2017

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2017/№1

Prognostic models for combination accounting of symptoms and risks for fatal outcome within one year in patients with community-acquired pneumonia and decompensated CHF

Simbirtseva A. S., Arutyunov G. P., Bylova N. A.
Federal State Budgetary Educational Institution of Higher Education, "Pirogov Russian National Research Medical University" of the Ministry of Health of the Russian Federation, Ostrovityanova 1, Moscow 117997

Keywords: decompensated CHF, clinical phenotypes, prognosis, pneumonia

DOI: 10.18087/rhfj.2017.1.2317

Aim. To develop methods for one-year prediction of fatal outcomes based on clinical and laboratory data in patients hospitalized for decompensated CHF and pneumonia; to evaluate a statistical value of the developed methods. Materials and methods. At the first stage, the study included 98 patients hospitalized for decompensated CHF and pneumonia with the following results of sputum culture: Str. pneumoniae, “no growth” or mixed infection (combination of Str. pneumoniae with other bacteria or fungi). Statistical analyses of obtained data were performed using the IBM SPSS Statistics 23 software. At the second stage, the study included 58 patients with the same clinical characteristics and the same inclusion and non-inclusion criteria as at the first stage of study. Results. The analysis (to assess quantitatively the effect of a set of clinical and laboratory factors on the risk of death) performed using the method of binary logistic regression (exclusion of statistically insignificant variables according to Wald) provided three prognostic models. A prospective study showed that the most accurate data were obtained by using Model 1 with sensitivity of 94.8% and specificity of 91.4%. When the prediction was positive by all three models, a fatal outcome occurred within one year in 95.2% of cases. 63.6% of positive predictions by all three models were characterized by in-hospital mortality; survival time of the rest of patients in this group did not reach six months in 31.8% of cases. The one-year mortality of patients with risk class V according to PSI score was 85.7%. Among patients with risk class IV according to PSI score, a fatal outcome occurred in 22.2% of cases. The correlation of fatal outcomes and PSI risk classes and the results predicted by Models 1, 2 and 3 was statistically significant while the correlation of fatal outcomes and CURB65 score was statistically nonsignificant. Conclusion. The developed models for prediction of fatal outcomes are highly sensitive and specific and can more accurately than CURB65 and PSI predict probabilities of fatal outcomes in patients with pneumonia associated with decompensated CHF.
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Simbirtseva A. S., Arutyunov G. P., Bylova N. A. Prognostic models for combination accounting of symptoms and risks for fatal outcome within one year in patients with community-acquired pneumonia and decompensated CHF. Russian Heart Failure Journal. 2017;18 (1):72–80

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