2012


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2012/№3

Effect of urinary tract infections on the course and prognosis of heart failure

Pashkevich D. D., Arutyunov A. G.
State Budgetary Educational Institution of Higher Professional Education, “N.I. Pirogov Russian National Research Medical University” of the RF Ministry of Health Care, Ostrovityanova 1, Moscow 117997

Keywords: urinary tract infections, prognosis, CHF

DOI: 10.18087/rhfj.2012.3.1688

Relevance. While mechanism of CHF development remains unexplained, more attention is devoted to the role of systematic inflammation. Urinary tract infections (UTI) might contribute to production of anti-inflammatory cytokines and, consequently, to CHF progress. Objective. To study prevalence of UTI in CHF patients and effect of UTI on remote outcomes – frequency of lethal outcomes and repeated hospitalizations. Materials and methods. A retrospective study was conducted with 282 case histories of patients with decompensated CHF. The anamnesis data, laboratory and instrumental investigations at the hospitalization stage were analyzed. The period of subsequent observation was 12 months. Results.The data on high prevalence of UTI among patients with CHF decompensation were obtained, it reached 34,8 %, the most frequent form of UTI was pyelonephritis. Multifactor analysis demonstrated the statistically significant impact of UTI on frequency of repeated hospitalizations (OR 5,4). Combination of two infectious diseases – UTI and pneumonia increases the risk of repeated hospitalizations and lethal outcomes (OR 7,3). The obtained data allow supposing that presence of UTI in CHF patients is an important prognostic sign as related to repeated hospitalization and related to the combined value – lethality rate and repeated hospitalization. Formation of UTI at early stages of CHF formation affects the scenario of subsequent disease development. Combination of UTI and pneumonia considerably increases the risk of not only repeated hospitalizations but the risk of lethal outcome. Conclusion. Subsequent studies allow formation of a more accurate understanding of UTI as an early negative prognostic factor – the factor reflecting symbiosis of the low virulent bacterial agent and microorganism – a CHF patient with reduced immunity and expressed system inflammation.
  1. Агеев Ф. Т., Арутюнов Г. П., Беленков Ю. Н. и др. Хроническая сердечная недостаточность. – М., «ГЭОТАР-Медиа», 2010. – 336с.
  2. Калюжин В. В., Тепляков А. Т., Вечерский Ю. Ю. Патогенез хронической сердечной недостаточности: изменение доминирующей парадигмы. Бюллетень сибирской медицины. 2007;4:71–76.
  3. Гусев Е. Ю., Черешнев В. А., Журавлева Ю. А. и др. Варианты развития хронического системного воспаления. Медицинская иммунология. 2009;2–3:131–140.
  4. Мазур В. В., Калинкин М. Н., Егорова Е. Н. Динамика факторов системного воспаления и аминоконцевого мозгового натрийуретического пропептида при лечении хронической сердечной недостаточности. Терапевтический архив. 2011;83 (1):56–59.
  5. Anker SD, von Haehling S. Inflammatory mediators in chronic heart failure: an overview. Heart. 2004;90 (4):464–470.
  6. Chen D, Assad-Kottner C, Orrego C, Torre-Amione G. Cytokines and acute heart failure. Crit Care Med. 2008;36 (1 Suppl): S9–16.
  7. Horio T. [Pathophysiological role of cytokines in heart failure]. Nihon Rinsho. 2006;64 (5):843–847.
  8. Арутюнов Г. П., Кафарская Л. И., Савелов Н. А. и др. Хроническая сердечная недостаточность: структурные и микробиологические изменения в толстой кишке. Терапевтический архив. 2007;79 (2):31–37.
  9. Sandek A, Bauditz J, Swidsinski A et al. Altered intestinal function in patients with chronic heart failure. J Am Coll Cardiol. 2007;50 (16):1561–1569.
  10. Чернова А. А., Старикова Э. А., Соколов Д. И. и др. Влияние продуктов бактериального происхождения на экспрессию поверхностных молекул моноцитоподобных и эндотелиальных клеток. Журнал микробиологии. 2008;4:60–63.
  11. Wiles TJ, Kulesus RR, Mulvey MA. Origins and virulence mechanisms of uropathogenic Escherichia coli. Exp Mol Pathol. 2008;85 (1):11–19.
Pashkevich D. D., Arutyunov A. G. Effect of urinary tract infections on the course and prognosis of heart failure. Russian Heart Failure Journal. 2012;13(3):176-179

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