Zhao Lili, Shang Ying, Luo Qiongzhen, Ma Xinqian, Ni Wentao, He Yukun, Yang Donghong, Xu Yu, Gao Zhancheng
Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, China.
Department of Respiratory and Critical Care Medicine, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China.
Front Med (Lausanne). 2022 Jul 29;9:807536. doi: 10.3389/fmed.2022.807536. eCollection 2022.
Community-acquired pneumonia (CAP) is a respiratory disease that frequently requires hospital admission, and is a significant cause of death worldwide. Plasma fetuin-A levels were significantly lower in patients with sepsis, but data regarding CAP are scarce. This study aimed to evaluate the usefulness of fetuin-A as a prognostic biomarker of CAP.
A multicenter cohort study on CAP was conducted between January 2017 and December 2018. Demographic and clinical data were recorded for all enrolled patients. Plasma fetuin-A levels were determined using a quantitative enzyme-linked immunosorbent assay. A Cox proportional hazards regression analysis was used to analyse the effect of variables on 30-day mortality. A logistic regression analysis was performed to assess risk factors associated with severe CAP (SCAP) and 30-day mortality. A receiver operating characteristic (ROC) curve was used to verify the association between variables and CAP prognosis. Correlations were assessed using Spearman's test. Survival curves were constructed and compared using the log-rank test.
A total of 283 patients with CAP were enrolled in this study. Fetuin-A levels were decreased in patients with CAP, especially in SCAP and non-survivors. A cox regression analysis showed that CURB-65 and fetuin-A levels were independent prognostic indicators of 30-day mortality. a multiple logistic regression analysis, plasma level of fetuin-A (<202.86 mg/L) was determined to be the strongest independent predictor of 30-day mortality considered (odds ratio, 57.365), and also was also determined to be an independent predictor of SCAP. The area under the curve (AUC) of fetuin-A for predicting 30-day mortality was 0.871, and accuracy was high ( < 0.05). Plasma fetuin-A levels were negatively correlated with WBC, NE%, Glu, CRP, PCT, CURB-65, and pneumonia severity index scores and positively correlated with albumin level. Kaplan-Meier curves showed that lower plasma levels of fetuin-A levels were associated with increased 30-day mortality levels ( < 0.0001).
Plasma fetuin-A levels were decreased in patients with CAP. Fetuin-A can reliably predict mortality in patients with CAP, and is a useful diagnostic indicator of SCAP.
社区获得性肺炎（CAP）是一种常需住院治疗的呼吸道疾病，也是全球范围内的一个重要死亡原因。脓毒症患者的血浆胎球蛋白-A水平显著降低，但关于CAP的数据却很稀少。本研究旨在评估胎球蛋白-A作为CAP预后生物标志物的效用。
于2017年1月至2018年12月开展了一项关于CAP的多中心队列研究。记录所有入组患者的人口统计学和临床数据。采用定量酶联免疫吸附测定法测定血浆胎球蛋白-A水平。使用Cox比例风险回归分析来分析各变量对30天死亡率的影响。进行逻辑回归分析以评估与重症CAP（SCAP）和30天死亡率相关的危险因素。采用受试者工作特征（ROC）曲线来验证各变量与CAP预后之间的关联。使用Spearman检验评估相关性。构建生存曲线并使用对数秩检验进行比较。
本研究共纳入283例CAP患者。CAP患者的胎球蛋白-A水平降低，尤其是在SCAP患者和非存活者中。Cox回归分析表明，CURB-65和胎球蛋白-A水平是30天死亡率的独立预后指标。在多元逻辑回归分析中，确定血浆胎球蛋白-A水平（<202.8 mg/L）是所考虑的30天死亡率的最强独立预测因子（比值比，57.365），并且也被确定为SCAP的独立预测因子。胎球蛋白-A预测30天死亡率的曲线下面积（AUC）为0.871，准确性较高（P<0.05）。血浆胎球蛋白-A水平与白细胞、中性粒细胞百分比、血糖、C反应蛋白、降钙素原、CURB-65及肺炎严重程度指数评分呈负相关，与白蛋白水平呈正相关。Kaplan-Meier曲线显示，较低的血浆胎球蛋白-A水平与30天死亡率升高相关（P<0.0001）。
CAP患者的血浆胎球蛋白-A水平降低。胎球蛋白-A能够可靠地预测CAP患者的死亡率，并且是SCAP的一项有用的诊断指标。
