| Objective:To investigate the role of lysophosphatidylcholine(LPC)in assessing the severity of disease and predicting mortality in patients with community-acquired pneumonia(CAP).Methods:This was a prospective study of inpatients admitted to the Department of Respiratory and Critical Care Medicine,the Emergency Department and the Intensive Care Unit of Qingdao Municipal Hospital Headquarters between November 2020 and November 2021 finally diagnosed with CAP.A total of 378 patients with non-severe CAP(NSCAP)and 76 patients with severe CAP(SCAP)were enrolled according to the Inclusion and exclusion criteria,and 40 healthy individuals were recruited for the control study.Patients’ clinical data were collected,including age,sex,comorbidities,clinical symptoms on enrolment,lung imaging changes,laboratory tests,complications and prognosis,to create a database of patient information.Serum samples were also collected from patients within 24 hours of admission and on day 6 of treatment,and serum concentrations of IL-6,IL-8 and LPC cytokines were measured by ELISA.Differences between the two groups were compared by Manne-Whitney U test,chi-squared test or Fisher’s exact test.Correlations between data on continuous variables were analysed using the Spearman method.Multifactorial analysis was performed using binary logistic regression models.ROC curves were constructed to analyse the predictive power of biomarkers and to compare the clinical predictive value of biomarkers and disease severity scores.Kaplan-Meier survival curves were used to analyse the values of the best variables influencing in-hospital mortality in patients with CAP.Results:1.LPC levels were significantly lower within 24 hours of admission in patients with severe pneumonia compared to those with non-severe pneumonia(P<0.001).Signifcant alterations in the concentration of LPC were not afected by the causative etiology.Patients in the high-risk group had significantly lower LPC levels than those in the low-and intermediate-risk group when risk was graded according to the CURB-65 score(P=0.021);patients in the intermediate-and high-risk group had significantly lower LPC levels than those in the low-risk group when stratified according to the PSI score(P<0.001).2.Patients in the death group had significantly lower LPC levels within 24 hours of admission compared to patients in the survival group(P=0.021).However,there was no significant change in LPC levels before and after treatment.3.Correlation analysis showed a significant negative correlation between LPC and IL-6(r=-0.212,P=0.009),IL-8(r=-0.262,P=0.0001),CURB-65(r=-0.368,P<0.0001)and PSI score(r=-0.351,P<0.0001).4.LPC predicted SACP with an area under the curve of 0.715(95%CI:0.633-0.797,P<0.001)and a threshold of 33.72 ng/ml(sensitivity and specificity 63.2%and 73.7%,respectively).5.LPC levels are elevated in CAP patients and tend to decrease with increasing disease severity to a certain point.Patients with LPC levels in the range of 26.58-33.72 ng/ml can be detected by altered consciousness(OR:34.053,95%CI:3.196-362.782,P=0.003)and heart rate>100 beats/min(OR:21.705,95%CI:1.164-404.882,P=0.016)to help rapidly predict SCAP.6.ROC curve analysis showed that LPC predicted CAP mortality with an AUC of 0.660(95%CI:0.539-0.782,P=0.021),with a sensitivity and specificity of 56.8%and 80%respectively.Dividing CAP patients into two groups(high group≥31.25ng/mL and low group<31.25 ng/mL)based on the optimal cut-off values calculated from ROC curve analysis,KaplanMeier survival curves showed a statistically significant difference in mortality between the LPC low and high groups(log-rank χ2=3.727,P=0.05)and HR=2.654(1.084-6.495),indicating a significant increase in in-hospital mortality for patients with LPC levels below 31.25ng/ml.Conclusion:1.The LPC levels of the patients with severe pneumonia were significantly lower than those of the non-severe pneumonia group.Correlation analysis showed that LPC levels were negatively correlated with IL-6,IL-8,CURB-65 score,and PSI score,indicating that LPC levels could better evaluate the severity of CAP disease.2.The LPC levels of CAP death group patients were significantly lower than those of the survival group at 24 hours after admission.The optimal threshold of LPC level to predict the mortality of CAP patients was 31.25ng/ml.When LPC was less than 31.25ng/ml,the mortality risk of the patient was 2.654 times higher than that of the patient with LPC greater than or equal to 31.25ng/ml.And LPC less than 31.25ng/ml was an independent risk factor for in-hospital death in CAP patients... |
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