Chen Cheng-Han, Lee Yi-Tzu, Shen Ching-Fen, Cheng Chao-Min
Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Intern Emerg Med. 2025 May 27. doi: 10.1007/s11739-025-03975-7.
Current severity scoring systems (PSI and CURB-65) have limitations in risk stratification for elderly patients with community-acquired pneumonia (CAP). Given the complex immune responses in elderly populations, dynamic biomarker monitoring may provide additional prognostic value. This study evaluates whether integrating early cytokine dynamics with traditional severity scores improves mortality prediction in elderly CAP patients. This prospective observational study included 81 CAP patients aged ≥ 65 years. Multiple cytokines were measured at admission and within 48 h. Traditional severity scores (PSI and CURB-65) were calculated at baseline. Patients were categorized into survival (n = 67) and mortality (n = 14) groups. The predictive value of cytokine dynamics alone and in combination with severity scores was assessed using ROC curve analysis. Among measured cytokines, IL-6 demonstrated significant prognostic value. The mortality group showed an 88% increase in IL-6 levels within 48 h, contrasting with a 49% decrease in survivors (p = 0.040). While individual PSI (AUC = 0.6631) and CURB-65 (AUC = 0.6231) showed modest discrimination, integration with IL-6 dynamics significantly improved predictive accuracy (PSI + IL-6: AUC = 0.7676, p = 0.0017; CURB-65 + IL-6: AUC = 0.7564, p = 0.0027). Early dynamic monitoring of cytokines, particularly IL-6, significantly enhances the prognostic accuracy of traditional severity scores in elderly CAP patients. This pilot study suggests that this integrated approach provides a more precise risk stratification tool, potentially enabling more personalized clinical decision-making. Larger multicenter studies are warranted to validate these findings and establish standardized cutoff values for clinical implementation.
当前的严重程度评分系统（肺炎严重指数[PSI]和CURB-65）在社区获得性肺炎（CAP）老年患者的风险分层方面存在局限性。鉴于老年人群复杂的免疫反应，动态生物标志物监测可能具有额外的预后价值。本研究评估将早期细胞因子动态变化与传统严重程度评分相结合是否能改善老年CAP患者的死亡率预测。这项前瞻性观察性研究纳入了81例年龄≥65岁的CAP患者。入院时及48小时内检测了多种细胞因子。在基线时计算传统严重程度评分（PSI和CURB-65）。患者被分为生存组（n = 67）和死亡组（n = 14）。使用ROC曲线分析评估单独的细胞因子动态变化以及与严重程度评分相结合时的预测价值。在所检测的细胞因子中，白细胞介素-6（IL-6）显示出显著的预后价值。死亡组在48小时内IL-6水平升高了88%，而存活者则下降了49%（p = 0.040）。虽然单独的PSI（曲线下面积[AUC]=0.6631）和CURB-65（AUC = 0.6231）显示出适度的区分能力，但与IL-6动态变化相结合显著提高了预测准确性（PSI + IL-6：AUC = 0.7676，p = 0.0017；CURB-65 + IL-6：AUC = 0.7564，p = 0.0027）。细胞因子的早期动态监测，尤其是IL-6，显著提高了传统严重程度评分对老年CAP患者的预后准确性。这项初步研究表明，这种综合方法提供了一种更精确的风险分层工具，有可能实现更个性化的临床决策。需要进行更大规模的多中心研究来验证这些发现并建立临床应用的标准化临界值。
