The objective of the study was to determine the indicators of clinical and laboratory studies of patients with impaired immunity because of oncohematological pathology determining the severe course and fatal outcome of pneumonia. Materials and methods of research. The authors of research created a computer database with the results of studying 811 patients with impaired immunity. These patients were examined or treated for various nosological forms of oncohematological pathology in the hematological center "City Clinical Multiprofile Hospital No. 4", Dnipro, 2010-2015. The following indicators were studied and analyzed: the age of the patients; form, stage, duration of the disease; number of HT courses; pathogens, pneumonia, the presence of cough and sputum, physical examination data (dry and wet wheezing, percussion data), the time of complaints, body temperature, X-ray data, the course of pneumonia of its complications, heart rate, pulse; laboratory indicators of the blood general analysis, number of leukocytes and neutrophils, immunograms data; accompanying illnesses. The statistical processing of the results was carried out using the methods of descriptive and analytical biostatistics (StatSoftInc., Serial No. AGAR909E415822FA) Microsoft Excel (Office Home Business 2KB4Y-6H9DB-BM47K-749PV-PG3KT). To describe the quantitative traits, the median (Me) interquartile range (25%, 75%) was used to describe the variation of the characteristics. Nonparametric variance analysis of Craskell-Wallis, correlation analysis with calculation of the Spearman rank correlation coefficients (ρ), multiple comparisons were performed with Bonferroni and the Holm corrections. We studied a set of anamnesis, clinical and laboratory signs that could, in complex mathematical analysis, act as factors that determined the poor prognosis of pneumonia in patients with impaired immunity because of oncohematological pathology. To solve the problem, factor analysis was carried out using the method of principal components using varimax rotation. Results of the study identified five groups of factors that caused the severity of the course and the occurrence of a lethal outcome of pneumonia and determined the overall dispersion by 63.3%. The appearance of lethal outcome of pneumonia in patients with impaired immunity because of oncohematological diseases is affected by a number of indicators grouped into five factors: cellular immunity (39.1% in the total variance); neutropenia and the state of phagocytosis (6.96%); anemia (6.5%); humoral immunity (5.75%) and clinical symptoms of pneumonia (4.99). Pneumonia in patients with impaired immunity is a separate nosological form. Disturbance of immunity in patients with pneumonia with oncohematological background had the greatest impact on the occurrence of severe course of pneumonia. The contribution of the immune response to the possibility of a lethal outcome of pneumonia was more than 50% of the total factor influence of the factors identified in the study. Therefore, we should further study the possibilities of treating pneumonia in patients with impaired immunity from the standpoint of the state of the immune response of patients on the background of oncohematological pathology.
Keywords: pneumonia, clinical and laboratory indicators, impaired immunity, factors of poor prognosis
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