Role of Comorbid Diseases and Some Biochemical Markers in Determination of Severity and Prognosis of Community Acquired Pneumonia // Роля на коморбидните заболявания и някои биохимични маркери в определяне тежестта и прогнозата на пневмония придобита в обществото

Abstract

Дисертационният труд оценява значението на коморбидните заболявания и някои биомаркери в определяне тежестта и изхода от заболяването при хоспитализирани болни с пневмония придобита в обществото (ППО). Определена е честотата на придружаващите заболявания. Особено внимание е обърнато на влиянието на социално значими заболявания като сърдечно-съдови заболявания, захарен диабет и ХОББ върху хода на пневмонията. Изследвана е и кумулативната тежест на коморбидните заболявания, оценена чрез Индекса на коморбидностите на Чарлсон (CCI) , върху хода и изхода от заболяването. Разгледана е ролята на биомаркерите – левкоцити, С-реактивен протеин, Д-димер и прокалцитонин в определяне тежестта и прогнозата на ППО. Сравнена е предиктивната стойност за вътреболнична смъртност на CCI и изследваните биомаркери с тази на основните скали за тежест - PSI, CURB-65, IDSA/ATS критерии. Направен е цялостен анализ на вътреболничната смъртност. Разработен е рисков профил на пациентите с ППОс включване в него на коморбидности и биомаркери. Изработен е алгоритъм за избор на място на лечение и проследяване на пациентите с ППО.

Community-acquired pneumonia (CAP) is a disease with a high incidence, hospitalization and still high mortality rate. Despite the success of antibiotic treatment, the mortality rate ranged between 5-15%, and in intensive care units it is up to 50%. The presence of comorbid diseases affects the course and outcome of the disease. There is no single opinion regarding their significance as the concomitant diseases vary in their nature and severity and their impact in the course of pneumonia is difficult to define. In this paper we evaluate not only the significance of particular diseases to the course of pneumonia, but also evaluate the cumulative risk in polimorbid patients assessed through Charlson Comorbidity Index (ССI). Adding of ССI to the basic severity scales can improve the stratification of risk in patients with pneumonia. Some of the severity scales for CAP such as PSI and IDSA/ATS criteria include a relatively large number of indices and require time to complete them making them difficult to be used in routine practice. Therefore, the interest in markers that are quickly achievable, objective and reliable severity predictors is growing. Some biochemical markers meet these conditions. Their role in diagnosing pneumonia is expressed in several directions – establishing of diagnosis, referring to etiological agent, severity prediction, treatment failure and mortality from pneumonia, referring to an appropriate choice of antibiotic and determining the duration of treatment. Some of the biomarkers such as leucocytes and CRP are routinely used in clinical practice. Other, such as procalcitonin (PCT) and D-dimer are yet to enter in diagnosis and determination of prognosis in CAP. Adding biomarkers to pneumonia severity scales and even their individual use will improve the detection of high-risk patients and reduce the mortality from the disease. For that reasons the topic has not only great scientific but also practical application. The aim of this paper is to investigate the role of comorbid diseases and some biomarkers on the community-acquired pneumonia severity and outcome. In conclusion: CAP is a common disease with heterogeneous clinical picture – from mild and well amenable outpatient treatment, to severe life-threatening infection. Comorbid diseases have significant impact on the course and prognosis of CAP. There cumulative burden can be well assessed through CCI, which must be incorporated in risk assessment models. It is also appropriate to add biomarkers to other factors included in the main scales in order to improve risk stratification in CAP patients. Proper risk assessment will help to identify high-risk patients who require active monitoring and more aggressive treatment to improve the prognosis of the disease.