Elevated KLF2 and YKL-40 with reduced vitamin A as predictive biomarkers for severity and prognosis in neonatal respiratory distress syndrome.

OBJECTIVE

This study aimed to investigate the relationships between Krüppel-like factor 2 (KLF2), YKL-40, and vitamin A levels, as well as their association with the severity and prognosis of Neonatal Respiratory Distress Syndrome (NRDS), with the goal of improving predictive accuracy and clinical management.

METHODS

A retrospective cohort study was conducted at Bozhou Municipal People's Hospital between January 2019 and January 2022. A total of 128 neonates diagnosed with NRDS were included, along with 128 healthy neonates as controls. Blood samples were collected within one hour of admission. Levels of KLF2, YKL-40, and vitamin A were measured using enzyme-linked immunosorbent assay (ELISA) and high-performance liquid chromatography (HPLC). Neonates were grouped based on NRDS severity, and the relationships between biomarker levels and clinical outcomes were analyzed.

RESULTS

Significant differences in KLF2, YKL-40, and vitamin A levels were observed between the NRDS group and control group ( < 0.001). Elevated KLF2 and YKL-40 levels were strongly correlated with more severe disease, while lower vitamin A levels were associated with worse outcomes. Multivariate logistic regression identified KLF2, YKL-40, and vitamin A levels as independent predictors of NRDS severity ( < 0.05). The nomogram achieved a concordance index (C-index) of 0.93 (95% CI: 0.89-0.97), indicating excellent discrimination of different disease severity. Receiver's operating characteristic (ROC) curve analysis showed that combining these biomarkers improved the prediction of NRDS severity, with the joint model achieving an AUC of 0.95, sensitivity of 91.2%, and specificity of 90.1%.

CONCLUSION

KLF2, YKL-40, and vitamin A are significant biomarkers for predicting the severity and prognosis of NRDS. Combining these biomarkers enhances predictive accuracy, aiding in the early identification and personalized management of neonates with NRDS.