DOI: https://doi.org/10.26641/2307-0404.2018.1(part2).126945

The optimization of treatment of patients with community-acquired pneumonia with high cardiovascular risk (case from practice).

V. F. Orlovskii, A. V. Zharkova, S. Ya. Udovichenko

Abstract


Pneumonia occupies a significant part in the structure of morbidity and mortality of the population of Ukraine and the whole world. The incidence of this disease is several times higher among elderly patients. At the same time the prognosis for patients of this category can be fairly unfavorable, being connected with a number of age features. This fact, in its turn, points out the necessity of more precise criteria and new methods of assessing changes in the condition of a patient with pneumonia, and it also became a valid criterion to use in determining the severity and prognosis of the disease course. In this article the specific example of the application of the algorithm, named “Integral geriatric evaluation adapted for emergency care”, in the treatment of an elderly patient with pneumonia was considered. The role of statins in the complex treatment of patients with inflammatory diseases and their link with the level of C-reactive protein as a risk indicator of the unfavourable course of the disease in the form of the thrombotic complications was specifieced. So, medical care for elderly patients with pneumonia should be comprehensive in terms of diagnosis (improving the fairness through the application of the new and more precise methodology of assessing the functional state of a human organism) and treatment. The high degree of comorbidity among patients of the category “frail elderly” with pneumonia requires the application of approaches, which enable to reduce the cardiovascular risks and otherones. Such approaches include the administering of statins at high doses, in light of its impact on the level of C-reactive protein as a predictor of the thrombotic complications.


Keywords


pneumonia; elderly patients; statins; Ischaemic heart diseases; comorbidity; C-reactive protein

References


[An adapted evidence-based clinical practice guideline. Unified protocol for the provision of medical care to adult patients with community-acquired pneu­monia. "Community-acquired pneumonia in adults: etio­logy, pathogenesis, classification, diagnosis, antibiotic therapy and prophylaxis"]. Kyiv,NationalAcademyof Medical Sciences ofUkraine, 2016.

Mel'nik PS, DzyubaOM, Slabkiy GO, et al. [An­nual report on the health status of the population, the sanitary and epidemiological situation and the results of the Ukrainian health care system]. Ministry of HealthcareUkraine, Kyiv, 2017;516. Ukrainian.

Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project (HCUP), National Inpatient Sample (NIS), 2015. Available from: https://www.ahrq.gov/research/data/hcup/index.html

Rockwood K, Song X, MacKnight C, Berg­man H, Hogan DB, McDowell I, et al. A global clinical mea­sure of fitness and frailty in elderly people. Can Med Assoc J. 2005;173:489-95.

Fang-Cheng Su, Xi-Dong Li, Shao-Xia Sun, et al. Atorvastatin Treatment for Atrial Fibrillation Reduces Serum High-Sensitivity C-Reactive Protein Levels. BioMed Research International. 2015;Article ID 402481:10. doi: 10.1155/2015/402481

El-Solh AA, Niederman MS, Drinka P. Nursing home-acquired pneumonia: a review of risk factors and therapeutic approaches. Curr Med Res Opin. 2010 Dec;26(12):2707-14. doi: 10.1185/03007995.2010.530154

Froes F. Community-acquired pneumonia in adults in mainland Portugald incidence and mortality in hospital inpatients between 1998 and 2000. Rev Port Pneumol. 2003 May-Jun;9(3):187-94. PMID: 14685629

González-Castillo J, Martín-Sánchez F, et al. Gui­delines for the management of community- acquired pneumonia in the elderly patient. Rev Esp Quimioter. 2014 Mar;27(1):69-86. PMID: 24676248

Morimoto K, Suzuki M, Ishifuji T, Yaegashi M, Asoh N, Hamashige N, et al. The Burden and Etiology of Community-Onset Pneumonia in the Aging Japanese Population: A Multicenter Prospective Study. PLoS ONE. 2015;10(3):e0122247. Available from: https://doi.org/10.1371/journal.pone.0122247


GOST Style Citations


  1. Адаптована клінічна настанова, заснована на доказах. Уніфікований протокол надання медичної допомоги дорослим хворим на негоспітальну пнев­монію: негоспітальна пневмонія у дорослих осіб: етіологія, патогенез, класифікація, діагностика, анти­бактеріальна терапія та профілактика. Рішення Пре­зидії Національної академії медичних наук України, протокол № 12/6 від 10.11.2016 р.. 2016: НАМН України, 10.11.2016. – 108 c.
  2. Щорічна доповідь про стан здоров’я насе­лення, санітарно-епідемічну ситуацію та результати діяльності системи охорони здоров’я України / П.С. Мельник, О.М. Дзюба, Г.О. Слабкий [та ін.] // http://www.niss.gov.ua/. — 2017. — Режим доступу: http://www.uiph.kiev.ua/vidavnicha-diyalnist/shchorich­na-dopovid.
  3. Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project (HCUP). National Inpatient Sample (NIS), 2015 https://www.ahrq.gov/research/data/hcup/index.html
  4. A global clinical measure of fitness and frailty in elderly people / K. Rockwood, X. Song, C. MacKnight [et al.] // Canadian Medical Association J. – 2005. – Vol. 173, N 5. – P. 489-495.
  5. Atorvastatin Treatment for Atrial Fibrillation Re­duces Serum High-Sensitivity C-Reactive Protein Levels / Fang-Cheng Su, Xi-Dong Li, Shao-Xia Sun [et al.] // Bio. Med. Research Inter., 2015. – P. 1-10.
  6. El-Solh A.A. Nursing home-acquired pneumonia: a review of risk factors and therapeutic approaches / A.A. El-Solh, M.S. Niederman, P. Drinka // Curr. Med. Res. Opin. – 2010. – Vol. 26, N 12. – P. 2707-2714.
  7. Froes F. Community-acquired pneumonia in adults in mainland Portugald incidence and mortality in hospital inpatients between 1998 and 2000 / F. Froes // Rev. Port. Pneumol. – 2003. – Vol. 9, N 3. – P. 187-194.
  8. Guidelines for the management of community- acquired pneumonia in the elderly patient / J. González-Castillo, F. Martín-Sánchez [et al.] // Revista Espanola De Quimioterapia. – 2014. – Vol. 27, N 1. – P. 69-86.
  9. The Burden and Etiology of Community-Onset Pneumonia in the Aging Japanese Population: A Mul­ticenter Prospective Study / K. Morimoto, M. Suzuki, T. Ishifuji [et al.] // PLOS One. – 2015. – Vol. 10, N 3.




 

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