The Value Of RAGE,SP-D,ANG2,and HMGB1 In The Assessment Of Severity And Prognosis Of Community-acquired Pneumonia

Objective:Community-acquired pneumonia(CAP)refers to pulmonary parenchymal inflammation caused by infection in the community environment,which is widespread worldwide and has a considerable impact on the global healthcare system.Patients with non-severe community-acquired pneumonia(NSCAP)may present with fever,cough,sputum,chest pain,hemoptysis,and other discomfort.Patients with severe community-acquired pneumonia(SCAP)may present with respiratory failure and multiple organ failure,which seriously threatens the health and life of patients.Early identification of SCAP is of great significance.This study explores the value of receptors for advanced glycation end products(RAGE),surfactant protein D(SP-D),angiopoietin 2(ANG2),and high mobility group protein B1(HMGB1)in assessing the severity and prognosis of CAP.Method:According to the inclusion and exclusion criteria of this study,112 patients diagnosed with CAP were included consecutively,who were hospitalized in the Department of Respiratory and Critical Care Medicine of Henan Provincial People’s Hospital from January 2022 to January 2023.According to the "Guidelines for the Diagnosis and Treatment of Community-acquired Pneumonia in Adults in China(2016Edition)",patients with CAP were divided into NSCAP group and SCAP group,and patients with CAP were divided into survival group and death group according to the 30-day survival status after discharge.General data were collected,including age,sex,smoking history,drinking history,comorbidities,as well as laboratory indicators,CURB-65 score,and early morning fasting peripheral blood from two groups of individuals who were diagnosed with NSCAP and SCAP within 24 hours,respectively.Plasma concentrations of RAGE,SP-D,ANG2,and HMGB1 were detected by enzyme linked immunosorbent assay(ELISA).SPSS 25.0 statistical software was used for processing and analyzing.The differences in four biomarkers were compared between the NSCAP group and the SCAP group,as well as between the survival group and the death group,respectively.Binary logistic regression analysis was used to evaluate the relationship between the four biomarkers and the severity of CAP,as well as the relationship between the four biomarkers with the CURB-65 score and the 30-day mortality risk of patients with CAP.Receiver operating characteristic curve(ROC)was plotted to evaluate the predictive ability of related biomarkers for the severity and prognosis of CAP,and to determine the area under the curve(AUC)value,optimum cut-off value,sensitivity,and specificity.Result:1.There were 70 patients in the NSCAP group and 42 patients in the SCAP group,with 30-day mortality rates of 1.4% and 66.7%,respectively,with statistically significant differences(P<0.05).The plasma concentrations of RAGE,SP-D,ANG2,and HMGB1 in the NSCAP group were 1.21(0.88,2.26)ng/m L,2.45(1.36,3.77)ng/m L,0.90(0.53,1.64)ng/m L,and 14.09(7.96,25.31)ng/m L,respectively.The plasma concentrations of RAGE,SP-D,ANG2,and HMGB1 in the SCAP group were 2.09(0.90,4.99)ng/m L,3.48(2.22,6.98)ng/m L,3.59(2.50,6.31)ng/m L,and 47.52(25.99,80.58)ng/m L,respectively.The differences were statistically significant(P<0.05).2.Logistic regression analysis indicated that ANG2 and HMGB1 were independent risk factors for SCAP among the four biomarkers.To predict the severity of CAP,the area under the ROC curve of ANG2 and HMGB1 were 0.912 and 0.854,respectively.The optimum cut-off values were 2.05 ng/m L and 19.55ng/m L,respectively.The sensitivity value was 88.1%.The specificity values were 84.3% and 72.9%,respectively.The AUC value obtained by ANG2 combined with HMGB1 was 0.923.The optimum cut-off value was 0.38.The sensitivity and specificity were 83.3% and 85.7%,respectively.3.There were 83 people in the survival group and 29 people in the death group.The plasma concentrations of RAGE,SP-D,ANG2,and HMGB1 in the survival group were 1.24(0.90,2.37)ng/m L,2.61(1.38,4.32)ng/m L,1.00(0.60,1.98)ng/m L,and 15.05(9.26,26.44)ng/m L,respectively.The plasma concentrations of RAGE,SP-D,ANG2,and HMGB1 in the death group were 2.73(0.82,4.59)ng/m L,3.41(2.49,6.86)ng/m L,4.30(2.98,6.63)ng/m L,and 64.01(35.32,89.34)ng/m L,respectively.The differences were statistically significant(P<0.05).4.Logistic regression analysis indicated that ANG2,HMGB1,and CURB-65 score were independent risk factors for 30-day mortality in patients with CAP among the four biomarkers and CURB-65 score.To predict the 30-day mortality risk of patients with CAP,the AUC values of ROC for ANG2,HMGB1,and CURB-65 score were 0.939,0.903,and 0.883,respectively.The optimum cut-off values were 2.49ng/m L,26.99ng/m L,and 1.5 points,respectively.The sensitivity values were 93.1%,93.1%,and 96.6%.The specificity values were 84.3%,75.9 %,and 72.3%,respectively.To predict the 30-day mortality risk of patients with CAP,the ability of ANG2 and HMGB1 combined with CURB-65 score was superior to the ability of ANG2 and HMGB1 alone.In addition,ANG2 and HMGB1 combined with the CURB-65 score could more accurately predict the 30-day mortality of patients with CAP,with the AUC value reaching0.970,the sensitivity of 89.7%,and specificity of 92.8%.Conclusion:1.The plasma concentrations of RAGE,SP-D,ANG2,and HMGB1 in patients with SCAP are higher than those in patients with NSCAP.ANG2 and HMGB1 can be used as independent risk factors for SCAP.The combination of ANG2 and HMGB1 can improve the value of individual predictions.2.The plasma concentrations of RAGE,SP-D,ANG2,and HMGB1 in dead patients are higher than those in surviving patients.ANG2,HMGB1,and CURB-65 score can be used as independent risk factors for the 30-day mortality of patients with CAP.The combination of ANG2,HMGB1,and CURB-65 score can improve the value of individual predictions.