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CAUSES OF LETHAL OUTCOMES IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE ACCORDING TO A RETROSPECTIVE ANALYSIS
Abduganieva Elnora Abralovna, Ph D., student Republican specialized scientific and practical medical center of Phthisiology and Pulmonology
Liverko Irina Vladimirovna, Head of Pulmonology Department Republican Specialized scientific and practical medical center of Phthisiology and pulmonology
E-mail: evovision@bk.ru
CAUSES OF LETHAL OUTCOMES IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE ACCORDING TO A RETROSPECTIVE ANALYSIS
Abstract: The article provides an analysis of the causes of death in patients with chronic obstructive pulmonary diseases (COPD) according to a retrospective analysis of autopsy protocols. As a result, the authors concluded that diseases of the circulatory system of thrombogenic etiology are the main cause of death in patients with COPD. Keywords: cause, death, chronic obstructive lung disease.
Chronic obstructive pulmonary disease (COPD), as the most common nosology in the COPD group, has a stable tendency to increase in prevalence and according to who studies, by 2020 will occupy the 5th place in morbidity and 3rd place in the structure of mortality among all diseases [1]. In this connection, one of the main problems of modern medicine is timely treatment, improving the quality of life and reducing mortality among this group of patients.
Given the high degree of COPD comorbidity and coronary heart disease(CHD), the risk of death from cardiovascular accidents in patients with COPD is very high [2]. Given that in the modern world there is a growing number of factors of cardiovascular risk, such as Smoking, overweight, hypodynamia and hypercholesterolemia, as well as the factor that systemic inflammation, as one of the main pathogenetic mechanisms of COPD is a stimulant of hypercoagulation States, we can conclude about the increasing role of cardiovascular disasters in the development of deaths in patients with COPD.
The aim of the study was to study the significance of cardiovascular accidents on the background of thrombosis in the development of deaths in patients with COPD in hospital.
Materials and methods: Retrospective analysis of 281 autopsy protocols of pathologic-anatomical Department of GKB № 1 of Tashkent city clinical hospital and Republican specialized scientific-practical center of Phthisiology and pulmonology of the Ministry of health of Uzbekistan.
Results and discussion: a Retrospective analysis of 281 autopsy findings showed that in 70.0% (197 cases) the cause of death was diagnosed, reflecting the state of hemostasiologi-cal disorders, including AMI 74.6% (147 patients), AMI by ischemic type 22.8% (45 patients), PE and Schmidt syndrome by 1% (2 patients), thrombosis of mesenteric vessels (0.5%).
Considering the frequency of thrombogenic disasters as the cause of death, in correlation with final clinical diagnoses for the autopsy noted that diseases of the circulatory system account for 64.9 per cent (128 cases), diseases of the respiratory organs of 21.3% (42 cases), diseases of the genitourinary system is 0.5% (1 case) and neoplasms of 0.5% (1 case).
In 83% of cases (145 cases) thrombogenic catastrophes as a cause of death were registered at the age of 60 years, in 57.7% - at the age of 40-60 years and in 14.3% - up to 40 years. It was noted that the incidence of thrombogenic catastrophes is 1.4 times higher at the age of 40-60 years and 5.8 times higher compared to the age of 40 years. Considering the relationship of age with the development of thrombogenic catastrophes from the structure of the final clinical diagnosis, respiratory diseases occupy the second rank place, yielding to diseases of the circulatory system.
Thrombogenic catastrophes as a cause of death were recorded in 66.0% of men (88 out of 134 men) and 73.9%(108 out of 147 women). Considering the relationship of sex with the development of thrombogenic catastrophes from the structure of the final clinical diagnosis, respiratory diseases occupy the second rank place, yielding to diseases of the circulatory system and do not have a significant difference in the frequency among men and women.
Retrospective analysis of 281autopsiynyh conclusions showed that lifetime diagnosis of chronic obstructive pulmonary disease (COPD), as reflected in the structure of the final diagnosis was only 13.9% (39 cases), and autopsy pathomor-phological diagnosis allowed to determine the signs of COPD in 37.0% (104 of 281 autopsies).
Morphological signs of COPD were determined according to the classification ofchuchalina (2004) and included: defeat of
Section 2. Medical science
bronchial tree in the form ofhyperemia and swelling ofthe bronchial mucosa, strengthening its longitudinal folding, detection in the lumen ofsmall bronchi mucous plugs in 91.3% ofcases; signs ofemphysema ofthe lungs ofvarying severity of33.7% and signs of diffuse peribronchial pneumosclerosis in 32.7% of autopsies.
Evaluation of the frequency of pathomorphological signs of COPD as a factor of comorbidity, in accordance with the final clinical diagnosis showed that in 63.5% of diseases of the circulatory system there is this factor of comorbidity and its presence was found only in 1.9% of cases of digestive system disease.
Retrospective analysis of 104 autopsy findings with pathomorphological verification of COPD showed that in 93.3% (97 cases) the cause of death was diagnosed, reflecting the state of hemostasiological disorders (thrombosis), including AMI 77.3% (75 cases), AMI by ischemic type 22.7% (45 cases).
In the analysis of causes of death according to the final clinical diagnosis-chronic obstructive pulmonary disease - in
94.9% of cases (37 of 39 cases) the cause is hemostasiological disorders, including AMI in 81.1% (30 of 37 cases) and AMI in 18.9% (7 of 37 cases).
Summary
1. COPD remains a diagnosis-underestimated by clinicians, which creates the risk of incorrect assessment of the patient's condition, without taking into account the aggravating effect of comorbid pathology.
2. In the literature, there is a lot of data on the main causes of death of patients with COPD, such as respiratory failure, lung cancer, pulmonary embolism, but because of the high comorbidity of COPD with cardiovascular disease, and the mechanism of mutual burden of these nosologies, according to our study to date, the main causes of death of patients with COPD are cardiovascular accidents caused by thrombosis. Thus, hemostasiological disorders are the leading causes of death among patients with COPD and comorbid conditions with it - diseases of the circulatory system.
References:
1. The modern approaches to the diagnosis and treatment of chronic obstructive pulmonary disease from the standpoint of GOLD2017. Military medicine. 2017; 4: 90-92.
2. Laforest L., Roche N., Devouassoux G., Belhassen M., Chouaid C., Giroux. Frequency of comorbidities in chronic obstructive pulmonary disease, and impact on all-cause mortality: a population-based cohort study. Respir Med 2016; 117: 33-39.
