Drug induced lung toxicity by nitrofurantoin

We present the clinical case of the patient with nitrofurantoin (FUR) lung toxicity. Diagnosis was made from detailed history of the patient and by studying CT images before the start of FUR treatment. An extensive interstitial changes were evident on HRCT scan at the presentation at our clinic. The definitive diagnosis was supported by negative microbiology and autoantibody screening and almost complete regression of changes after FUR treatment withdrawal. There was no need for corticosteroid treatment or immunosuppressive medication.

Effect of pirfenidone on lung function decline and survival: 5-yr experience from a real-life IPF cohort from the Czech EMPIRE registry.

INTRODUCTION: Pirfenidone, an antifibrotic drug, slows-down the disease progression in idiopathic pulmonary fibrosis (IPF) over 12 months, however limited data on the decline of lung function and overall survival (OS) in real-world cohorts on longer follow-up exists. PATIENTS/METHODS: Of the enrolled Czech IPF patients (n = 841) from an EMPIRE registry, 383 (45.5%) received pirfenidone, 218 (25.9%) no-antifibrotic treatment and 240 (28.5%) were excluded (missing data, nintedanib treatment). The 2- and 5-yrs OS and forced vital capacity (FVC) and diffusing lung capacity for carbon monoxide (DLCO) were investigated at treatment initiation and 6, 12, 18 and 24 months' follow-up. RESULTS: During a 2-yr follow-up, less than a quarter of the patients progressed on pirfenidone as assessed by the decline of ≥10% FVC (17.0%) and ≥ 15% DLCO (14.3%). On pirfenidone, the DLCO (≥10%) declines at 6, 12, 18 and 24 months' and DLCO (≥15%) declines at 6, 18 and 24 months' follow-up were associated with increased mortality. The DLCO decline showed higher predictive value for mortality than FVC decline. In patients with no-antifibrotics, FVC and DLCO declines were not predictive for mortality. Pirfenidone increased 5-yrs OS over no-antifibrotic treatment (55.9% vs 31.5% alive, P = 0.002). CONCLUSION: Our study observed the 2-yrs sustained effect of pirfenidone on the decline of lung function and survival in the real-world patient's IPF cohort. DLCO decline of ≥10% shows a potential as a mortality predictor in IPF patients on pirfenidone, and should be routinely evaluated during follow-up examinations.

Limited ambulatory night sleep testing in patients with a suspicion of sleep apnoea syndrome: Is its indication tenable?

INTRODUCTION: Ambulatory sleep testing is nowadays an available diagnostic method, measuring air flow and blood oxygen saturation in patients with a suspicion of obstructive sleep apnoea syndrome (OSAS). It can be performed by either a general practitioner or an ambulatory specialist in various fields. Using this simple screening method it is possible to exclude subjects without OSAS, who therefore do not require further sleep testing at a sleep laboratory. There is no published data regarding the use of ambulatory sleep testing by sleep laboratories in the Czech Republic. The aim of this study was to evaluate the proportion of patients examined by ambulatory sleep testing and to determine the factors influencing its indication. MATERIAL AND METHODS: The study involved 497 patients (363 males) with an average age of 55.5 ± 12.3 years. These patients were tested by the sleep laboratory at University Hospital Olomouc with a suspicion of OSAS. The clinical complaints of the patients were evaluated (e.g. excessive daytime sleepiness, microsleeps, etc.) along with a basic examination, including anthropometric parameter measurements, on admission to the ward. Whilst admitted, night sleep testing using respiratory polygraphy or videopolysomnography was performed in all patients. Furthermore, the number of patients that underwent ambulatory sleep testing prior to admission to the sleep laboratory and the number of patients with an indication for positive airway pressure therapy (PAP) (apnoea-hypopnea index > 15) was assessed. The results were processed using the software IBM SPSS Statistics v22. RESULTS: Ambulatory sleep testing was performed in only 96 patients (19.3 %). Among these patients, 76 (79.0 %) were diagnosed with OSAS with an indication for PAP. In the 401 patients who did not undergo ambulatory sleep tests, 227 (53.9 %) were diagnosed with OSAS with an indication for PAP. Patients who underwent ambulatory sleep tests and those who did not differed only in age (p = 0.03). There were no significant differences in other parameters (sex, height, weight, BMI, circumference of neck, waist and hips, ESS), including sleepiness (p = 0.605) and microsleeps (p = 0.74). CONCLUSION: Ambulatory sleep testing is performed in only a small proportion of patients. Its use can reduce healthcare costs as well as waiting times for sleep laboratory tests.

Phenotypes of organ involvement in sarcoidosis.

Sarcoidosis is a highly variable, systemic granulomatous disease of hitherto unknown aetiology. The GenPhenReSa (Genotype-Phenotype Relationship in Sarcoidosis) project represents a European multicentre study to investigate the influence of genotype on disease phenotypes in sarcoidosis.The baseline phenotype module of GenPhenReSa comprised 2163 Caucasian patients with sarcoidosis who were phenotyped at 31 study centres according to a standardised protocol.From this module, we found that patients with acute onset were mainly female, young and of Scadding type I or II. Female patients showed a significantly higher frequency of eye and skin involvement, and complained more of fatigue. Based on multidimensional correspondence analysis and subsequent cluster analysis, patients could be clearly stratified into five distinct, yet undescribed, subgroups according to predominant organ involvement: 1) abdominal organ involvement, 2) ocular-cardiac-cutaneous-central nervous system disease involvement, 3) musculoskeletal-cutaneous involvement, 4) pulmonary and intrathoracic lymph node involvement, and 5) extrapulmonary involvement.These five new clinical phenotypes will be useful to recruit homogenous cohorts in future biomedical studies.

Expression analysis of extracellular microRNA in bronchoalveolar lavage fluid from patients with pulmonary sarcoidosis.

BACKGROUND AND OBJECTIVE: MicroRNA (miRNA) are transcriptional regulators implicated in pulmonary sarcoidosis and packaged in extracellular vesicles (EV) during cellular communication. We characterized EV and investigated miRNA expression in bronchoalveolar lavage (BAL) fluid from sarcoidosis patients. METHODS: EV were characterized for size(s) using dynamic light scattering and transmission electron microscopy (TEM) analysis and protein markers by immunoblotting. Twelve extracellular and 5 cellular miRNA were investigated in BAL from 16 chest X-ray stage-I (CXR-I) and 17 CXR stage-II (CXR-II) sarcoidosis patients. Associations between miRNA and disease characteristics (extrapulmonary involvement, pulmonary function and BAL cell profile) were statistically analysed. RESULTS: BAL from sarcoidosis patients contained exosomes and microvesicles (MV) as EV. In these EV, expression of miR-146a (P = 0.007), miR-150 (P = 0.003) and BAL cellular miR-21 (P = 0.01) was increased in CXR-II compared with CXR-I. Other detected EV (miR-21 and miR-26a) and cellular (miR-31, miR-129-3p, miR-146a and miR-452) miRNA were not differentially expressed. The investigated miRNA did not reflect extrapulmonary involvement, but EV miR-146a and miR-150 were negatively correlated with pulmonary function (miR-146a with vital capacity (VC; Spearman's correlation coefficient (rs ), P = -0.657, 0.007), percent predicted forced expiratory volume in 1 s (FEV1 ; -0.662, 0.006) and FEV1 /forced vital capacity (FVC) ratio (-0.649, 0.008); miR-150 correlated negatively with VC (-0.584, 0.019) and FEV1 /FVC ratio (-0.746, 0.001) in CXR-II cases). CONCLUSION: Our data provide evidence that exosomes and microvesicles as extracellular vesicles are present in the bronchoalveolar space of sarcoidosis patients and they differentially express EV miRNA (miR-146a and miR-150), the expression of which correlates negatively with pulmonary function indices. The significance of these findings for disease pathophysiology and clinical course require further investigation.

[Malign pleural mesothelioma - so far an undefeated tumor]. / Maligní mezoteliom pleury - dosud nepokorený nádor.

Malign pleural mesothelioma is the most frequent primary tumor of the pleura of high aggressiveness. Its most frequent cause is contact with asbestos and, although working with asbestos is already prohibited in developed countries, its incidence is on the increase so far. Diagnostics primarily considers anamnesis, clinical symptoms and immunohistochemical examination of a tumor sample. The basic therapy used over the past 10 years is chemotherapy with cisplatin - pemetrexed combinations. Numerous studies are going on with a different biologically targeted therapy, immunotherapy and other drugs which may improve patients prognosis. The surgical approach is limited by a suitable choice of patients and sufficient experience of the medical center. Extrapleural pneumonectomy or extended pleurectomy are performed. However even the combined therapy with adjuvant or neoadjuvant chemotherapy or radiotherapy has not considerably extended survival.Key words: diagnostics - epidemiology - malign pleural mesothelioma - therapy.

[Diagnostics and treatment of community-acquired pneumonia - simplicity is the key to success]. / Diagnostika a lécba komunitní pneumonie - v jednoduchosti je klíc k úspechu.

Pneumonia is the most wide-spread infectious disease and requires unrelenting attention. It is defined as an acute inflammatory disease affecting pulmonary alveoli, respiratory bronchioles and the pulmonary interstitium. In recent years we have seen the endeavour to rationalize the approach to pneumonias and utilize the current methods of administering effective antibiotics to reduce occurrence of complications, limit the number of hospitalizations and shorten the length of treatment. With the awareness of all the potential agents it is empiric therapy which predominates, being supported by the knowledge of a regional epidemiological situation, good diagnosing and experience of rational antibiotic treatment. Very important is categorization of patients based on possible risks of complications and mortality. Considering that an appropriate form of treatment is chosen: outpatient care or hospitalization.Key words: community-acquired pneumonia - treatment criteria - prognosis - occurrence.

[Hospital-acquired pneumonias]. / Nozokomiální pneumonie.

Nosocomial infections are a common complication of hospital care. Hospital-acquired (HAP) pneumonia is one of the most common nosocomial infections and it is the most dangerous in terms of mortality. The problem is mainly selected hospital bacterial strains with rising antibiotic resistance. Diagnosis of the cause of pneumonia is difficult and often does not lead to a positive result. Management is complex and is based on timely and appropriate empirical antibiotic treatment. Local and extrapulmonary complications are relatively common and they increase morbidity and mortality. Prognosis of the HAP is often unfavorable, especially in the elderly and polymorbid individuals.Key words: complications - etiology - hospital-acquired pneumonia - management.

[Sarcoidosis - enigmatic disease still unresolved]. / Sarkoidóza - nadále záhadné onemocnení.

Sarcoidosis is a systemic disease of unknown etiology, characterized by the presence of granulomatous inflammation in affected tissues. In about 90 % it affects the lungs, but it may basically affect any organ, the most frequently the skin, lymph nodes and eyes. In the case of classic lung manifestation this disease is not difficult to diagnose. When dealing with extrapulmonary manifestations, interdisciplinary cooperation is necessary. The treatment of sarcoidosis is needed in about half of the cases, in some 30 % of patients it may change into a chronic stage and possibly lead to serious health problems or premature death. Treatment is commenced following individual evaluation of the extent of the disease and considering its benefit against possible secondary effects. Corticosteroids remain the systemic drugs of first choice. When ineffective or not tolerated, the drugs of second choice are given, these are corticosteroid replacement drugs such as methotrexate, antimalarial drugs and immunosuppressive drugs. For refractory forms, biological therapy is administered, in particular infliximab or adalimumab.Key words: biological therapy - corticosteroids - corticosteroid replacement treatment - extrapulmonary lesions - sarcoidosis.

[The complications after lung transplantation]. / Komplikace po transplantaci plic.

Lung transplantation (LuTx) is an important treatment for a selected group of patients in the terminal stage of a number of lung diseases, which can bring them a significant improvement in quality of life and long-term survival. Nowadays a perioperative period is not significant limitation for patient survival due to the development of transplant surgery, but the period of months to years after LuTx is crucial for survival. The post-transplant period is very complicated for LuTx patients due to a special treatment regimen, special medication, especially immunosuppressive drugs and the possibility of many complications, whether early or late or acute or chronic. These complications can be divided into several groups. These are rejections, infections, tumors, non-infectious pulmonary complications, and extrapulmonary complications. This is a very wide range of diverse states and to cope with them, it is necessary, apart from good patient co-operation, to team together with specialists in many fields of medicine. But the reward is the satisfaction, good quality of life and long-term survival of transplanted patients.Key words: infection - lung transplantation - rejection - tumours.

Thyroid transcription factor 1 expression is associated with outcome of patients with non-squamous non-small cell lung cancer treated with pemetrexed-based chemotherapy.

Pemetrexed is an antifolate cytostatic agent targeting several folate-dependent enzymatic pathways, widely used in the treatment of locally advanced or metastatic stage non-small cell lung cancer. Aside from the non-squamous histology, there is still no available molecular biomarker predicting treatment efficacy of pemetrexed-based chemotherapy. The aim of our retrospective study was to evaluate the association of thyroid transcription factor 1 expression with outcome of a large cohort of patients with non-squamous non-small cell lung cancer treated with pemetrexed. We retrospectively analysed clinical data of 463 patients with advanced-stage non-small cell lung cancer (IIIB or IV) treated with pemetrexed-based chemotherapy. Thyroid transcription factor 1 expression was assessed using indirect immunohistochemical detection in formalin-fixed paraffin-embedded tumour tissue at the time of diagnosis. Thyroid transcription factor 1 expression was detected in the tumour tissue from 76.0% of patients, and tumours from 24.0% of patients were thyroid transcription factor 1 negative. The median progression-free survival and overall survival for patients with thyroid transcription factor 1 positive tumours were 4.8 and 11.8 months compared to 2.8 and 8.3 months for those with thyroid transcription factor 1 negative tumours (p = 0.001 and p < 0.001). The multivariable Cox proportional hazards model revealed that thyroid transcription factor 1 expression was significantly associated with progression-free survival (hazard ratio = 1.57, p < 0.001) and also with overall survival (hazard ratio = 1.73, p < 0.001). In conclusion, the results of the conducted retrospective study suggest that the thyroid transcription factor 1 expression was independently associated with progression-free survival and overall survival in patients with advanced-stage non-squamous non-small cell lung cancer treated with pemetrexed-based chemotherapy.

High-Density Genetic Mapping Identifies New Susceptibility Variants in Sarcoidosis Phenotypes and Shows Genomic-driven Phenotypic Differences.

RATIONALE: Sarcoidosis is a multisystem disease of unknown cause. Löfgren's syndrome (LS) is a characteristic subgroup of sarcoidosis that is associated with a good prognosis in sarcoidosis. However, little is known about its genetic architecture or its broader phenotype, non-LS sarcoidosis. OBJECTIVES: To address the genetic architecture of sarcoidosis phenotypes, LS and non-LS. METHODS: An association study in a white Swedish cohort of 384 LS, 664 non-LS, and 2,086 control subjects, totaling 3,134 subjects using a fine-mapping genotyping platform was conducted. Replication was performed in four independent cohorts, three of white European descent (Germany, n = 4,975; the Netherlands, n = 613; and Czech Republic, n = 521), and one of black African descent (United States, n = 1,657), totaling 7,766 subjects. MEASUREMENTS AND MAIN RESULTS: A total of 727 LS-associated variants expanding throughout the extended major histocompatibility complex (MHC) region and 68 non-LS-associated variants located in the MHC class II region were identified and confirmed. A shared overlap between LS and non-LS defined by 17 variants located in the MHC class II region was found. Outside the MHC region, two LS-associated loci, in ADCY3 and between CSMD1 and MCPH1, were observed and replicated. CONCLUSIONS: Comprehensive and integrative analyses of genetics, transcription, and pathway modeling on LS and non-LS indicates that these sarcoidosis phenotypes have different genetic susceptibility, genomic distributions, and cellular activities, suggesting distinct molecular mechanisms in pathways related to immune response with a common region.

[Community pneumonia - fundamentals of diagnosing and treatment]. / Komunitní pneumonie - základy diagnostiky a lécby.

Pneumonia is the most serious respiratory disease which causes more than 3 000 deaths per year in the Czech Republic. Community-acquired pneumonia is contracted in the ordinary life environment outside of hospitals, its development is caused by known infectious agents which mostly exhibit satisfactory sensitivity to antibiotics. Diagnosing, prevention and treatment of the disease are described including considerations of individual evaluation of the risk of complications and possible death. The strategy of administering antibiotics is discussed.Key words: antibiotics - community-acquired pneumonias - diagnosing - treatment.

The Serum Expression of Selected miRNAs in Pulmonary Sarcoidosis with/without Löfgren's Syndrome.

Purpose. Pulmonary sarcoidosis is associated with dysregulated expression of intracellular miRNAs. There is however only little information on extracellular miRNAs and their association with the disease course in sarcoidosis. We therefore assessed serum miRNAs in sarcoidosis classified according to the presence of Löfgren's syndrome (LS) as a hallmark of good prognosis in contrast to more advanced disease course. Methods. RT-PCR was used to assess 35 miRNAs in 13 healthy controls and 24 sarcoidosis patients (12 with X-ray (CXR) stage ≤ 1 and LS and 12 with insidious onset and CXR stage ≥ 3). Results. Compared to controls, we consistently observed dysregulated expressions of miR-146, miR-16, miR-425-5p, and miR-93-5p in both sarcoidosis groups irrespective of disease course. Specifically, patients without LS had dysregulated expressions of miR-150-5p, miR-1, and miR-212 compared to controls. Patients with LS had dysregulated expressions of miR-21-5p and miR-340-5p compared to controls. Bioinformatics predicted consistently "Pathways in cancer" to be modulated by both altered profiles in patients with/without LS. Three miRNAs (miR-21-5p, miR-340-5p, and miR-212-3p) differed between our patients with LS and those without LS; their cumulative effect may modulate "TGF-ß signalling pathway." Conclusions. Further study should focus on possible applications of serum miRNAs for diagnostics follow-up and for prognosis.

[Prolonged culture in a humid chamber increases the yields of pathogenic bacteria from the respiratory tract samples of patients suffering from cystic fibrosis].

Current standards of care for cystic fibrosis (CF) patients lack unequivocal recommendations concerning the duration of primary culture of bacteriological samples. With the exception of Burkholderia cepacia (5 days), the minimum recommended duration of primary culture varies between 48 and 72 hours. Our aim was to evaluate the effect of an extended 10-day period of primary culture in a humid chamber in samples acquired from the respiratory tract of patients suffering from CF. Compared to standard culture, prolonged culture in a humid chamber yielded 1.85 times more isolates of pathogenic species in pharyngeal swabs (76 versus 41 isolates) and 1.4 times more isolates in sputum samples (116 versus 82), but only 1.14 times more isolates in nasal swabs (25 versus 22). Prolonged culture was most beneficial for Achromobacter spp. (6 versus 0), Stenotrophomonas maltophilia (16 versus 5) and Pseudomonas aeruginosa (69 versus 49), whereas there was little or no benefit at all for Staphylococcus aureus (87 versus 73) and Moraxella catarrhalis (10 versus 10). Therefore, prolonged culture in a humid chamber may definitely be recommended for pharyngeal swabs and sputum samples obtained from patients suffering from CF to achieve the maximum recovery rate of pathogenic bacteria, in particular non-fermenting Gram-negative rods.

[Beta-blockers and chronic obstructive pulmonary disease]. / Betablokátory a chronická obstrukcní plicní nemoc.

This general article discusses the problems of beta-blockers use in patients with chronic obstructive pulmonary disease (COPD). Its aim is to refute exaggerated concerns of physicians over possible undesirable effects of beta-blockers on the patient respiratory functions and present new data on the effects of beta-blockers on the extent of COPD exacerbations, bronchial reactivity and mortality of patients.

Correlation Network Analysis Reveals Relationships between MicroRNAs, Transcription Factor T-bet, and Deregulated Cytokine/Chemokine-Receptor Network in Pulmonary Sarcoidosis.

Sarcoidosis is an inflammatory granulomatous disease with unknown etiology driven by cytokines and chemokines. There is limited information regarding the regulation of cytokine/chemokine-receptor network in bronchoalveolar lavage (BAL) cells in pulmonary sarcoidosis, suggesting contribution of miRNAs and transcription factors. We therefore investigated gene expression of 25 inflammation-related miRNAs, 27 cytokines/chemokines/receptors, and a Th1-transcription factor T-bet in unseparated BAL cells obtained from 48 sarcoidosis patients and 14 control subjects using quantitative RT-PCR. We then examined both miRNA-mRNA expressions to enrich relevant relationships. This first study on miRNAs in sarcoid BAL cells detected deregulation of miR-146a, miR-150, miR-202, miR-204, and miR-222 expression comparing to controls. Subanalysis revealed higher number of miR-155, let-7c transcripts in progressing (n = 20) comparing to regressing (n = 28) disease as assessed by 2-year follow-up. Correlation network analysis revealed relationships between microRNAs, transcription factor T-bet, and deregulated cytokine/chemokine-receptor network in sarcoid BAL cells. Furthermore, T-bet showed more pronounced regulatory capability to sarcoidosis-associated cytokines/chemokines/receptors than miRNAs, which may function rather as "fine-tuners" of cytokine/chemokine expression. Our correlation network study implies contribution of both microRNAs and Th1-transcription factor T-bet to the regulation of cytokine/chemokine-receptor network in BAL cells in sarcoidosis. Functional studies are needed to confirm biological relevance of the obtained relationships.

[Validity comparison of various biological samples from lower airway and their contribution for the detection of nosocomial pneumonia etiological agents]. / Porovnání validity ruzných vzorku biologického material z dýchacích cest a jejich prínosu v detekci puvodcu nozokomiální pneumonie.

BACKGROUND: The aim of the study was to compare the validity of bronchial secretion sampling and bronchoscopy-assisted protected specimen brushing (PSB) in patients with hospital-acquired pneumonia (HAP). MATERIALS AND METHODS: In patients with HAP, bronchial secretion samples (aspiration of lower airway secretions from an orotracheal tube with a suctioning catheter) and PSB (bronchoscopy-assisted sampling from the most affected area of the lung, verified by CT scan) were taken at the same time. Both samples were processed by semiquantitative routine microbiological techniques. Identification of microorganisms was performed by standard microbiological techniques using the MALDI-TOF automated system. For similarity or identity determination of bacterial isolates from bronchial secretion sampling and PSB, pulsed-field gel electrophoresis was used. RESULTS: Thirty patients were enrolled into the study. Thirty pairs of bronchial secretion samples and PSB samples were obtained and processed. The samples were positive in 23 patients (77 %) and 15 patients (50 %), respectively. In 15 cases, the same pathogen was determined in both samples, and in all those cases, the isolates were genetically identical. CONCLUSION: The results of the study show that bronchial secretion samples analysis enabled identification of all pathogens that were identified by PSB. Given the high sensitivity of the bronchial secretion aspiration technique and genetic identity of isolates in both samples, bronchial secretion sampling may be recommended for determining HAP etiological agents as the samples are much easier to obtain from patients.

[Research of relations among sleep disorders, obstructive sleep apnoea, hypertension onset and hypertensive treatment - current or long-term trend?]. / Studium souvislostí poruch spánku, obstrukcní spánkové apnoe a vzniku a lécby arteriální hypertenze - módní vlna nebo dlouhodobý trend?

This paper is discussing recent findings about links between obstructive sleep apnea syndrome and arterial hypertension. It describes diagnostic approaches and also therapy of patients. It is describing options of pharmacological treatment and the influence of continuous positive airway pressure therapy on blood pressure level.

[Utility of Pneumonia Severity Index in hospitalized patients with pneumonia in intensive respiratory care units]. / Význam Pneumonia Severity Index u pacientu s pneumonií hospitalizovaných na jednotce intenzivní pneumologické péce.

INTRODUCTION: The aim of this study was to evaluate the prognostic value of Pneumonia Severity Index (PSI) for prediction of 30-day mortality in patients admitted to intensive care unit (ICU) for community-acquired pneumonia (CAP). In patients with CAP, comorbidities, complications, and physical, laboratory, radiological and microbiological findings were evaluated relative to their prognosis. PATIENT AND METHODS: In the study, 197 patients with CAP, hospitalised at ICU of Department of Respiratory Medicine, University Hospital Olomouc between 2008 and 2012, were enrolled. Risk factors according to PSI were assessed in all patients. RESULTS: In the studied cohort of patients with CAP, mean values of PSI were 115.4 ± SD 30.4 points. Overall, 29 patients (14.7 %) deceased. When comparing deceased and survived patients, statistically significant differences were found in PSI (mean ± SD: 137.4 ± 26.1 vs 111.7 ± 29.6 points, p < 0.0001), age (mean ± SD: 76.3 ± 12.9 vs 65.5 ± 14.7 years, p < 0.0001), incidence of heart diseases (86.2 % vs 67.3 %, p = 0.04) and ischaemic heart disease (58.6 % vs 38.7 %, p = 0.04). Assessment of physical and laboratory findings showed that deceased patients had significantly increased incidence of tachycardia above 90/min (51.7 % vs 27.4 %, p = 0.01), tachypnoe above 30/min (37.9 % vs 13.7 %, p = 0.001) and acidosis with pH < 7.35 (27.6 % vs 8.9 %, p = 0.004) comparing to survived patients. No significant correlation between PSI and the length of hospitalisation in survived patients was observed. In patients with Staphylococcus sp. and Klebsiella pneumoniae infection, longer hospitalisation period was observed. Comparison of other parameters such as comorbidities, physical and laboratory findings, and pathogens showed no significant differences when comparing deceased to survived patients. CONCLUSION: Our study showed that PSI represents an important predictor of 30-day mortality in patients with CAP at ICU, but does not correlate neither with the length of hospitalisation nor with particular pathogens. Independent negative prognostic factors in CAP were age, incidence of heart diseases (most importantly ischaemic heart disease), tachycardia, tachypnoe and acidosis. Staphylococcus sp. and Klebsiella pneumoniae infection led to longer hospitalisation period. All these factors point out the need for increased care in CAP patients.