Хроническая обструктивная болезнь легких (ХОБЛ) является одной из ведущих причин заболеваемости и смертности в современном обществе. В настоящее время летальность от ХОБЛ занимает 4 е место сре ди всех причин смерти в общей популяции [1]. Более того, ее уровень постоянно растет [2]. Согласно прогнозам экспертов ВОЗ, к 2020 г. ХОБЛ выйдет на 3 е место среди причин летальности и на 1 е -среди причин инвалидности у взрослых [2, 3]. Для ХОБЛ характерно развитие обострений, частота которых прогрессивно увеличивается с нара станием тяжести заболевания [4]. По данным между народной статистики, внутригоспитальная леталь ность больных, госпитализированных с обострением ХОБЛ, составляет около 8 %, а через 1 год после обострения -23 % [5]. По результатам различных ра бот, внутригоспитальная летальность пациентов с острой дыхательной недостаточностью (ОДН) на
Nosocomial pneumonia (NP) is one of widespread in hospital infectious diseases. Chronic obstructive pulmonary disease is one of risk factors of NP. The aim of this study was to investigate features of NP and a role of inflammatory biomarkers in patients with COPD and NP. One hundred and eighty four patients with acute exacerbation of COPD were involved. Of them, 22 (11.9 %) patients developed pneumonia while staying in a hospital (18 males, 4 females, mean age, 66.0 ± 11.02 years). The CPIS scale was 9.4 ± 2.1 for all the NP patients, Charlson's co mor bidity index was 7.9 ± 2.5. In 90.9 % of the patients, NP occurred in 5 days after admission. The following microorganisms were identified: Pseudomonas aeruginosa (5), Staphylococcus aureus (4), Streptococcus pneumoniae (4), Acinetobacter spp. (3). Mechanical lung ventilation was required in 13.6 %, non invasive lung ventilation was required in 36.4 % and supplemental oxygen was used in 90.9 % of the patients. The mean length of hospitalization of COPD patients with NP was 42.6 ± 20.3 days; 27.3 % of patients died. Serum levels of C reactive protein (CRP) increased significantly in a day of diagnosis of NP compared to the baseline values: 105.5 (83.3-145.8) mg / L vs 14.5 (12.0-29.3) mg / L (p < 0.0001). Changes in CPR concentration allowed prediction the prognosis of NP patients (p = 0.002). Therefore, NP typically has severe course with significant systemic inflammatory response and acute respiratory failure in patients with COPD. Apart from the APACHE II scale, inflammatory biomarkers could facilitate predicting prognosis and outcomes of NP.
The purpose of this study was to assess the performance of a rapid bedside whole blood test of C reactive protein (CRP) for diagnosis of bacterial infection and pneumonia in patients with acute exacerbation of COPD (AE COPD). One hundred and twenty three patients with AE COPD admit ted to a hospital (mean age 65.4 ± 48.8 years, smoking history 42.8 ± 14.3 packs years) were studied. CRP concentration was determined by using the finger stick blood test (NycoCard II Test Kit). Patients with AE COPD were divided into three groups according to the sputum purulence and appearance of radiographic pneumonic infiltrates: 1) AE COPD with pneumonia; 2) AE COPD with mucoid sputum; 3) AE COPD with purulent sputum. In the study, 23 patients had radiographic evidence of pneumonia. The mean CRP in this group was 105.8 ± 66.1 mg/L and was signifi cantly higher than that in AE COPD patients without pneumonia (p < 0.001). Patients with AE COPD and mucoid sputum (n = 26) had mean CRP 12.1 ± 7.0 mg/L that was significantly lower when compared to the patients with purulent sputum (n = 74; mean CRP 34.5 ± 18.8 mg/L; p < 0.001). A rapid bedside whole blood CRP test is a useful tool for diagnosis of bacterial infection and pneumonia in patients with AE COPD. It may be used as a guide for administration of empiric antibacterial therapy in AE COPD patients.
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