2015


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2015/№6

Prognostic role of clinical phenotypes and verified flora in patients with pneumonia associated with decompensated CHF

Simbirtseva A. S., Rylova N. V.
State Budgetary Educational Institution, “N. I. Pirogov Russian National Research Medical University”, the RF Ministry of Health Care, Ostrovityanova 1, Moscow 117997

Keywords: “vascular” age, circulatory decompensation, мокрота,pneumonia, patient phenotype, CHF

DOI: 10.18087 / rhfj.2015.6.2174

Background. According to the ORACUL RF registry, pneumonia on admission of patients with decompensated CHF is a distinctive feature of the Russian population. Effects of pneumonia and causative flora on remote prognosis have not been analyzed earlier in patients with circulatory decompensation. Aim. To study results of sputum culture and to evaluate the remote prognosis in patients with pneumonia detected during CHF decompensation. Materials and methods. This retrospective study included 284 patients with decompensated CHF and pneumonia confirmed by clinical data and results of x-ray test. Patients were divided into groups based on results of sputum culture. Clinical course of disease, in-hospital mortality, and mortality for a year following the hospitalization were evaluated for each group. Body composition was evaluated using the bioimpedance method. Pneumonia severity was evaluated by CURB-65 (2010) and PSI (Pneumonia Severity Index) (1997) scales, and the Charlson comorbidity index was calculated. A notion of “clinical phenotype” was introduced to characterize patients with high comorbidity at different combinations of clinical parameters. Results. The in-hospital mortality was 20.4 %; the post-discharge mortality reached 50.4 % in 6 months and 62.3 % in 12 months. Statistically significant differences were observed for two parameters, COPD and lean body weight (LBW) deficit. 9.5 % of patients had COPD. The LBW deficit exceeding 10 % was found in 16.2 % of patients; 5–10 % – in 25.4 % of patients; and less than 5 % – in 51.1 % of patients. Odd ratios were calculated for detection of different types of flora depending on clinical phenotypes. Conclusions. Presence of mixed infection in sputum culture of pneumonia patients with decompensated CHF is an unfavorable prognostic factor. An extremely unfavorable prognostic criterion is a LBW deficit exceeding 10 %. Detection of mixed infection is more probable in patients with higher comorbidity and a phenotype which includes one or more of the following factors: LBW deficit exceeding 10 %; LBW deficit of 5–10 %; COPD; reduced GFR; and frequent hospitalizations.
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Simbirtseva A.S., Rylova N. V. Prognostic role of clinical phenotypes and verified flora in patients with pneumonia associated with decompensated CHF. Russian Heart Failure Journal. 2015;16 (6):331–338

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