Cerebral natriuretic peptide and systemic inflammation factors in the combined course of community-acquired pneumonia and gastroesophageal reflux disease

Objective: to determine the level of cerebral natriuretic peptide (CNP) and markers of systemic inflammation in the dynamics of treatment of CAP in patients with GERD.

Materials and methods: 84 patients with CAP were studied at an average age (42.3±2.9) years, including 44 men and 40 women who were treated in a therapeutic hospital. All patients with VP had a mild course. Among patients with CAP, 48 were diagnosed with GERD (main group), 36 patients had no symptoms of GERD (comparison group 1). Comparison group 2 consisted of 36 patients with GERD without CAP. In addition to conventional examination methods, all patients with CAP and GERD were assessed for CRP, procalcitonin (PCT), BNP (by its stable fragment NTproBNP), interleukins (IL)-1, IL-6, IL-8 at the start of therapy and before discharge.

Results: in all patients with CAP in combination with GERD, respiratory and dyspeptic symptoms were noted, along with symptoms of intoxication. Electrocardiography in patients with CAP in combination with GERD diagnosed low voltage voltage of QRS complexes, right ventricular extrasystoles, violations of the processes of repolarization of the left ventricle. During laboratory examination in patients with САP combined with GERD, a significant increase in the level of CRP, PCT, and proinflammatory cytokines was observed, which characterized a pronounced systemic inflammatory syndrome. At the same time, by discharge in patients with CAP combined with GERD, blood levels of CRP and IL-1, IL-6 and IL-8 remained elevated, despite clinical recovery from CAP. Positive correlations were found between CRP and proinflammatory cytokines, which weakened by discharge. In patients with CAP combined with GERD and with only CAP, at the beginning of treatment, the level of NTproBNP was within the reference values, and by discharge it increased by 1.2 times, more significantly in patients with CAP combined with GERD.

Conclusions: the clinical course of САP in patients with GERD is characterized by respiratory and dyspeptic syndromes, as well as more frequent ECG changes in the form of extrasystole. In patients with САP combined with GERD, there is a pronounced systemic inflammatory syndrome with a significant increase in the concentration of CRP, PCT and proinflammatory cytokines in the blood compared with patients with САP without GERD. At the same time, by discharge in patients with САP combined with GERD, blood levels of CRP and IL-1, IL-6 and IL-8 remain elevated, despite clinical recovery from САP. An increase in the level of MNUP (according to a stable fragment of NTproBN) in patients with САP combined with GERD, which appeared during clinical recovery from САP, taking into account its pathogenetic role, should be considered as a risk factor for myocardial involvement in the preserved inflammatory process, which determines careful monitoring of the dynamics of CRP, MNUP (NTproBN), proinflammatory cytokines and the state of myocardial infarction in patients with GERD who underwent САP during the dispensary observation.

1. Muslimova O.V., Sokova E.A., Prokofiev A.B., Zhuravleva M.V., Shapchenko A.V., Alexandrova T.V. Evaluation of the Effect of Comorbidity on the Efficacy and Safety of β-Lactam Antibiotics in Patients with Community-Acquired Pneumonia. Safety and Risk of Pharmacotherapy. 2022;10(2):96-109. (In Russ.) DOI: 10.30895/2312-7821-2022-10-2-96-109

2. Larina V.N., Bondarenkova A.A., Lunev V.I., Golovko M.G. Extra-esophageal symptoms of gastroesophageal reflux disease, as manifestations of polymorbidity. Experimental and Clinical Gastroenterology. 2019;(6):4-8. (In Russ.) DOI: 10.31146/1682-8658-ecg-166-6-4-8

3. Abrosimov V.N., Ponomareva I.B., Nizov A.A., Solodun M.V. On respiratory manifestations of gastroesophageal reflux disease. Terapevticheskii arkhiv. 2018;90(8):131-136. DOI: 10.26442/terarkh2018908131-136

4. Hsu WT, Lai CC, Wang YH, Tseng PH, Wang K, Wang CY, et al. Risk of pneumonia in patients with gastroesophageal reflux disease: A population-based cohort study. PLoS One. 2017;12(8):e0183808. DOI: 10.1371/journal.pone.0183808

5. Eurich DT, Marrie TJ, Minhas-Sandhu JK, Majumdar SR. Risk of heart failure after community acquired pneumonia: prospective controlled study with 10 years of follow-up. BMJ. 2017;356:j413. DOI: 10.1136/bmj.j413

6. Lyamina S.V., Maev I.V., Kladovikova O.V., Malyshev I.Y. Cellular and molecular mechanisms of inflammation of esophageal mucosa under different clinical course of gastroesophageal reflux disease and its complications. Terapevticheskii arkhiv. 2018;90(2):79-84. (In Russ.) DOI: 10.26442/terarkh201890279-84

7. Avdeev S.N., Dekhnich A.V., Zaytsev A.A., Kozlov R.S., Rachina S.A., Rudnov V.A., et al. Federal guidelines on diagnosis and treatment of community-acquired pneumonia. Pulmonologiya. 2022;32(3):295-355. (In Russ.) DOI: 10.18093/0869-0189-2022-32-3-295-355

8. Ivashkin V.T., Maev I.V., Trukhmanov A.S., Lapina T.L., Storonova O.A., Zayratyants O.V., et al. Recommendations of the Russian Gastroenterological Association in Diagnosis and Treatment of Gastroesophageal Reflux Disease. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2020;30(4):70-97. (In Russ.) DOI: 10.22416/1382-4376-2020-30-4-70-97

9. Bobylev А.А., Ratchina S.A., Avdeev S.N., Malov V.V. Serum biomarkers for predicting of community-acquired pneumonia in patients with chronic heart failure. Clin. Pharmacol. Ther. 2018;27(3):16-25. (In Russ.) eLIBRARY ID: 35554400 EDN: LZFPBR

10. Doletskii A.A., Shchekochikhin D.YU., Maksimov M.L. Differentsial'nyi diagnoz odyshki v klinicheskoi praktike. RMJ. 2014;22(6):458-461. (In Russ.) eLIBRARY ID: 21846301 EDN: SKBQDL

11. Shishlov A.YU., Dymshits M.A. Odnovremennoe RN- i EHKG-monitorirovanie pri gastroehzofageal'noi reflyuksnoi bolezni i ishemicheskoi bolezni serdtsa. Aktual'nye voprosy vnutrennei meditsiny i pedagogiki. Sb. nauchnykh tr. M. ID "Russkii vrach. 2000:132-136. (In Russ.)

12. Bobylev A.A., Rachina S.A., Avdeev S.N., Kozlov R.S. The diagnostics of community-acquired pneumonia in patients with chronic heart failure: a literature review and study outcomes. CTRI Bulletin. 2020;(2):7-21. (In Russ.) DOI: 10.7868/S2587667820020028

13. Shalnova S.A., Kutsenko V.A., Yakushin S.S., Kapustina A.V., Evstifeeva S.E., Balanova Yu.A., et al. Associations of elevated levels of brain natriuretic peptide and heart failure and their contribution to survival in the Russian middle-aged population: data from the ESSE-RF study. Cardiovascular Therapy and Prevention. 2023;22(6):3553. (In Russ.) DOI: 10.15829/1728-8800-2023-3553

14. Chaulin A.M., Duplyakov D.V. Increased natriuretic peptides not associated with heart failure. Russian Journal of Cardiology. 2020;25(4S):4140. (In Russ.) DOI: 10.15829/1560-4071-2020-4140

15. Соснин Д.Ю., Гилева О.С., Мозговая Л.А., Сивак Е.Ю., Белева Н.С., Кривцов А.В. и др. NT-proBNP в слюне и сыворотке крови в норме и при пародонтите. Клиническая лабораторная диагностика. 2018;63(3):164-168 Sosnin D.Yu., Gileva O.S., Mozgovaia L.A., Sivak E.Yu., Beleva N.S., Krivtsov A.V., et al. The nt-probnp in saliva and blood serum in norm and under periodontitis. Clinical laboratory diagnostics. 2018;63(3):164-168. (In Russ.) eLIBRARY ID: 32782303 EDN: YVQOUG

16. Antropova O.N., Pyrikova N.V., Osipova I.V. Atrial fibrillation and gastrooesophageal reflux disease: association mechanisms, treatment approaches. Russian Journal of Cardiology. 2019;(7):103-109. (In Russ.) DOI: 10.15829/1560-4071-2019-7-103-109