rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2024-2-14-28rmt-2401Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯCLINICAL STUDIESПрогностические маркеры гнойно-деструктивных заболеваний легкихPrognostic Markers of Acute Suppurative Lung Diseasehttps://orcid.org/0000-0002-5477-4920ФетламД. Л.FetlamD. L.

Фетлам Дмитрий Леонидович

107031, Москва, ул. Петровка, д. 25, стр. 2

Dmitry L. Fetlam

25 Petrovka Str., Bldg. 2, 107031 Moscow

dmfetlam@yandex.ruhttps://orcid.org/0000-0001-6279-2849ЧумаченкоА. Г.ChumachenkoA. G.

Анастасия Геннадьевна Чумаченко

107031, Москва, ул. Петровка, д. 25, стр. 2

Anastasia G. Chumachenko

25 Petrovka Str., Bldg. 2, 107031 Moscow

a_chumachenko@mail.ruВязьминаМ. Д.VyazminaM. D.

Мария Дмитриевна Вязьмина

107031, Москва, ул. Петровка, д. 25, стр. 2

Maria D. Vyazmina

25 Petrovka Str., Bldg. 2, 107031 Moscow

masha83857@mail.ruhttps://orcid.org/0000-0002-8880-7364МорозВ. В.MorozV. V.

Виктор Васильевич Мороз

107031, Москва, ул. Петровка, д. 25, стр. 2

Victor V. Moroz

25 Petrovka Str., Bldg. 2, 107031 Moscow

vmoroz@fnkcrr.ruhttps://orcid.org/0000-0002-5930-0118КузовлевА. Н.KuzovlevA. N.

Артем Николаевич Кузовлев

107031, Москва, ул. Петровка, д. 25, стр. 2

Artem N. Kuzovlev

25 Petrovka Str., Bldg. 2, 107031 Moscow

artem_kuzovlev@mail.ruhttps://orcid.org/0000-0002-5729-9846ПисаревВ. М.PisarevV. M.

Владимир Митрофанович Писарев

107031, Москва, ул. Петровка, д. 25, стр. 2

Vladimir M. Pisarev

25 Petrovka Str., Bldg. 2, 107031 Moscow

vpisarev@gmail.comНИИ общей реаниматологии им. В.А. Неговского Федерального научно-клинического центра реаниматологии и реабилитологииРоссияV.A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and RehabilitologyRussian Federation2024240420242021428Copyright © Фетлам Д.Л., Чумаченко А.Г., Вязьмина М.Д., Мороз В.В., Кузовлев А.Н., Писарев В.М., 20242024Фетлам Д.Л., Чумаченко А.Г., Вязьмина М.Д., Мороз В.В., Кузовлев А.Н., Писарев В.М.Fetlam D.L., Chumachenko A.G., Vyazmina M.D., Moroz V.V., Kuzovlev A.N., Pisarev V.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/2401

Показатель летальности среди пациентов с гнойно-деструктивными заболеваниями (ГДЗЛ) в ОРИТ достигает 30%. Для обеспечения персонификации и повышения эффективности лечения при ГДЗЛ необходимы ранние патогенетически значимые биомаркеры. Такими биомаркерами-кандидатами могут быть количественные вариации содержания клеток иммунной системы в кровотоке.

Цель исследования

Цель исследования. Выявление потенциальных маркеров исхода ГДЗЛ после перенесенной внебольничной пневмонии и COVID-19.

Материалы и методы

Материалы и методы. В исследование включили пациентов ГКБ г. Москвы (n=216) с ГДЗЛ после перенесенной внебольничной пневмонии, переболевших (n=81), либо не переболевших COVID-19 (n=135), в возрасте 18–87 лет.

Результаты

Результаты. Выживаемость пациентов, переболевших COVID-19, зависела от количества лимфоцитов на 1-й день госпитализации (Hazard Ratio, HR=5,9 95%CI 0,9–37,4; p=0,0188, логранговый критерий). У пациентов, не переболевших COVID-19, обнаружили разницу выживаемости в зависимости от содержания лимфоцитов (HR=2,9 95%CI 1,0–8,4; p=0,0184, логранговый критерий), а также моноцитов (HR=2,7 95%CI 0,8–9,5; p=0,0196, логранговый критерий) в 1-й день госпитализации. У пациентов, переболевших COVID-19, обнаружили разницу выживаемости в зависимости от значения SII (Systemic Immune-inflammation Index, HR=9,3 95%CI 1,7–49,8; p=0,0124, логранговый критерий), SIRI (Systemic Inflammation Response Index, HR=7,2 95%CI 1,4–36,6; p=0,0339, логранговый критерий) и NLR (Neutrophil-to-Lymphocyte Ratio, Отношение нейтрофилов к лимфоцитам, ОНЛ, HR=9,6 95%CI 1,8–52,0; p=0,0108; логранговый критерий) в 1-й день госпитализации. У пациентов, не переболевших COVID-19, разницу выживаемости в зависимости от значения SII (p=0,26, n=135), SIRI (p=0,31) и NLR (p=0,23) не обнаружили.

Заключение

Заключение. Количество лимфоцитов в 1-й день госпитализации позволяет строить прогноз исхода при эмпиеме плевры независимо от наличия COVID-19 в анамнезе, а именно: снижение количества лимфоцитов ниже значений 1,2×10⁹ в л ассоциируется с летальным исходом. Для пациентов с эмпиемой плевры, не переболевших COVID-19, прогностической информативностью обладает показатель содержания моноцитов. Из относительных показателей при определении в 1-й день госпитализации индексы SIRI, SII и NLR позволяли прогнозировать исход ГДЗЛ только для пациентов, переболевших COVID-19: увеличенные значения этих показателей ассоциированы с летальностью. При этом наиболее информативным оказался индекс NLR. Увеличение оценки по шкале Cirs выше 10 связано с неблагоприятным исходом ГДЗЛ, независимо от наличия COVID-19 в анамнезе.

The mortality rate among patients with acute suppurative lung diseases (ASLD) in the ICU reaches 30%. Early, pathogenetically relevant biomarkers are needed to ensure personification and better efficacy of ASLD treatment. Numeric variations in the counts of immune system cells in patient’s blood can be viewed as such candidate biomarkers.

The aim of the study

The aim of the study. Identification of potential markers predicting ASLD outcome after community-acquired pneumonia and COVID-19.

Materials and methods

Materials and methods. The study included 216 in-hospital patients aged 18-87 with ASLD after community-acquired pneumonia with (N=81) and without (N=135) COVID-19 history.

Results

Results. Patients survival after COVID-19 was linked to lymphocyte count on Day 1 of hospital stay (hazard ratio, HR=5.9 95%CI 0.9–37.4; P=0.0188, log-rank test). In patients who had not have COVID-19, a difference in survival was associated with lymphocyte (HR=2.9 95%CI 1.0–8.4; P=0.0184, log-rank test; N=135), and monocyte counts (HR=2.7 95% CI 0.8–9.5; P=0.0196, log-rank test) on Day 1 of hospital stay. Patients’ survival after COVID-19 infection depended on SII (systemic immune-inflammation index. HR=9.3 95%CI 1.7–49.8; P=0.0124, log-rank test; N=81, SIRI (systemic inflammatory response index, HR=7.2 95%CI 1.4–36.6; P=0.0339, log-rank test; N=81) and NLR (neutrophil-to-lymphocyte ratio, HR=9.6 95%CI 1.8–52.0; P=0.0108; log-rank test; N=81) values on Day 1 of hospital stay. In patients who did not have COVID-19 SII values had no influence on survival.

Conclusion

Conclusion. The lymphocyte count makes it possible to predict outcomes of pleural empyema, regardless of patient’s history of COVID-19, i. e. a decrease in the lymphocyte count below 1.2×10⁹ in 1 L is associated with fatal outcome. Monocyte count carries prognostic information for cases of pleural empyema without previous COVID-19 infection. As for the relative indicators, SIRI, SII and NLR values measured on Day 1 in the hospital were predictors of ASLD outcome only in patients after COVID-19 infection, i. e., higher values were associated with increased risk of death, with NLR index being the most informative. Overall severity of illness above 10 scores by CIRS was associated with an unfavorable ASLD outcome, regardless of patient’s history of COVID-19.

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The authors declare that there are no conflicts of interest present.