Clinical and diagnostic significance of erythrocyte indices and fetal hemoglobin in community-acquired and nosocomial pneumonia

Community-acquired pneumonia is a leading cause of morbidity and mortality both globally and in Russia. Pneumonia that occurs in a hospital during treatment for another illness is called nosocomial pneumonia, according to the World Health Organization. Hematological parameters play a significant role in the pathogenesis of pneumonia. The purpose of the study: was to to study the values of changes in red blood cell indices and parameters at different stages of treatment of patients with community-acquired and nosocomial pneumonia. Materials and methods. The study included 85 patients admitted to the State Budgetary Healthcare Institution of the Astrakhan Region Aleksandro-Mariinskaya Regional Clinical Hospital. Of these, 67 were admitted to the hospital's internal medicine department with moderate community-acquired pneumonia, and 18 were admitted to the intensive care unit with severe nosocomial pneumonia. We analyzed the following red blood cell parameters (number of erythrocytes, hemoglobin, fetal hemoglobin, hematocrit) and derived erythrocyte indices (mean corpuscular volume, mean corpuscular hemoglobin content, erythrocyte distribution width) from printouts from the “Sysmex XN 2000” hematology analyzer. In addition, fetal hemoglobin concentrations were determined in collected blood hemolysates from all patients with community-acquired and nosocomial pneumonia using the Mancini immunoassay. These parameters were assessed at the peak of the disease and before discharge. Statistical data processing was performed using the “Statistica 12.0” software package from “Statsoft”. Research results. A comparison of medians and interquartile ranges of red blood cell, hemoglobin, hematocrit, erythrocyte indices, and fetal hemoglobin values was conducted in patients with community-acquired and nosocomial pneumonia at the peak of the disease and before discharge. The erythrocyte indices and fetal hemoglobin values characteristic of community-acquired and nosocomial pneumonia were determined. The erythrocyte anisocytosis and fetal hemoglobin values were determined, which serve as the basis for transferring patients with pneumonia to the intensive care unit. Conclusion. Thus, for the first time, a relationship was identified between the erythrocyte distribution width and fetal hemoglobin in both community-acquired and nosocomial pneumonia. While the median of erythrocyte distribution width in nosocomial pneumonia was only 1.2 times higher than the median in community-acquired pneumonia, the median fetal hemoglobin in nosocomial pneumonia was even 1.65 times higher. Thus, an increase in erythrocyte anisocytosis above 15 % and fetal hemoglobin above 4.5 g/L are grounds for transferring patients with pneumonia to the intensive care unit for intensive infusion therapy and respiratory support. The erythrocyte distribution width and fetal hemoglobin indicators are simple and reliable biomarkers for predicting the severity and outcome of community-acquired and nosocomial pneumonia. 

1. Beloborodov V. B., Kovalev I. A., Sapronov G. V. Current issues of empirical therapy for severe bacterial community-acquired pneumonia during the season of respiratory viral infections. Antibiotiki i khimioterapiya = Antibiotics and chemotherapy. 2020; 65 (9–10): 64–76. doi: 10.37489/0235-2990-2020-65-9-10-64-70 (In Russ.).

2. Nozokomialnaya pnevmoniya u vzroslykh: Rossiyskie natsionalnye rekomendatsii = Nosocomial pneumonia in adults: Russian national guidelines. Ed. by B. R. Gelfand. Moscow: Medical Information Agency Publishing House; 2016; 176 (In Russ.).

3. Chuchalin A. G. Pneumonia – a pressing problem of 21st century medicine. Pul'monologiya = Pulmonology. 2015; 25 (2): 143–50. doi: 10.18093/0869-0189-2015-25-2-133-142 (In Russ.).

4. Pavlovich N. V., Tsymbalistova M. V., Aronova N. V., Anisimova A. S., Vodopyanov S. O., Vodopyanov A. S., Gudueva E. N., Sagakyants M. M., Kovalev E. V., Noskov A. K. Community-acquired pneumonia of bacterial etiology and the spectrum of sensitivity of pathogens to antibiotics in corona-positive and corona-negative patients in Rostov-onDon. Antibiotiki i khimioterapiya = Antibiotics and chemotherapy. 2021; 66 (1–2): 26–32. doi: 10.24411/0235-29902021-66-1–2-26-32 (In Russ.).

5. Rachina S. A., Fedina L. V., Sukhorukova M. V., Sychev I. N., Larin E. S., Alkhlavov A. A. Diagnostics and antibacterial therapy of nosocomial pneumonia in adults: from recommendations to real practice. Terapevticheskiy arkhiv = Therapeutic archive. 2023; 95 (11): 996–1003. doi: 10.26442/00403660.2023.11.202467 (In Russ.).

6. Thomas J., Pociute A., Kevalas R., Malinauskas M., Jankauskaite L. Blood biomarkers differentiating viral versus bacterial pneumonia aetiology: a literature review. Ital J Pediatr. 2020; 46 (1): 4. doi: 10.1186/s13052-020-0770-3.

7. Stulova M. V., Kudryasheva I. A., Polunina O. S., Cherenova L. P., Arshba T. E., Lisina O. A., Kazakova E. A. Comparative clinical and laboratory analysis of COVID-19 associated pneumonia with community-acquired pneumonia of bacterial etiology. Sovremennyye problemy nauki i obrazovaniya = Modern problems of science and education. 2020; 3: 134–142. URL: https://science-education.ru/ru/article/view?id=29905 (In Russ.).

8. Miroshnikov V. M., Kokhanov A. V. Immunobiological features of regeneration with the use of official protein preparations. Patologicheskaya fiziologiya i eksperimental'naya terapiya = Pathological physiology and experimental therapy. 1988; 4: 54–59 (In Russ.).

9. Fetlam D. L., Chumachenko A. G., Danilov A. V., Kuzovlev A. N., Grechko A. V., Pisarev V. M. Erythrocyte index RDW as a marker for prognostication of the course and outcome of pleural empyema that developed after pneumonia: a prospective cohort study. Vestnik intensivnoy terapii im. A.I. Saltanova = Bulletin of Intensive Care named after A. I. Saltanov. 2024; 3: 125–138. doi: 10.21320/1818-474X-2024-3-125-138 (In Russ.).

10. Stulova M. V., Kudryasheva I. A., Kokhanov A. V., Muldasheva N. G. Features of immunogram indicators in community-acquired pneumonia. Nauchnyy almanakh = Scientific almanac. 2024; 6–3 (116): 75–78 (In Russ.).

11. Danilova L. A. Fetal hemoglobin – a reporter of metabolism. Detskaya meditsina Severo-Zapada = Children's medicine of the North-West. 2020; 8 (1): 141 (In Russ.).

12. Kriventsev Yu. A., Kriventseva L. A. Human hemoglobins as diagnostic markers. Nauchnoye obozreniye. Meditsinskiye nauki = Scientific review. Medical sciences. 2018; 1: 16–20 (In Russ.).

13. Shamratova A. R., Shamratova V. G., Kayumova A. F., Ziyakaeva K. R. Capabilities of hematological analyzers in assessing physiological and pathological states of the body (review). Zhurnal mediko-biologicheskikh issledovaniy = Journal of Medical and Biological Research. 2021; 9 (1): 89–101. doi: 10.37482/2687-1491-Z047 (In Russ.).

14. Petrova O. V., Tverdokhlebova D. K., Popov E. A., Nikulina D. M., Shashin S. A., Tarasov D. G. The relationship between blood type and Rh factor with a new coronavirus infection. Astrakhanskiy meditsinskiy zhurnal = Astrakhan Medical Journal. 2021; 16 (3): 41–46 (In Russ.).

15. Gao Q., Li Z., Mo X., Wu Y., Zhou H., Peng J. Combined procalcitonin and hemogram parameters contribute to early differential diagnosis of Gram-negative / Gram-positive bloodstream infections. J Clin Lab Anal. 2021; 35 (9): e23927. doi: 10.1002/jcla.23927.

16. Kokhanov A. V., Shininova S. V., Voronkova M. Yu., Bisalieva R. A. Normative indices of red blood cells in healthy preschool children in the south of the Astrakhan region. Sovremennyye problemy nauki i obrazovaniya = Modern problems of science and education. 2016; 5: 59–65. URL: https://science-education.ru/ru/article/view?id=25205 (In Russ.).

17. Kokhanov A. V., Bisalieva R. A., Ebzeeva L. Kh. Hemoglobins in ischemic brain injury: from fetal hemoglobin to neuroglobin. Molekulyarnaya meditsina = Molecular Medicine. 2025; 23 (2): 3–11. doi: 10.29296/24999490-2025-02-01 (In Russ.).

18. Kokhanov A. V., Bisalieva R. A., Ebzeeva L. Kh. Fetal hemoglobin and neuroglobin in the blood of patients after reconstructive surgeries on the carotid arteries. Krymskiy zhurnal eksperimentalnoy i klinicheskoy meditsiny = Crimean Journal of Experimental and Clinical Medicine. 2024; 14 (2): 39–46. doi: 10.29039/2224-64442024-14-2-39-46 (In Russ.).

19. Kokhanov A. V., Ploskonos M. V., Stulova M. V., Kondakova T. O., Popov E. A., Lutseva O. A., Kudryasheva I. A. Relationship between fetal hemoglobin concentration and the nature of the infectious agent of community-acquired pneumonia. Mezhdunarodnyy nauchno-issledovatel'skiy zhurnal = International Research Journal. 2024; 11 (149). doi: 10.60797/IRJ.2024.149.35 (In Russ.).

20. Shininova S. V., Satasheva Z. M., Saidulaev V. A., Kokhanov A. V., Kchibekov E. A., Gudinskaya N. I., Zhmykhov D. V., Musalaev H. A. Comparison of lactoferrin and fetal hemoglobin levels in the blood of elderly residents of the south of the Astrakhan region and mountainous areas of Dagestan. Sovremennyye problemy nauki i obrazovaniya = Modern problems of science and education. 2023; 4: 91–99. URL: https://science-education.ru/article/view?id=32739 (In Russ.).