Application Of Blood Heparin-binding Protein And Neutrophil-to-lymphocyte Ratio In The Severity And Prognosis Of Community-acquired Pneumonia

Background Community-acquired pneumonia(CAP)is a prevalent respiratory disease with a high morbidity and mortality rate globally.The elderly and immunocompromised populations are particularly vulnerable,and CAP places a significant financial and medical burden on society.The 2007 Infectious Diseases Society of America/American Thoracic Society criteria for severe pneumonia are the generally accepted diagnostic criteria for this condition.Other commonly used indicators to evaluate the severity and prognosis of CAP include the pneumonia severity index(PSI),Consciousness,urea nitrogen,respiratory rate,blood pressure,and age(CURB-65),etc.,but it is frequently challenging to strike a balance between simplicity and accuracy,limiting its clinical use and usefulness as practical advice.Finding novel reference indicators to forecast CAP severity and prognosis from the perspective of biomarkers has become an increasingly popular endeavor.The hunt for new biomarkers has never ended because established biomarkers like white blood cell count,C-reactive protein,and procalcitonin offer clinical reference but also have some drawbacks.Heparin-binding protein(HBP)is a multifunctional granule protein secreted by neutrophils,and the neutrophil-to-lymphocyte ratio(NLR),a crucial marker connecting intrinsic immunity and adaptive immunity,both of which have demonstrated therapeutic relevance in a variety of infectious illnesses.The clinical significance of HBP and NLR in CAP,however,has not received much attention,and it is unknown what the prognostic value of their combined measurements would be.Considering that both are closely related to neutrophils,which play an important role in host immune defense,this study will examine the value of HBP and NLR in CAP with the goal of providing a reference for CAP severity assessment and prognosis prediction.Objectives To investigate the prognostic value of blood HBP and NLR in the severity and prognosis of CAP in adults and to conduct a study on the relationship between HBP and the etiology of CAP.Methods The clinical information of 206 CAP patients who were hospitalized to the First Affiliated Hospital of Anhui Medical University between April 2020 and July 2022 was retrospectively analyzed.HBP,NLR,and other related indicators were checked within 48 hours after the patient being admitted to the hospital.Receiver operating characteristic curves were created,and the accuracy of the diagnosis of severe pneumonia was evaluated by the area under the curve.Univariate and multivariate Cox regression analyses were used to examine independent factors affecting the 30-day prognosis.The Kruskal-Wallis test was utilized to contrast the variations among etiology.Spearman correlation analysis was used to examine the relationship between HBP and other markers.Results 1.Patients with severe pneumonia showed greater HBP and NLR compared to those with common pneumonia(P<0.05).The area under the curve of plasma HBP for the diagnosis of severe pneumonia was 0.723(95% confidence interval: 0.655-0.790),with the highest specificity(76.19%)at a cut-off value of 126.13 ng/ml.The optimal cut-off value for NLR was 6.68,with a high sensitivity(80.00%).The combination of HBP and NLR improved the specificity of the diagnosis of severe pneumonia(84.13%),and the combination of HBP,NLR and white blood cell count significantly improved the sensitivity of the diagnosis(86.25%).2.Blood HBP ≥213.9 ng/ml and NLR ≥10.3 were independent predictors of 30-day mortality in CAP patients.3.Patients with CAP who had various pathogen infections did not have substantially different plasma HBP(P > 0.05).4.According to the Spearman correlation analysis,plasma HBP levels in CAP patients were connected positively with neutrophil count,C-reactive protein,procalcitonin,creatinine,lactate,and Sequential Organ Failure Assessment(SOFA)score and negatively with Pa O2/Fi O2.Conclusion HBP and NLR were independent predictors of 30-day death in CAP patients and grew with increasing severity in these patients.Their combination opened up new possibilities.Furthermore,there is no connection between HBP and the etiology of CAP.