International Medical Journal, Vol. 23., Iss. 4, 2017, P. 17−25.
PNEUMONIA LETHAL OUTCOME PREDICTORS IN PATIENTS WITH ONCOHEMATOLOGICAL DISEASES
Dnipro Medical Academy, Ministry of Health of Ukraine, Ukraine
Significance of the problem of diagnosis and treatment of pneumonia in patients with a background of blood cancer is due to a high incidence, lack of clinical manifestations, severe course, frequent complications and rapid development of fatal consequences. Pulmonologists believe that assessment of pneumonia severity, based on the grade of the clinical manifestations, which allows to identify the patients in need of intensive care, determine the most optimal therapeutic tactics (the type and amount of antibacterial, detoxification therapy) and estimate the prognosis, is of the principal importance. To determine the predictors of pneumonia lethal outcomes in patients with immune disorders against a background of blood cancer, statistical analysis of a set of clinical, laboratory, history and immunological indices characterizing the course of pneumonia and the basic blood disease was performed. The archival data of 605 cases of in−patients with oncological blood diseases (2011−2014) were analyzed; 206 cases were investigated prospectively (2014−2016). The diagnosis of the nosological form of oncological blood disease and pneumonia were verified according to generally accepted clinical, radiological and morphological criteria. The features of the course of pneumonia were studied regardless of the phase of the disease. Formalized case reports of the patients, which included the results of clinical, instrumental and laboratory methods of investigation, including microbiological, main groups of antibacterial drugs, terms of their administration, were created. According to the results of the study, the equation of logistic regression of the prediction of pneumonia lethal outcome onset in patients with a background oncological blood diseases with 97,67 sensitivity, 100,0 % specificity, 0,999 area under the ROC curve, in which the most significant indicators were used: the presence of gram−negative pathogens of pneumonia, the number of erythrocytes; immunoregulatory index (СD4/СD8); the number of leukocytes; grade 3 neutropenia. and IgG, was obtained. Fatal prognosis is also caused by other indicators characterizing the underlying disease: anemia, thrombocytopenia, the number of chemotherapy (8 and more) courses. The use of the obtained logistic regression equation to predict pneumonia mortality in patients against a background of oncological blood disease allows to predict pneumonia lethal outcomes based on a few number of parameters that are available in hematological hospitals. This can help to timely optimize the treatment of pneumonia and reduce the mortality rate of the patients and duration of the hospital stay.
Key words: pneumonia, immunity disturbances, oncohematological diseases, prognosis, lethal outcome.