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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">avk</journal-id><journal-title-group><journal-title xml:lang="ru">Архивъ внутренней медицины</journal-title><trans-title-group xml:lang="en"><trans-title>The Russian Archives of Internal Medicine</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2226-6704</issn><issn pub-type="epub">2411-6564</issn><publisher><publisher-name>“SINAPS” LLC</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.20514/2226-6704-2024-14-2-132-143</article-id><article-id custom-type="elpub" pub-id-type="custom">avk-1752</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОРИГИНАЛЬНЫЕ СТАТЬИ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>ORIGINAL ARTICLE</subject></subj-group></article-categories><title-group><article-title>Ранние клинико-лабораторные предикторы госпитальной летальности у пациентов с сепсисом на фоне пневмонии</article-title><trans-title-group xml:lang="en"><trans-title>Early Clinical and Laboratory Predictors of Hospital Mortality in Patients with Sepsis Secondary to Pneumonia</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-6819-6968</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Родионова</surname><given-names>Ю. О.</given-names></name><name name-style="western" xml:lang="en"><surname>Rodionova</surname><given-names>Yu. O.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Юлия Олеговна Родионова</p><p>Томск</p></bio><bio xml:lang="en"><p>Yuliya O. Rodionova</p><p>Tomsk</p></bio><email xlink:type="simple">rodionova.yo@ssmu.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Старовойтова</surname><given-names>Е. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Starovoitova</surname><given-names>E. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Томск</p></bio><bio xml:lang="en"><p>Tomsk</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Федосенко</surname><given-names>С. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Fedosenko</surname><given-names>S. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Томск</p></bio><bio xml:lang="en"><p>Tomsk</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Нестерович</surname><given-names>С. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Nesterovich</surname><given-names>S. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Томск</p></bio><bio xml:lang="en"><p>Tomsk</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Иванова</surname><given-names>А. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Ivanova</surname><given-names>A. I.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Томск</p></bio><bio xml:lang="en"><p>Tomsk</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Аржаник</surname><given-names>М. Б.</given-names></name><name name-style="western" xml:lang="en"><surname>Arzhanik</surname><given-names>M. B.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Томск</p></bio><bio xml:lang="en"><p>Tomsk</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Семенова</surname><given-names>О. Л.</given-names></name><name name-style="western" xml:lang="en"><surname>Semenova</surname><given-names>O. L.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Томск</p></bio><bio xml:lang="en"><p>Tomsk</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Зима</surname><given-names>А. П.</given-names></name><name name-style="western" xml:lang="en"><surname>Zima</surname><given-names>A. P.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Томск</p></bio><bio xml:lang="en"><p>Tomsk</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Винокурова</surname><given-names>Д. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Vinokurova</surname><given-names>D. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Томск</p></bio><bio xml:lang="en"><p>Tomsk</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Денисова</surname><given-names>О. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Denisova</surname><given-names>O. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Томск</p></bio><bio xml:lang="en"><p>Tomsk</p></bio><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ФГБОУ ВО «Сибирский государственный медицинский университет» Минздрава России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Federal State Budgetary Educational Institution of Higher Education “Siberian State Medical University” of the Ministry of Health of Russia</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2024</year></pub-date><pub-date pub-type="epub"><day>06</day><month>04</month><year>2024</year></pub-date><volume>14</volume><issue>2</issue><fpage>132</fpage><lpage>143</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Родионова Ю.О., Старовойтова Е.А., Федосенко С.В., Нестерович С.В., Иванова А.И., Аржаник М.Б., Семенова О.Л., Зима А.П., Винокурова Д.А., Денисова О.А., 2024</copyright-statement><copyright-year>2024</copyright-year><copyright-holder xml:lang="ru">Родионова Ю.О., Старовойтова Е.А., Федосенко С.В., Нестерович С.В., Иванова А.И., Аржаник М.Б., Семенова О.Л., Зима А.П., Винокурова Д.А., Денисова О.А.</copyright-holder><copyright-holder xml:lang="en">Rodionova Y.O., Starovoitova E.A., Fedosenko S.V., Nesterovich S.V., Ivanova A.I., Arzhanik M.B., Semenova O.L., Zima A.P., Vinokurova D.A., Denisova O.A.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.medarhive.ru/jour/article/view/1752">https://www.medarhive.ru/jour/article/view/1752</self-uri><abstract><p>Несмотря на значительный прогресс в области профилактики, ранней диагностики и антибактериальной терапии, внебольничная пневмония по-прежнему сохраняет статус не только наиболее распространенного среди острых инфекционных заболеваний, но и является частым источником развития сепсиса, многократно повышающего вероятность летального исхода в данной группе пациентов.Целью исследования стало выполнение сравнительного анализа клинико-лабораторных показателей и оценка характера их изменений в первые 48 часов от момента верификации сепсиса, развившегося на фоне пневмонии, у пациентов терапевтического отделения в зависимости от исхода госпитализации.Клинические группы и методы исследования. Выполнено ретроспективное сравнительное исследование, включившее методом сплошной выборки пациентов с сепсисом, развившемся на фоне пневмонии у пациентов, госпитализированных в терапевтические клиники ФГБОУ ВО СибГМУ Минздрава России в период с 01.01.2019 г. по 30.04.2023 г. Всего в исследование включены 40 пациентов обоего пола с последующим разделением на две группы сравнения в зависимости от исхода госпитализации (выписка из стационара или наступление летального исхода) для динамической оценки клинико-анамнестических и лабораторных параметров в ранние сроки развития септического состояния (первые 48 часов) с целью определения их связи с исходом госпитализации.Результаты. Все пациенты были разделены на 2 группы. Первую группу (n=17, 42,5 %) составили пациенты с благоприятным исходом госпитализации (выздоровление), вторую группу (n=23, 57,5 %) составили пациенты с летальным исходом. На момент верификации сепсиса пациенты с благоприятным исходом имели значимо ниже балл по шкале SOFA (3 (2; 6) балла), чем у пациентов с летальным исходом (6 (5; 7) баллов), р=0,037. Изменение концентрации мочевины в первые 48 часов от момента верификации сепсиса в группе выживших составило -1,3 (-4,4; 1,99) ммоль/л, а в группе умерших 5,5 (-1,5; 12,2) ммоль/л, p=0,020. В группе умерших пациентов 8 человек (34 %) на момент верификации сепсиса имели сочетание гипотонии (&lt;90/60 мм рт. ст.) и содержание лактата в сыворотке крови &gt;5 ммоль/л. В группе выживших гипотония наблюдалась только у 2 человек (11 %), причем показатели уровня лактата у этих пациентов находились в диапазоне 4,5-4,6 ммоль/л. В точке 1 показатели незрелых гранулоцитов статистически значимо не различались у выживших и умерших пациентов (1,2 (0,7; 2,1)% vs 0,8 (0,6; 1,5)%, соответственно, р&gt;0,05). Через 48 часов уровень незрелых гранулоцитов нарастал у выживших пациентов до 1,5 (1; 3,2)% и наоборот, снижался до 0,65 (0,45; 1,45)% в группе умерших, причем разница этих показателей между группами стала статистически значимой, р &lt;0,05.Заключение. У пациентов с сепсисом на фоне тяжелой пневмонии летальность составила 57,5 %. С целью выделения групп высокого риска летального исхода помимо оценки по шкале SOFA следует осуществлять динамический контроль в первые 48 часов от момента верификации септического состояния таких биомаркеров, как уровень мочевины, лактата, уровень незрелых гранулоцитов и ретикулоцитов.</p></abstract><trans-abstract xml:lang="en"><p>Despite significant progress in the field of prevention, early diagnosis and antibacterial therapy, community-acquired pneumonia still retains the status of not only the most common among acute infectious diseases, but is also a frequent source of sepsis, which greatly increases the likelihood of death in this group of patients. The purpose of the study was to perform a comparative analysis of clinical and laboratory parameters and assess the nature of their changes in the first 48 hours from the moment of verification of sepsis that developed against the background of pneumonia in patients of the therapeutic department, depending on the outcome of hospitalization.Clinical groups and research methods. A retrospective comparative study was carried out, which included, using a continuous sampling method, patients with sepsis that developed against the background of pneumonia in patients hospitalized in therapeutic clinics of the Federal State Budgetary Educational Institution of Higher Education Siberian State Medical University of the Ministry of Health of Russia in the period from 01/01/2019 to 04/30/2023. In total, the study included 40 patients of both gender, followed by division into two comparison groups depending on the outcome of hospitalization (discharge from hospital or death) for the dynamic assessment of clinical, anamnestic and laboratory parameters in the early stages of the development of a septic condition (the first 48 hours) in order to determine their relationship with the outcome of hospitalization.Results. All patients were divided into 2 groups. The first group (n=17, 42.5 %) consisted of patients with a favorable outcome of hospitalization (recovery), the second group (n=23, 57.5 %) consisted of patients with a fatal outcome. At the time of verification of sepsis, patients with a favorable outcome had a significantly lower SOFA score (3 (2; 6) points) than patients with a fatal outcome (6 (5; 7) points), p = 0.037. The change in urea concentration in the first 48 hours from the moment of verification of sepsis, which in the group of survivors was -1.3 (-4.4; 1.99) mmol/l, and in the group of deceased 5.5 (-1.5; 12. 2) mmol/l, p=0.020. In the group of deceased patients, 8 people (34 %) at the time of verification of sepsis had a combination of hypotension (&lt;90/60 mm Hg) and serum lactate &gt;5 mmol/l. In the survivor group, hypotension was observed in only 2 people (11 %), and lactate levels in these patients were in the range of 4.5- 4.6 mmol/l. At point 1, the indicators of immature granulocytes were not statistically significantly different between surviving and deceased patients (1.2 (0.7; 2.1)% vs 0.8 (0.6; 1.5)%, respectively, p&gt;0. 05). After 48 hours, the level of immature granulocytes increased in surviving patients to 1.5 (1; 3.2)% and, conversely, decreased to 0.65 (0.45; 1.45)% in the group of deceased patients, and the difference in these indicators between groups became statistically significant, p &lt;0.05.Conclusion. Thus, in patients with sepsis against the background of severe pneumonia, the mortality rate was 57.5 %. In order to identify groups at high risk of death due to sepsis due to pneumonia, in addition to the SOFA scale, dynamic monitoring of biomarkers such as urea, lactate, immature granulocytes and reticulocytes should be carried out in the first 48 hours from the moment of verification of the septic state.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>сепсис</kwd><kwd>летальность</kwd><kwd>пневмония</kwd><kwd>предикторы летального исхода</kwd></kwd-group><kwd-group xml:lang="en"><kwd>sepsis</kwd><kwd>mortality</kwd><kwd>pneumonia</kwd><kwd>predictors of death</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Всемирная организация здравоохранения. Информационный бюллетень от 09.12.2020 г. [Электронный ресурс] URL: 15. https://www.who.int/ru/news-room/fact-sheets/detail/the-top-10-causes-of-death. 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