Department of Anesthesiology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China.
Department of Anesthesiology, the Third People Hospital of Chengdu, Chengdu, Sichuan, China.
World J Surg. 2024 Oct;48(10):2383-2390. doi: 10.1002/wjs.12343. Epub 2024 Sep 19.
This study aimed to conduct a retrospective study to identify inflammatory biomarkers for predicting ventilator-associated pneumonia in elderly patients.
Our retrospective study included 265 elderly patients (age ≥60 years) undergoing abdominal surgery with tracheal intubation and general anesthesia, with 93 experiencing varying degrees of ventilator-associated pneumonia during hospitalization, and 172 without. Serum concentrations of serum amyloid A (SAA), toll-like receptor 4 (TLR4), and soluble myeloid triggering receptor 1 (sTREM-1) were measured at 24 h post-operation using enzyme-linked immunosorbent assay. Comparisons of SAA, TLR4, and sTREM-1 and other risk factors at 24 h post-operation between elderly patients with and without ventilator-associated pneumonia were performed.
The study revealed a 35.1% incidence of postoperative ventilator-associated pneumonia among elderly patients. Upregulations of SAA, TLR4, and sTREM-1 were observed in patients with ventilator-associated pneumonia. Chronic obstructive pulmonary disease, smoking, and tracheal intubation were identified as independent risk factors. The joint prediction model was demonstrated with superior predictive accuracy (area under the curve = 0.89) compared to individual biomarkers. Correlations with procalcitonin further supported the predictive potential of SAA, TLR4, and sTREM-1 in an inflammatory response.
SAA, TLR4, and sTREM-1, particularly when combined, serve as valuable prognostic indicators for postoperative ventilator-associated pneumonia in elderly patients undergoing abdominal surgery with tracheal intubation and general anesthesia. The joint prediction model offered a promising tool for early risk assessment.
本研究旨在进行一项回顾性研究，以确定预测老年患者呼吸机相关性肺炎的炎症生物标志物。
我们的回顾性研究纳入了 265 例（年龄≥60 岁）接受气管插管和全身麻醉的腹部手术的老年患者，其中 93 例在住院期间发生不同程度的呼吸机相关性肺炎，172 例无呼吸机相关性肺炎。术后 24 小时使用酶联免疫吸附试验测定血清淀粉样蛋白 A（SAA）、Toll 样受体 4（TLR4）和可溶性髓系触发受体 1（sTREM-1）的血清浓度。比较了有和无呼吸机相关性肺炎的老年患者术后 24 小时 SAA、TLR4 和 sTREM-1 及其他危险因素。
研究显示，老年患者术后呼吸机相关性肺炎的发生率为 35.1%。患有呼吸机相关性肺炎的患者 SAA、TLR4 和 sTREM-1 水平升高。慢性阻塞性肺疾病、吸烟和气管插管被确定为独立危险因素。联合预测模型显示出优于单个生物标志物的预测准确性（曲线下面积=0.89）。与降钙素原的相关性进一步支持了 SAA、TLR4 和 sTREM-1 在炎症反应中的预测潜力。
SAA、TLR4 和 sTREM-1，特别是联合使用，可作为气管插管和全身麻醉下接受腹部手术的老年患者术后呼吸机相关性肺炎的有价值的预后指标。联合预测模型为早期风险评估提供了一种有前途的工具。
