Predictors of community-acquired pneumonia severity in patients with chronic heart failure

Abstract

Introduction. Community-acquired pneumonia (CAP) remains a major cause of morbidity and mortality, particularly in patients with chronic heart failure (CHF), who are at increased risk of adverse outcomes. Identifying reliable predictors of disease severity in this population is essential for timely risk stratification and optimization of therapeutic strategies. Aim of the study. Assessment of clinical and disease-course characteristics, oxidative stress, and predictors of CAP severity in patients with CHF. Materials and methods. A total of 210 patients were enrolled in the study and divided into two groups: group 1 (n = 105) – patients with community-acquired pneumonia associated with chronic heart failure and group 2 (n = 105) – patients with community-acquired pneumonia without chronic heart failure. The research was conducted based on clinical examination of patients, daily monitoring of the inflammatory process, assessment of comorbidities, and paraclinical investigations. Statistical analysis of the collected data was performed using a wide range of methods, including descriptive statistics, correlational analysis, and regression models. Results. The age of patients in the study group ranged from 50 to 92 years, with a mean of 70.6 ± 8.89 years (95% CI [68.8–72.3]), (F = 18.109; p = 0.205). In Group 1, the proportion of women was 57 (54.3%; 95% CI [44.8-64.1]), and that of men was 48 (45.7%; 95% CI [35.9-55.2]). In Group 2, the proportion of men was higher than that of women: 54 (51.4%; 95% CI [42.3-61.0]) men and 51 (48.6%; 95% CI [39.0-57.7]) women, respectively (χ2 = 0.686; df = 1; p = 0.407). Ischemia- modified albumin values were higher in patients in Group 1 compared to Group 2: 236.60 ± 57.23 μM/L and 229.77 ± 64.35 μM/L, respectively, (F = 0.660; p = 0.045). The IMA threshold value of 218.98 μM/L was determined for patients with CHF and severe CAP. The mean NT-proBNP values in Group 1 patients were 1371.88 ± 498.91 pg/ml, compared to Group 2: 58.19 ± 48.22 pg/ml, (F = 721.54; p < 0.0001). The NT-proBNP threshold value of 1665.73 pg/ml was identified for severe CAP in CHF patients. A method which allows early detection in 87.0% of cases of patients with CHF at high risk of severe community-acquired pneumonia was developed. Conclusions. Our hypothesis that community-acquired pneumonia in patients with chronic heart failure is more frequently associated with a severe clinical course was confirmed. The proposed NT-proBNP and ischemia-modified albumin threshold values, together with our risk estimation formula, may improve early therapeutic intervention to prevent severe complications.