| Background and Object:Community-acquired pneumonia is one of the diseases with the highest morbidity and mortality rates worldwide.CAP and sepsis management guidelines recommend the use of risk stratification tools to assess disease severity and prognosis in order to admit critically ill patients to intensive care units as early as possible,reduce population mortality,and conserve healthcare resources.The current risk stratification methods commonly used in CAP are clinical assessment,which relies on the subjective judgment of clinicians and has personal limitations,and rating scale assessment,which is complex and lacks accuracy in predicting long-term mortality.Biomarkers are indicators used to reflect physiological and pathological processes or biological effects of interventions,and have prognostic,predictive,diagnostic,efficacy,safety,and monitoring functions.As reproducible tests with certain predictive functions and easy collection,they can compensate to some extent for the deficiencies of existing CAP risk stratification tools.The biomarkers calcitoninogen,granulocyte lymphoid ratio,human neutrophil apolipoprotein,and interleukin-6 are widely used to reflect the inflammatory status of the body and have become more established markers of inflammation.Some studies have shown that the above biomarkers alone or in combination have some predictive value for CAP severity and prognosis,but there is controversy.The purpose of this paper is to investigate the value of NLR,HNL,IL-6,and PCT in assessing the severity and prognosis of CAP,and to provide new ideas for clinical assessment of risk stratification of CAP patients.Materials and methods:This paper is a retrospective study,120 adult patients who were hospitalized in the Department of Respiratory Medicine and the Department of Critical Care Medicine of a hospital and clearly diagnosed with CAP from January 2022 to January 2023 were selected,and general data such as gender,age,cardiovascular and cerebrovascular history;clinical data such as symptoms,signs and disease regression;NLR,HNL,IL-6,PCT,routine blood,glucose,ion,renal function Blood gas analysis,chest CT and other laboratory tests and imaging data,and the PSI score and CURB-65 score of each patient were counted.Patients were divided into 3 subgroups according to the CURB-65 score,low risk group(0-1 score),intermediate risk group(2 score),and high risk group(≥3 score),and analyzed whether NLR,HNL,IL-6,and PCT were differentially expressed between the groups.The biomarkers with differential expression among them were selected,and their correlation with the severity of pneumonia was reflected by studying their correlation with PSI scores.The biomarkers with predictive value for the severity of CAP patients were thus selected.Based on the condition regression within 30 days after hospital discharge,the patients were divided into the death group(35 cases)and the survivor group(85 cases),and the differences in the expression of NLR,HNL,IL-6,PCT and other factors that may affect the mortality of CAP were analyzed between the two groups to identify the differentially expressed indicators in the two groups.The independent predictors of 30-day mortality in patients with CAP were selected based on the elimination of confounding factors.And the biomarker with the greatest predictive value was combined with the other three biomarkers separately to calculate the area under curve(AUC)of the ROC curve and compare it with the scored AUC to explore the predictive value under the combined form of biomarkers.Results:1、The serum PCT,HNL,NLR and IL-6 levels increased gradually in the low-risk,intermediate-risk and high-risk groups.PCT was expressed at lower levels in the low-risk group than in the intermediate-risk(P=0.025)and high-risk groups(P<0.001),while there was no significant difference in expression between the intermediate-risk and high-risk groups(P>0.05).HNL was expressed at higher levels in the high-risk group than in the intermediate-risk(P=0.003)and low-risk groups(P<0.001),while there was no significant difference in expression between the intermediate-risk and low-risk groups(P>0.05).IL-6 was expressed at higher levels in the high-risk group than in the low-risk group(P=0.003),while there was no significant difference in expression between the intermediate-risk and low-risk groups(P>0.05).(P=0.003),and there was no significant difference between the intermediate-risk and low-risk groups,and between the intermediate-risk and high-risk groups(P>0.05).2、There was a positive correlation between serum HNL,PCT,NLR,and IL-6 levels and PSI scores(r=0.493,P<0.001;r=0.481,P<0.001;r=0.406,P<0.001;r=0.245,P=0.008).3、IL-6,HNL,PCT,and NLR were higher in the death group than in the survivor group,with statistically significant differences(P < 0.05).4、Each 1-unit increase in NLR was associated with a 7.3% increase in 30-day mortality in CAP patients(OR 1.073,95% CI 1-1.15,P=0.049,standard error 0.036,Jorden index 3.88),and the Jorden index was superior to other biomarkers.5、Among several biomarkers,NLR predicted 30-day mortality in CAP patients with a maximum AUC of 0.822(95% CI 0.737-0.883,P <0.001),which was not statistically significant(P > 0.05)from PSI,with a specificity of 70.2% and sensitivity of 82.9% when 8.2 was taken as the threshold value;IL-6,HNL,and PCT predicted 30-day mortality in CAP patients with a statistically significant difference(P < 0.05).The AUCs of30-day mortality in patients were all smaller than PSI,and the differences were statistically significant(P < 0.05).6.AUC of NLR+HNL group 0.863(P<0.001,95%CI 0.787-0.920,specificity 71.1%,sensitivity 91.2%).a UC of IL-6+NLR group 0.868(P<0.001,95%CI 0.787-0.920,specificity 71.4%,sensitivity 90.9%).a UC of PCT+ The AUC of the three combined groups was not statistically different compared with PSI(P > 0.05).Conclusion:1.HNL is positively correlated with CAP severity and is expected to be a biomarker for predicting CAP severity.2.NLR is an independent predictor of 30-day mortality in CAP and may be a biomarker for predicting CAP prognosis.3.NLR in combination with HNL or IL-6 or PCT improves the latter’s predictive efficacy for 30-day mortality in CAP patients,and NLR has the highest value for predicting 30-day mortality in CAP when combined with IL-6 and is expected to be an indicator for prognostic assessment of CAP. |
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