[Clinical features of community-acquired pneumonia associated with acute kidney injury in elderly patients.]

The aim of the study was to determin the incidence, severity and prognostic significance of acute kidney injury (AKI) in elderly patients with community-acquired pneumonia (CAP). 122 older patients (≥60 years) with community-acquired pneumonia were examined. Acute kidney injury was diagnosed in 49 (40,2%) patients including 47 (95,9%) patients with AKI occurring prehospital. In patients with community-acquired pneumonia associated with acute kidney injury the clinical picture of AKI was harder. Also disturbance of consciousness, dyspnea, leg swelling, tachycardia, abnormal liver function tests such as hyperbilirubinemia and hypertransaminasemia were diagnosed more frequently in this group of patients. With the development of AKI increased in-hospital mortality: odds ratio of death among patients with CAP associated with AKI was 8,3 (95% CI 2,75-25,28). So, the development of AKI in elderly patients with CAP is an actual health problem requiring the development of preventive measures and drug therapy in patients with CAP and also mandatory monitoring of patients who have had acute kidney injury.

[Prognostic value of acute kidney injury in patients with community-acquired pneumonia].

AIM: To investigate the incidence, severity, and prognostic value of acute kidney injury (AKI) in patients with community-acquired pneumonia (CAP). SUBJECTS AND METHODS: A total of 293 CAP patients (185 men and 108 women; mean age 54.3±17.1 years) were examined. AKI was diagnosed and classified in accordance with the 2012 KDIGO guidelines. RESULTS: On admission, the serum concentration of creatinine averaged 104.5±73.3 µmol/l. AKI was diagnosed in 83 (28.3%) patients with CAP. Hospital-acquired AKI was found in 25 (8.5%) patients, which amounted to 30.1% of all the AKI cases. The disease severity according to both the CURB-65 scale and the CRB-65 scale, which neglect blood urea nitrogen concentrations, was higher than that in patients with CAP associated with AKI (1.4±1.0 versus 0.4±0.6 scores; respectively; р<0.0001 and 0.8±0.7 versus 0.3±0.5 scores, respectively р<0.0001). The disease ended in a fatal outcome in 16 (5.5%) patients. The mortality in the presence of AKI was higher: 9 (10.1%) patients died in the AKI-complicated CAP group; that in the absence of AKI was 7 (5.2%; χ(2)=4.78; р=0.03), the odds ratio for death in the patients with CAP associated with AKI was 3.4; 95% confidence interval, 2.27 to 17.46. Multivariate logistic regression analysis revealed that the occurrence of AKI was independently influenced by age (р<0.001), systolic and diastolic blood pressures (p=0.01 and p=0.01, respectively), and a history of urinary tract diseases (p=0.04) and diabetes mellitus (p<0.001). CONCLUSION: AKI complicates CAP in 28.3% of cases and increases mortality in patients with CAP. The predictors of AKI in CAP patients are old age, hemodynamic disorders, diabetes mellitus, and prior urinary tract diseases.

[Prognostic Significance of Erythropoietin in Patients With Acute Coronary Syndrome].

AIM: to investigate the prognostic role of erythropoietin (EPO) in patients with acute coronary syndrome (ACS). MATERIAL AND METHODS: Eighty-four patients (46 men, 38 women, mean age 63+/-11 years) with ACS were studied. Twenty-one patients had ST-elevation myocardial infarction (STEMI), 12 - non-ST-elevation myocardial infarction, 51 - unstable angina (UA). Ten patients with STEMI received thrombolytic therapy. Coronary angiography during hospitalization was criterion for exclusion from the study. Serum EPO was measured at hospital admission. RESULTS: In-hospital mortality was 5%. Median EPO serum level was higher among patients who died (78.1 [27.8-143.5] vs. 9.0 [6.4-14.1]I.U./ml, p=0.004). Acute kidney injury (AKI) was observed in 7 patients with myocardial infarction (21%) and only in 1 with UA.EPO >10.5 I.U./ml was a significant predictor of AKI development (area under curve 0.73; sensitivity 71%, specificity 67%). CONCLUSION: The results of the present study indicate that in patients with ACS admission serum level of EPO may be an important biomarker of development of AKI and in-hospital mortality.

[Prognostic value of detection of arterial hypotensive episodes in patients with chronic heart failure].

AIM: To define the prognostic value of arterial hypotension (AH) episodes in patients with chronic heart failure (CHF). SUBJECTS AND METHODS: One hundred and ninety-nine patients (mean age 57.2 +/- 10.5 years) were examined. Functional Class I, II, III, and IV CHF was diagnosed in 24, 92, 82, and 1 patients, respectively. The cause of CHF was coronary heart disease concurrent with hypertensive disease in 160 patients. AH was diagnosed when their blood pressure (BP) was < or = 100/60 mm Hg during medical visits and daytime BP < or = 100/60 mm Hg and nocturnal BP < or = 85/47 mm Hg were measured during 24-hour BP monitoring (BPM). The follow-up lasted 24 months. The major end-point was a combined measure of death rates from any cause, incidence rates of myocardial infarction (MI) or stroke. RESULTS: AH was identified in 6.5% of the patients with CHF when BP was measured during their medical visit; 24-hour BPM revealed hypotensive episodes in 65.8%. There were no differences in the major endpoint in relation to the presence of AH episodes. MI developed only in patients with systolic AH episodes (5 versus 0 patients; chi2 = 5.55; p = 0.02) and the risk of MI was associated with the greater magnitude of diastolic AH. CONCLUSION: 24-hour BPM can substantially increase the detection rate of potentially dangerous BP changes. Almost three fourths of patients with CHF were observed to have AH episodes during a day. The use of angiotensin-converting enzyme (ACE) inhibitor/ diuretic, ACE inhibitor/mineral corticoid receptor antagonist, ACE inhibitor/nitrate combinations in the treatment of patients with CHF increase the risk of transient AH. In patients with CHF, the risk of MI is associated with the detection of systolic AH episodes and the magnitude of diastolic AH.

[S24-hour arterial pressure monitoring in patients with chronic cardiac failure and the state of renal function].

The 24-hr AP profiles were obtained in 194 patients with chronic cardiac failure (CCF) depending on the glomerular filtration rate (GFR). It was shown that 24-hour arterial pressure monitoring markedly improves detection of potentially dangerous changes of AP The target AP was achieved in 42.9 and 18.4% of the patients with GFR < or = 45.1 and > or = 69.8 ml/min/1.73 m2 respectively. Episodes of systolic arterial hypotony were diagnosed in 51.0 and 26.5% of the patients with GFR < or = 45.1 and 69.8 ml/min/1.73 m' respectively; episodes of diastolic arterial hypotony in 71.4 and 61.2% of the patients with GFR < or = 45.1 and > or = 69.8 ml/min/1.73 m2 respectively. Duration of systolic and diastolic arterial hypotony during 24 hr correlated with the level of glycemia and the age of the patients respectively.

[Chronic renal disease and atrial fibrillation in patients with chronic heart failure].

AIM: To specify an association between reduced renal function and atrial fibrillation (AF) in patients with chronic heart failure (CHF). SUBJECTS AND METHODS: Three hundred and forty patients (200 males and 140 females, mean age 58 +/- 13 years) with CHF were examined. The causes of CHF were arterial hypertension in 44 (13%) patients, coronary heart disease (CHD) in 112 (33%), and their concomitance in 184 (54%). Sixty-six (19%) patients had diabetes mellitus and 180 (53%) had sustained myocardial infarction. Glomerular filtration rate (GFR) was calculated using the MDRD (Modification of Diet in Renal Disease) formula. Thirty patients presented with paroxysmal persistent AF and 27 had continuous AF. RESULTS: GFR was 68.8 +/- 20.9 ml/min/1.73 m2 (19.2 to 149.7 ml/min/1.73 m2), 114 (33.5%) patients having a GFR of < 60 ml/min/1.73 m2. Proteinuria was observed in 38 (11.2%) patients. GFR was lower in patients with CHF and AF (58.8 +/- 14.2 ml/min/1.73 m2 than that in those without AF (69.1 +/- 18.8 ml/min/1.73 m2; p < 0.001). The patients with decreased renal function had a larger diameter of the left atrium and more commonly mitral regurgitation. Logistic regression analysis revealed that chronic renal disease (CRD) (relative risk (RR) 2.3, 95% confidence interval (CI) 1.2 to 4.3), functional class CHF (RR, 1.8, 95% CI 1.0 to 3.1) were independently associated with AF. CONCLUSION: Decreased renal function predisposes to the development of AF in patients CHF. CRD should be considered as a condition presenting a risk for AF.