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Vojnosanitetski pregled
2017, vol. 74, br. 9, str. 803-813
jezik rada: engleski
vrsta rada: izvorni naučni članak
doi:10.2298/VSP160211085V

Creative Commons License 4.0
Faktori udruženi sa ranim neuspehom u lečenju odraslih hospitalizovanih bolesnika sa vanbolnički stečenom pneumonijom
Vukadinović Dubravkaa, Samardžić Natalijab, Janković Slobodana ORCID, Tomić-Smiljanić Marijanac, Pavlović Radišaa, Stefanović Srđana ORCID
aUniverzitet u Kragujevcu, Medicinski fakultet
bClinical Center of Serbia, Clinic for Pulmonary Diseases, Belgrade
cPrimary Health Care Center Rakovica, Belgrade

e-adresa: sstefanovic@medf.kg.ac.rs

Projekat

Farmakološka analiza efekata biološki aktivnih supstanci na izolovane glatke mišice gastrointestinalnog i urogenitalnog trakta coveka (MPNTR - 175007)

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.

Ključne reči

pneumonija; hospitalizacija; lečenje; ishod; faktori rizika; komorbiditet

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