| Objective:To explore the value of serum calcium binding protein S100A12 combined with modified early warning score(MEWS)in evaluating the severity of adult community-acquired pneumonia;To compare the Clinical significance of S100A12,MEWS,pneumonia severity index,acute physiology and chronic health evaluation scoring system in the prognosis evaluation of CAP patients.Methods:A prospective study was conducted on adult CAP inpatients in the Affiliated Hospital of Southwest Medical University from January 2020 to September 2020.The subjects were randomly selected from the health management center as control,According to the severity of the disease,the subjects were divided into severe community acquired pneumonia group and non severe community acquired pneumonia group.According to the 30 day outcome as the end point,the adult CAP patients were divided into survival group and death group.All subjects’ gender,age,basic medical history,whether they were admitted to intensive care unit,whether they received invasive mechanical ventilation,admission signs and main symptoms,imaging and laboratory examination results were collected.According to the collected data,MEWS,PSI and APACHEII score were calculated.The differences of general information,invasive mechanical ventilation rate,ICU hospitalization rate and 30 day survival rate in different severity pneumonia and control groups were compared.The differences of serum inflammatory markers S100A12,procalcitonin(PCT),Serum C-reactive protein(CRP),neutrophil to lymphocyte ratio(NLR),WBC,serum amyloid A(SAA)between CAP patients with different severity and healthy people were compared by analysis of variance Count,and the change trend of each infection index with the course of antibiotic treatment.All patients were divided into low,medium and high risk groups according to MEWS score,The differences of invasive mechanical ventilation rate,mortality rate and S100A12 in different MEWS were compared.Univariate and multivariate logistic regression were used to analyze the influencing factors and independent risk factors related to the death of adult CAP patients,Receiver operating characteristic curve(ROC)was drawn to compare the predictive value of S100A12,PCT and each scoring system for 30 day mortality of CAP patients.Results:A total of 118 adult CAP inpatients were included in the study,and 10 of them did not complete the study;108 adult CAP patients completed the study and were divided into SCAP(23 cases),NSCAP group(85 cases)and control group(30 cases),There was no significant difference in age,gender,malignant tumor,cerebrovascular disease,chronic liver disease and chronic kidney disease among CAP patients with different severity(χ2=2.387,2.288,0.166,4.196,0.142,1.456;P > 0.05).There were significant differences in cardiovascular disease,ICU admission rate and invasive mechanical ventilation rate among the groups(χ2=8.670,10.777,10.618;P<0.05),In addition,the 30 day survival rate of NSCAP group(92.94%)was significantly higher than that of SCAP group(34.78%),the difference was statistically significant(χ~2=39.089,P=0.000).On the first day of admission,the concentrations of S100A12(39.63±26.24ng/ml),PCT(3.50± 4.57ng/ml),CRP(75.94±52.13mg/L)and SAA(407.40±194.62mg/L)in SCAP group were higher than those in NSCAP group and control group,The control group was lower than NSCAP group(P<0.05).There was no significant difference in NLR among the three groups(P>0.05).With the use of antibiotics,the levels of S100A12,PCT,CRP,WBC,SAA and other inflammatory indexes on the first day of admission were higher than those on the third day and one week after anti infection,and the levels of inflammatory indexes on the third day and more than one week after anti infection were higher than those on the first week after anti infection(P<0.05).According to the MEWS risk level,the patients were divided into high-risk group(7 cases),medium risk group(22cases)and low-risk group(79 cases).In MEWS,serum S100A12(48.27±27.89ng/ml)concentration in high-risk group was significantly higher than that in mediumrisk group(30.18±27.13ng/ml)and low-risk group(20.49±16.57ng/ml),and S100A12 level in low-risk group was lower than that in medium risk group;invasive mechanical ventilation rate in high-risk group(71.4%)was significantly higher than that in medium risk group(36.4%)and low risk group(10.1%),patients in low risk group were lower than those in medium-risk group;The 30 day mortality of high risk group(85.7%)was higher than that of medium risk group(22.7%)and low risk group(12.7%).The mortality of low-risk group was significantly lower than that of medium risk group(P<0.05).In the assessment of CAP,S100A12 was positively correlated with MEWS and PSI in Pearson correlation analysis(r=0.347,0.407;P<0.05),but not with APACHEⅡ(r=0.163;P>0.05).Taking the 30 days prognosis as the end point,the levels of S100A12(42.33±26.60ng/ml),PCT(4.27±4.44ng/ml),CRP(105.00 ± 48.91mg/L)and SAA(437.62 ± 144.19mg/L)in death group were significantly higher than those in survival group(P<0.05).The scores of MEWS(5.81±3.06),PSI(165.10±76.50)and APACHEⅡ(14.14±11.62)in death group were higher than those in survival group(P<0.05).ROC curve showed S100A12,PCT,MEWS,PSI,APACHEⅡ could effectively predict the death of adult CAP,the area under the curve(AUC)of 30 day death in adult CAP were0.85,0.78,0.80,0.86,0.66,respectively.The optimal cut-off values were18.190,1.72,5.50,117.50,9.50,respectively.The sensitivity was 0.9048,0.7619,0.5238,0.8571,0.6667,and the specificity was 0.7241,0.7816,0.9540,0.8161,0.7471,respectively.S100A12 combined with MEWS,PSI and APACHEⅡrespectively predicted the death value of CAP patients,S100A12+MEWS had the highest predicted value,AUC value was 0.87,the best critical value was0.20,sensitivity and specificity were 0.7143 and 0.8851 respectively(P<0.05).Conclusion:1.S100A12 combined with MEWS has positive application value in the severity assessment of adult CAP patients,and S100A12 is positively correlated with MEWS.The serum S100A12 concentration increased with the increase of MEWS.With the increase of concentration,the disease became more and more serious,and the prognosis was very poor.2.S100A12,PCT,MEWS,PSI,APACHEⅡ can effectively predict the risk of death in adult CAP patients.By comparing the single detection of the above indicators to predict the risk of death in CAP patients and S100A12 combined with MEWS,PSI,APACHEⅡ respectively to predict the risk of death in CAP patients,S100A12 combined with MEWS is the most effective in predicting the prognosis of adult CAP,the method of MEWS is fast and simple,The combination of S100A12 and MEWS has high clinical value. |
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