Faktori udruženi sa ranim neuspehom u lečenju odraslih hospitalizovanih bolesnika sa vanbolnički stečenom pneumonijom
Sažetak
Uvod/Cilj. Rani neuspeh u lečenju (early treatment failure – ETF) hospitalizovanih bolesnika sa vanbolnički stečenom pneumonijom (community-acquired pneumonia – CAP) udružen je sa produženom hospitalizacijom, većim rizikom od smrtnog ishoda i visokim troškovima lečenja. Cilj ove studije bio je da analizira relativni značaj faktora koji utiču na pojavu ETF kod odraslih hospitalno lečenih bolesnika zbog CAP, a koji još uvek nisu dovoljno istraženi. Metode. Sprovedena je retrospektivna studija tipa slučaj-kontrola na uzorku od 126 odraslih bolesnika lečenih zbog težih oblika CAP na Klinici za plućne bolesti Kliničkog centra Srbije u Beogradu, u periodu 01.01.2007–31.12.2011. godine. „Slučajeve“ su činila 63 uzastopno odabrana bolesnika sa uočenim neuspehom u lečenju u toku prva tri dana nakon prijema u bolnicu, dok se kontrolna grupa sastojala od identičnog broja nasumično izabranih bolesnika kod kojih takav ishod nije zabeležen. Povezanost između potencijalnih faktora rizika, odnosno protektivnih faktora i ETF procenjena je logističkom regresionom analizom. Rezultati. Udružena gastrointestinalna oboljenja [korigovani odds ration (OR) 18,83, 95% interval poverenja (CI) 1,15–309,04], viši CURB-65 (C – konfuzija; U – urea 7 mmol/L; R – frekvencija disanja ≥ 30 udisaja/min; B – sistolni krvni pritisak < 90 mmHg ili dijastolni krvni pritisak ≤ 60 mmHg; 65 – životno doba ≥ 65 godine) skor na prijemu (korigovani OR 2,57, 95% CI 1.05–6.25), inicijalna primena nesteroidnih antiinflamatornih lekova (NSAIL) u bolnici (korigovani OR 38,19, 95% CI 3,61–404,51) i prethodno ambulantno lečenje inhalacionim kortikosteroidima (korigovani OR 22,41, 95% CI 1,03–489,06), predstavljali su značajne faktore rizika za pojavu ETF. S druge strane, starije životno doba i upotreba antibiotika zbog iste infekcije pre prijema u bolnicu bili su povezani sa znatno nižim rizikom od razvoja ETF, smanjujući pritom šansu za 98%, odnosno za blizu 90%. Zaključak. Izbegavanje rutinske primene NSAIL u bolničkim uslovima i upotreba odgovarajućih antibiotika pre hospitalizacije mogu biti korisni za bolesnike obolele od CAP kod kojih je indikovano bolničko lečenje u smislu smanjenja rizika za nastanak ETF. CURB-65 skor na prijemu u bolnicu može biti bolji prediktor ETF od indeksa težine pneumonije. Dodatne prospektivne studije su potrebne kako bi se potvrdili ovi nalazi.
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