Lung vessels thrombosis in hospitalized patients with community-acquired pneumonia: role of endothelial function, hemostasis, fibrinolysis and inflammation on different phases of treatment

There are limited data on the relationship between the severity of community-acquired pneumonia (CAP), biomarkers of inflammation and coagulation as well. The aim was to evaluate the association between the severity of CAP and risk of thrombosis in patients with moderate and severe CAP. To estimate the role of parameters of systemic inflammation, endothelial dysfunction, hemostasis, coagulation on different phases of treatment. Materials and methods: The main group was 75 patients CAP. We divided the main group according severity: subgroup 1 – 41 patients with moderate CAP, subgroup 2 – 34 patients with severe CAP. Blood coagulation test, determination of biomarkers was performed at admission before starting of antibacterial treatment and after clinical stability on 7–10 day after hospitalization. Results: We found that in both subgroup 1 and subgroup 2 the mean levels of CRP and fibrinogen were higher than in control group. Moreover, the mean level of D-dimer was significantly higher and protein C (PC) was significantly lower in both subgroups in comparison with control group. Normalization of PC is coming after 7–10 days of antibacterial treatment, vice versa ET-1, which reflects prolong endothelial dysfunction in patients with severe CAP. Conclusions: patients with severe CAP have the high risk of thrombosis which can be associated with endothelial dysfunction; definition of such parameters as ET-1 and PC can be useful for establishment of different coagulant disorders in patient with mild and moderate CAP, and their dynamic changes could be the initial point of prescribing or cancelling of anticoagulant treatment

Neutrophil-to-lymphocyte ratio in predicting prognosis and course of community community-acquired pneumonia in hospitalized patients.

Currently, a marker which could be used both to assess the severity of community acquired pneumonia (CAP) and determine the risk of complications is being searched. According to some authors, Neutrophil-to-Lymphocyte Ratio (NLR) could be such a marker. Therefore, the aim of our research was to determine the diagnostic significance of NLR in patients with CAP and to establish the relationship of NLR with other clinical and laboratory parameters. We conducted a retrospective analysis of 171 case histories of patients with CAP of 3 and 4 clinical groups, with the calculation of NLR (according to the common blood count). In the course of the work, it was found that NLR reflects a balance between the response of neutrophils and lymphocytes and this parameter is associated with the severity of systemic inflammation in patients with CAP. NLR has good diagnostic value in determining the mortality risk in patients with CAP, specially an increase in the level of NLR (more than 10) is associated with a high risk of life-threatening complications

Community-aquired Pneumonia on the Background of Coronaviral Disease (COVID-19): Principles of Diagnostics and Determination of Risk Factors of Pathological Process Aggravation

The diagnosis of community-acquired pneumonia (CAP) on the background of COVID-19 is especially actual due to the prevalence of this pathology and the possible aggravation of the pathological process. The aim of our study was to improve the principles of CAP diagnostics on the background of COVID-19 and to determine risk factors for aggravating of the pathological process. Patients with respiratory symptoms who were hospitalized with suspected COVID-19 were examined. General clinical research methods were carried out, determination of SARS-CoV-2 virus RNA by PCR method, computer tomography (CT) to identify the features of lung tissue damage was performed. The main observation group consisted of 37 patients (men – 19 (51.4%), average age – 61 (57; 69) years) with pneumonia on the background of confirmed COVID-19. According to the severity of coronavirus disease, all patients of the main group were divided into 3 subgroups: subgroup 1 included 17 people with moderate COVID-19, subgroup 2 – 13 people with severe COVID-19, subgroup 3 – 7 people with critical COVID- 19 course. The levels of markers of systemic inflammation (C-reactive protein (C-RP) and fibrinogen) were also determined. Since patients with COVID-19 of moderate severity (which is characterized by the presence of community-acquired viral pneumonia) belong to the risk group of severe and critical course, it is suggested to consider the following risk factors for aggravating the pathological process as: temperature over 38.5°C, heart rate over 90 per minute, respiratory rate over 20 per minute, SpO2 ≤ 93%; absolute lymphopenia (less than 0.9 G/L) and an increase in serum levels of C-RP more than 50 mg/L and fibrinogen more than 5 g/L