Rachina Svetlana, Bobylev Andrey, Lazarev Pavel, Mladov Vladimir, Carrouel Florence, Avdeev Sergey, Kozlov Roman, Bourgeois Denis
Internal Medicine Department, Sechenov First Moscow State Medical University, 119991 Moscow, Russia.
Institute of Antimicrobial Chemotherapy, State Medical University, 214019 Smolensk, Russia.
J Clin Med. 2021 Oct 1;10(19):4570. doi: 10.3390/jcm10194570.
The diagnosis of community-acquired pneumonia (CAP) with chronic heart failure (CHF) is associated with objective difficulties. Our case-control study aims to establish whether established serum inflammatory biomarkers are relevant to the diagnosis of CAP in patients with CHF. Seventy inpatients with previously diagnosed CHF and suspected non-severe CAP were recruited and then stratified into two subgroups with confirmed and rejected diagnosis of CAP. C-reactive protein (CRP), procalcitonin (PCT), tumor necrosis factor α (TNFα), interleukin-6 (IL-6) and brain natriuretic peptide (BNP) were measured. The value of biomarkers was determined using logistic regression, and their discriminatory efficacy was assessed by analyzing receiver operating characteristic (ROC) curves. Significantly higher levels of CRP 50.0 (35.5-98.5) mg/L, PCT 0.10 (0.05-0.54) ng/mL and IL-6 46.1(21.4-150.3) pg/mL in cases were identified as compared to the control group-15.0 (9.5-25.0) mg/L, 0.05 (0.05-0.05) ng/mL and 13.6 (9.5; 25.0) pg/mL, respectively. The Area Under the ROC Curve (95% CI) was the highest for CRP-0.91 (0.83-0.98), followed by PCT-0.81 (0.72-0.90) and IL-6-0.81 (0.71-0.91). A CRP value of >28.5 mg/L had an optimal sensitivity and specificity ratio (85.7/91.4%). In conclusion, the measurement of serum CRP, PCT and IL-6 levels can be useful for the diagnosis of CAP in patients with CHF. CRP showed optimal diagnostic utility in this population.
社区获得性肺炎（CAP）合并慢性心力衰竭（CHF）的诊断存在客观困难。我们的病例对照研究旨在确定既定的血清炎症生物标志物是否与CHF患者的CAP诊断相关。招募了70例先前诊断为CHF且疑似非重症CAP的住院患者，然后将其分为CAP诊断得到证实和排除的两个亚组。检测了C反应蛋白（CRP）、降钙素原（PCT）、肿瘤坏死因子α（TNFα）、白细胞介素-6（IL-6）和脑钠肽（BNP）。使用逻辑回归确定生物标志物的值，并通过分析受试者工作特征（ROC）曲线评估其鉴别效能。与对照组相比，病例组的CRP水平显著更高，为50.0（35.5 - 98.5）mg/L，PCT为0.10（0.05 - 0.54）ng/mL，IL-6为46.1（21.4 - 150.3）pg/mL，而对照组分别为15.0（9.5 - 25.0）mg/L、0.05（0.05 - 0.05）ng/mL和13.6（9.5；25.0）pg/mL。ROC曲线下面积（95%CI）以CRP最高，为0.91（0.83 - 0.98），其次是PCT为0.81（0.72 - 0.90），IL-6为0.81（0.71 - 0.91）。CRP值>28.5 mg/L时具有最佳的敏感性和特异性比（85.7/91.4%）。总之，检测血清CRP、PCT和IL-6水平有助于CHF患者的CAP诊断。CRP在该人群中显示出最佳的诊断效用。
