Gerontology ICU, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China; ChineseAcademy of Sciences, Sichuan Translational Medicine Research Hospital, Chengdu, China.
Ann Palliat Med. 2021 Dec;10(12):12767-12774. doi: 10.21037/apm-21-3511.
This study aimed to explore the relationship between the severity and prognosis of elderly patients with ventilator-associated pneumonia (VAP) and the expression of serum interleukin-18 mRNA (IL-18 mRNA), Clara cell secretory protein 16 (CC16) and the soluble triggering receptor expressed on myeloid cells 1 (sTREM-1).
The patients were divided into a VAP group (n=75) and a non-VAP group (n=110). According to the Acute Physiology and Chronic Health Evaluation II (APACHEII) score, the patients with VAP were divided into a low-risk group, an intermediate-risk group and a high-risk group. According to the 28-day outcome, the patients were divided into a survival group and a death group. Serum levels of IL-18, CC16 and sTREM-1 were detected, and their value in the prediction and prognosis of VAP was analyzed using a receiver operating characteristic (ROC) curve.
Serum levels of IL-18 and sTREM-1 in the VAP group were higher than those in the non-VAP group, while CC16 levels were lower in the VAP group than those in the non-VAP group (P<0.05). Serum levels of IL-18 and sTREM-1 decreased in order from the high-risk group to the intermediate-risk group to the low-risk group, while CC16 levels increased in order (P<0.05). ROC curve analysis showed that the Youden index and AUC of combined diagnosis of VAP with serum IL-18 mRNA, CC16 and sTREM-1 were 0.710 and 0.930, which were higher than those of single diagnosis (P<0.05). Serum levels of IL-18 mRNA and sTREM-1 in the survival group were lower than those in the death group, and the CC16 level was higher than that in the death group (P<0.05). ROC curve analysis showed that the Youden index and AUC of combined diagnosis with serum IL-18 mRNA, CC16 and sTREM-1 were 0.506 and 0.731, which were higher than those of single diagnosis (P<0.05).
The combination of these 3 factors is of high value in predicting the severity and prognosis of VAP and can provide reference for clinical treatment.
本研究旨在探讨老年呼吸机相关性肺炎（VAP）患者病情严重程度和预后与血清白细胞介素-18mRNA（IL-18mRNA）、克拉拉细胞分泌蛋白 16（CC16）和髓系细胞触发受体 1 可溶性（sTREM-1）表达的关系。
将患者分为 VAP 组（n=75）和非 VAP 组（n=110）。根据急性生理学和慢性健康评估 II（APACHEII）评分，将 VAP 患者分为低危组、中危组和高危组。根据 28 天的转归，将患者分为存活组和死亡组。检测血清 IL-18、CC16 和 sTREM-1 水平，采用受试者工作特征（ROC）曲线分析其对 VAP 的预测和预后价值。
VAP 组血清 IL-18 和 sTREM-1 水平高于非 VAP 组，CC16 水平低于非 VAP 组（P<0.05）。血清 IL-18 和 sTREM-1 水平自高危组至中危组至低危组依次降低，CC16 水平依次升高（P<0.05）。ROC 曲线分析显示，血清 IL-18mRNA、CC16 和 sTREM-1 联合诊断 VAP 的约登指数和 AUC 分别为 0.710 和 0.930，均高于单项诊断（P<0.05）。存活组血清 IL-18mRNA 和 sTREM-1 水平低于死亡组，CC16 水平高于死亡组（P<0.05）。ROC 曲线分析显示，血清 IL-18mRNA、CC16 和 sTREM-1 联合诊断的约登指数和 AUC 分别为 0.506 和 0.731，均高于单项诊断（P<0.05）。
这 3 种因素联合对 VAP 严重程度和预后的预测具有较高的价值，可为临床治疗提供参考。
