community-acquired pneumonia; with D less than 54.25, an uncomplicated course of community-acquired pneumonia is predicted.

The following are two examples of the use of the claimed method.

Example 1. Patient A, 39 years old. Diagnosis: community-acquired pneumonia in the lower lobe of the left lung, moderate severity. Respiratory failure of 1 degree.

The initial data were respectively: FCT 2.0 pg / ml; CRP - 68 mg / l, TNF-α 4.2 pg / ml.

In order to predict the development of complications of community-acquired pneumonia, the discriminant equation is solved:

D = + 12.444 * 2.0 + 0.13 * 68 + 2.589 * 4.2 = 44.61.

Since the discriminant function is less than the boundary value (54.25), an uncomplicated course of community-acquired pneumonia was predicted. The patient had an uncomplicated course of community-acquired pneumonia.

Example 2. Patient L, 46 years old. Diagnosis: community-acquired bilateral polisegmental pneumonia, severe. Respiratory failure 3 degrees.

The initial data were respectively: PCT 10.0 pg / l, CRP 172 mg / l, TNF-α - 18.6 pg / ml.

In order to predict the development of complications of community-acquired pneumonia, the discriminant equation is solved:

D = + 12.444 * 10.0 + 0.13 * 172 + 2.589 * 18.6 = 194.955.

Since the discriminant function is greater than the boundary value (54.25), a complicated course of community-acquired pneumonia was predicted. On the fourth day of hospitalization, the patient developed complications in the form of acute respiratory failure, sepsis, toxic hepatitis, nephritis, anemia, and multiple organ failure. The complicated course of community-acquired pneumonia was diagnosed.

The proposed method has been clinically tested at the clinic of the Far Eastern Scientific Center for Physiology and Respiratory Pathology in 70 patients with community-acquired pneumonia.

The verification results of the claimed method showed its effectiveness, the correct prognosis was determined in 87.1% of cases.

Thus, the proposed method can be used in clinical practice to predict the development of complications in patients with community-acquired pneumonia.

Claims (1)

A method for predicting a complicated course in patients with community-acquired pneumonia, characterized in that it measures procalcitonin (PCT, pg / ml), tumor necrosis factor-α (TNF-α, pg / ml) and C-reactive protein (CRP, mg / l) in serum, solve the discriminant equation:
D = + 12.444; PCT + 0.13; CRP + 2.589; TNF-α
and with a D value greater than 54.25, the development of complications in patients with community-acquired pneumonia is predicted.