Changes And Clinical Significance Of Serum Soluble CD14 Subtypes And Soluble Urokinase Plasminogen Activator Receptor Levels In Patients With Community Acquired

Objective:To investigate the diagnostic value of prognosis and clinical significance of the serum soluble CD 14 subtype(sCD14-st)and soluble urokinase plasminogen activator receptor(suPAR)levels changes in patients with community-acquired pneumonia(CAP)in emergency department.Methods:Ninety patients with CAP admitted to the emergency department of Yang Pu Hospital affiliated to Tongji University from January 2018 to December 2019 were used as research objects.According to the sepsis 3.0 diagnostic criteria,the patients were divided into sepsis group and normal group,and the sepsis group was divided into death subgroup and survival subgroup based on the prognosis of the patients.The serum sCD14-st,suPAR,CRP,PCT concentration levels and sepsis-related sequential organ failure(SOFA)scores were compared between different groups at admission and before death.Pearson correlation was used to analyze the correlation between serum sCD14-st,suPAR,CRP,PCT and SOFA scores in the sepsis group,and the ROC curve was used to analyze the predictive value of the above indicators to death patients in the sepsis group.Results:1.90 CAP patients were rolled into this study,including 43 males and 47 females,and were divided into 40 cases in sepsis group and 50 cases in normal group.There were statistically significant differences between the two groups of patients in terms of age,proportion of patients with age over 60 years,combined chronic bronchitis,length of stay in hospital,and the proportion of death patients(all P<0.05).2.Multivariate logistic regression analysis was performed on the three statistically significant factors of age,age over 60 years,combined with chronic lung disease,and the results showed that all the three index were the risk factors that caused CAP patients to progress to sepsis(P<0.05).3.At admission,the serum sCD14-st,suPAR,CRP,PCT concentration levels and SOFA scores of patients in the sepsis group were significantly higher than those in the normal group,and the differences were statistical significance(all P<0.05).4.The results of Pearson correlation analysis in the sepsis group showed that there was a positive correlation between sCD14-st,PCT and SOFA score(r=0.639,0.576,P<0.001),CRP and SOFA score were weakly correlated(r=0.325,P=0.041),there was no significant correlation between suPAR and SOFA score(r=0.274,P=0.087).5.Forty patients in the sepsis group were divided into survival subgroup with 29 cases and death subgroup with 11 cases according to the outcome.The serum sCD14-st,suPAR,CRP,PCT concentration levels and SOFA scores of the death subgroup at admission were significantly higher than those of the survival subgroup,and the differences were statistically significant(all P<0.05).6.Compared with the time of admission,the serum levels of sCD14-st,suPAR,CRP and SOFA score of the sepsis patients before death were significantly increased,but no significant changes in PCT levels.7.The ROC curve was drawn based on the serum levels of sCD14-st,suPAR,CRP,and PCT in the sepsis group at admission to evaluate the predictive value of these indicators for death.The results showed that the area under the curve of serum sCD14-st(AUC=0.828)and suPAR(AUC=0.807)was higher than CRP(AUC=0.592)and smaller than PCT(AUC=0.997)and SOFA score(AUC=0.837).Conclusion:1.Old age and chronic bronchitis were risk factors for the progression of CAP patients to sepsis.Serum sCD14-st,suPAR,CRP,PCT concentration levels and SOFA scores are related to the severity of CAP patients.2.The high level of serum sCD14-st,suPAR,PCT and high SOFA scores at admission indicated a poor prognosis.3.Serum sCD14-st and suPAR had good diagnostic value for judging the prognosis of patients with sepsis.The detection of serum sCD14-st and suPAR levels at admission was helpful to assess the outcome of patients with sepsis.