| ObjectiveThe objective of this study is to analyze how serum levels of oncostatin-M(OSM),interleukin-6,and interleukin-8 affect patients with community-acquired pneumonia(CAP)with comorbid cardiovascular diseases(CVD),as well as the disease severity and prognosis in various age groups.To increase the ability to predict the risk of death in this population by analyzing the independent risk variables for one-year mortality in patients with community-acquired pneumonia with comorbid cardiovascular disease.MethodsThis is a prospective study of patients who were admitted to the respiratory and critical care unit,emergency ward,and intensive care unit(ICU)of Qingdao Municipal Hospital from November 2020 to November 2021 with a final diagnosis of community-acquired pneumonia.The 454 patients were classified into 213 patients(46.9%)with CVD-CAP and 241 patients(53.1%)with CAP alone according to whether they had prehospital hypertension,heart failure,or coronary atherosclerotic heart disease.Clinical data collected included age,gender,comorbidities,clinical symptoms within 24 hours after admission,pulmonary imaging changes,laboratory testing(e.g.,blood routine,liver and kidney function,coagulation routine,blood gas analysis,etc.),cytokine concentration measurements(e.g.,serum OSM,IL-6,IL-8,IL-10 levels),and prognosis.Serum OSM,interleukin-6(IL-6),interleukin-8(IL-8),and interleukin-10(IL-10)concentrations were measured by ELISA.Differences between two groups were compared by Mann-Whitney U test,chi-square test,or Fisher’s exact test,and differences between multiple groups were analyzed by Kruskal-Wallis test.A multifactorial analysis of independent risk factors influencing the one-year morbidity and mortality rate of CVD-CAP patients was performed by a binary logistic regression model.Results1.Compared with patients in the CAP-only group,patients in the CVD-CAP group were older,had more patients with comorbid malignancies,diabetes mellitus,and cerebrovascular diseases had longer hospitalization days,and had more severe disease(P < 0.05).2.Patients in the CVD-CAP group had higher inflammatory indexes(WBC,PLT,PCT,CRP,etc.)and were more likely to have hypoproteinemia,hepatic and renal insufficiency,and elevated levels of NT-pro BNP and D-dimer than those in the CAP-only group,and all were statistically different(P<0.05).Patients in the CVD-CAP group on the day of admission had the level of OSM(18.9(9.7-39.2)vs 31.2(12.2-72.3))pg/m L,IL-6(3.6(2.1-6.8)vs 5.8(3.0-11.6))pg/m L,and IL-8(14.7(10.8-21.7)vs 17.7(12.6-27.0))pg/m L concentrations were significantly higher than those of patients in the CAP-only group(P < 0.01),but IL-10 was not statistically significantly different between the two groups(P > 0.05).3.The CAP patients were divided into group A(without CVD group n=241),group B(combined one CVD group n=128),and group C(combined two or more CVD group n=85)according to the number of combined CVD.The level of OSM and IL-6 were different between group A and groups B and C(P<0.05),which indicated that the level of OSM and IL-6 were not related to the number of combined CVD.While IL-8 was significantly different only between groups A and C(P<0.05),there was no significant difference between the other two groups.4.Patients were grouped according to the number of combined CVD,and between groups they were classified according to severity of illness and prognosis.Patients were classified as non-serious,serious,surviving or dead.The results showed that regardless of the number of combined CVD,patients with severe5.The levels of OSM,IL-6 and IL-8 were significantly higher in the critically ill and deceased patients than in the non-critically ill and surviving patients(p<0.05).Patients with CVD-CAP were classified according to their age as <65 years(n=68),65-75 years(n=50),75-85 years(n=45),and ≥85 years(n=50).The results showed significant differences in the level of OSM in patients aged <65 years and65-75 years compared to those aged ≥85 years(P<0.05).IL-6 and IL-8 were statistically significant only between the <65 and ≥85 years groups(P<0.05).6.In each age group,CVD-CAP patients were divided into mild and severe patients according to the severity of the disease.The results showed that the level of OSM was significantly higher in patients <85 years of age in patients with severe disease compared to those with mild disease(P<0.05).The level of IL-6 was only elevated in patients <65 years of age in patients with severe disease compared to those with mild disease(P<0.05),and in patients ≥65 years of age,the level of IL-6 was not significantly different between the two groups.The level of IL-8 was elevated in patients with severe disease compared to those with mild disease between <65 and75-85 years of age(P<0.05).In all three groups,there was no significant difference between patients ≥85 years of age in patients with mild disease and those with severe disease(P>0.05).7.Patients with CVD-CAP are classified as survivors or deceased according to their prognosis.The results showed that compared to surviving OSM levels were significantly higher in deceased patients compared to survivors(P<0.05)in patients aged ≥75 years;IL-6 levels were significantly higher only in patients aged 65-75 years(P<0.05);In contrast,IL-8 was significantly higher in patients <65 and ≥85 years of age(P < 0.05).8.Variables with P<0.20 in the univariate statistical analysis(age,cerebrovascular disease,WBC,Neu,PLT,PCT,ALB,BUN,D-dimer,OSM,IL-6,IL-8)were included in the binary logistic multivariate regression analysis,and the results showed that age(OR 1.056,95% CI 1.017-1.097,P = 0.004),BUN(OR 1.065,95% CI1.011-1.121,P = 0.017),and OSM(OR 1.009,95% CI 1.003-1.014,P = 0.001)were independent risk factors affecting one-year morbidity and mortality in patients with combined cardiovascular disease CAP.Conclusions1.The level of serum OSM、 IL-6 and IL-8 was significantly higher on the day of admission in patients with CVD-CAP than in patients with CAP alone,suggesting that cardiovascular disease affected the expression of cytokines in CAP patients;The level of serum OSM,IL-6,and IL-8 was higher on the day of admission in patients with severe disease and death than in patients with mild disease and survival,suggesting that all three were associated with the severity of disease in patients with CVD-CAP and prognosis are closely related.2.In CVD-CAP patients,OSM,IL-6 and IL-8 showed different severity of disease and prognosis in each age group and prognosis in CVD-CAP patients,suggesting that age influences the expression levels of all three;The multifactorial analysis showed that age,BUN and OSM were independent risk factors for one-year mortality in CVD-CAP patients,suggesting that OSM may be more informative than IL-6 and IL-8 in predicting prognosis of CVD-CAP patients. |
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