Community-acquired pneumonia course peculiarities in comorbid patients hospitalized during the epidemic of respiratory viral infections


DOI: https://dx.doi.org/10.18565/therapy.2020.6.103-112

Izmozherova N.V., Popov A.A., Gavrilova E.I., Kuryndina A.A., Tagiltseva N.V. Shambatov M.A.

Ural State Medical University of the Ministry of Healthcare of Russia, Ekaterinburg
The purpose of the study was to estimate the peculiarities of comorbid pathology in patients with community-acquired pneumonia (CAP) hospitalized in a hospital during the period of the respiratory infection epidemic.
Material and methods. A simultaneous study of 213 medical histories of patients was performed. The data of anamnesis, physical examination, laboratory and instrumental studies were analyzed. Comorbidity was estimated by means of Charlson index (ICh), due to which patients were divided into two groups: with moderate (≤2 points) and high level of comorbidity (≤3 points). The severity of CAP was assessed at a CRB-65 scale.
Results. In the general structure of comorbidity were mostly common occurred such pathologies as arterial hypertension (AH) (33,9%), chronic heart failure (CHF) (21,9%), anemia (15%), type 2 diabetes mellitus (type 2) (11,2%) and HIV infection (9,9%). In case of high comorbidity significantly often took place arterial hypertension, coronary heart disease (CHD), atrial fibrillation (AF), heart failure, type 2 diabetes, chronic obstructive pulmonary disease (COPD), chronic renal failure (CRF), rheumatoid arthritis (RA), and HIV infection and chronic viral hepatitis C. Patients with high comorbidity were significantly older than patients with moderate comorbidity, they had lower saturation rates and higher values of respiratory rate, systolic blood pressure, leukocyte levels, C-reactive protein in blood. In patients with moderate comorbidity, tachycardia was more often observed, and the duration of antibiotic therapy was shorter. Patients with severe CAP had high comorbidity levels significantly more often. In bacteriological sputum examination in CAP patients with high comorbidity, the resistant staphylococci and Candida fungi were found significantly more common.
Conclusion. Cardiovascular diseases, anemia, type 2 diabetes, HIV infection prevailed in the general structure of comorbidity of hospitalized patients during the acute respiratory viral infection epidemic due to pneumonia arising. Among patients with CAP and high comorbidity, diseases of the cardiovascular system, type 2 diabetes, COPD, chronic renal failure, rheumatoid arthritis, HIV infection and chronic viral hepatitis C were found more often; resistant staphylococci and Candida fungi were detected more often. Patients with severe CAP (as assessed by CRB-65) were significantly more likely to have high levels of comorbidity, but most patients with mild CAP had a concomitant pathology that necessitated hospitalization.
Keywords: ARVI, community-acquired pneumonia, hospitalization
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About the Autors

Nadezhda I. Izmozherova, MD, associate professor, head of Department of pharmacology and clinical pharmacology of Ural State Medical University of the Ministry of Healthcare of Russia, Chief freelance specialist – clinical pharmacologist of the Ministry of Healthcare of the Sverdlovsk region. Address: 620000, Ekaterinburg, 17 Klyuchevskaya Str. Tel.: +7 (912) 289-92-13. E-mail: nadezhda_izm@mail.ru. ORCID: 0000-0001-78269657 (Contact person)
Artem A. Popov, MD, associate professor, head of Department of hospital therapy and emergency medical care of Ural State Medical University of the Ministry of Healthcare of Russia. Address: 620144, Ekaterinburg, 202a 8 Marta Str.
Tel.: + 7 (912) 249-71-49. E-mail: art_popov@mail.ru. ORCID: 0000-0001-6216-2468
Elena I. Gavrilova, PhD, associate professor of the Department of pharmacology and clinical pharmacology of Ural State Medical University of the Ministry of Healthcare of Russia. Address: 620000, Ekaterinburg, 17 Klyuchevskaya Str. Tel.: +7 (904) 543-47-50. E-mail: egavrilova7@gmail.com. ORCID: 0000-0003-4680-9254
Anna A. Kuryndina, PhD, associate professor of the Department of pharmacology and clinical pharmacology of Ural State Medical University of the Ministry of Healthcare of Russia. Address: 620000, Ekaterinburg, 17 Klyuchevskaya Str. Tel.: +7 (908) 634-05-19. E-mail: kurri-anna@yandex.ru
Natalia V. Tagiltseva, PhD, associate professor of the Department of pharmacology and clinical pharmacology of Ural State Medical University of the Ministry of Healthcare of Russia. Address: 620000, Ekaterinburg, 17 Klyuchevskaya Str.
Tel.: +7 (912) 248-21-04. E-mail: natatag@mail.ru
Muraz A. Shambatov, 6th year student of Faculty of medicine of Ural State Medical University of the Ministry of Healthcare of Russia. Address: 620000, Ekaterinburg, 3 Repin Str. Tel.: +7 (999) 564-65-48. E-mail: Muraz.shambatov@rambler.ru. ORCID: 0000-0001-7312-415X


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