Miao Lei, Xiao Qing, Liao Jingxian, Xie Chunhui, Shen Xiaozhu
Department of Critical Care Medicine, The Second People's Hospital of Lianyungang Affiliated to Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222000, People's Republic of China.
Department of Geriatrics, The Second People's Hospital of Lianyungang affiliated to Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, 222000, People's Republic of China.
Clin Interv Aging. 2025 Aug 25;20:1359-1380. doi: 10.2147/CIA.S533728. eCollection 2025.
The dynamic interplay between glucose metabolism and systemic inflammation is increasingly recognized as a pivotal factor influencing outcomes in older adults with community-acquired pneumonia (CAP), yet its temporal patterns and the modifying role of nutritional status remain insufficiently understood.
In this retrospective cohort study, 507 older adults (≥65 years) hospitalized with CAP were included. Serial measurements of blood glucose (GLU), C-reactive protein (CRP), and neutrophil-to-lymphocyte ratio (NLR) were obtained at admission, 24 hours, and 72 hours. Cross-correlation function (CCF) analysis was used to characterize lagged temporal relationships among biomarkers, while autoregressive integrated moving average (ARIMA) models predicted biomarker trends. Subgroup analyses were conducted according to 28-day survival, diabetes status, nutritional status, and age.
Patients who died within 28 days had higher CRP, NLR, and GLU levels across all time points compared to survivors, with pronounced delays in normalization of inflammatory markers and persistent hyperglycemia (all P<0.001). CCF analyses demonstrated that glucose elevations often preceded increases in CRP and NLR, particularly at a lag of -1, indicating early metabolic perturbations can foreshadow subsequent inflammatory surges. Survivors showed evidence of timely feedback regulation, with negative correlations at subsequent lags, while non-survivors, malnourished patients, and those aged ≥85 years exhibited disrupted, delayed, or reversed cross-correlation patterns. ARIMA models provided robust predictions, identifying critical intervention windows based on biomarker trends.
These findings reveal the systemic impact of hyperglycemia on inflammation and suggest potential benefits of nutritional interventions targeting glucose control to modulate inflammatory responses in elderly CAP patients. Overall, this study underscores the importance of integrating metabolic monitoring with nutritional strategies to improve outcomes in this vulnerable population.
葡萄糖代谢与全身炎症之间的动态相互作用日益被认为是影响社区获得性肺炎（CAP）老年患者预后的关键因素，但其时间模式以及营养状况的调节作用仍未得到充分理解。
在这项回顾性队列研究中，纳入了507名因CAP住院的老年人（≥65岁）。在入院时、24小时和72小时获取血糖（GLU）、C反应蛋白（CRP）和中性粒细胞与淋巴细胞比值（NLR）的系列测量值。使用互相关函数（CCF）分析来表征生物标志物之间的滞后时间关系，而自回归积分移动平均（ARIMA）模型预测生物标志物趋势。根据28天生存率、糖尿病状态、营养状况和年龄进行亚组分析。
与幸存者相比，在所有时间点28天内死亡的患者CRP、NLR和GLU水平更高，炎症标志物正常化明显延迟且持续存在高血糖（所有P<0.001）。CCF分析表明，血糖升高通常先于CRP和NLR升高，特别是在-1的滞后时间，表明早期代谢紊乱可预示随后的炎症激增。幸存者显示出及时反馈调节的证据，在随后的滞后时间存在负相关，而非幸存者、营养不良患者和年龄≥85岁的患者表现出交叉相关模式中断、延迟或逆转。ARIMA模型提供了可靠的预测，根据生物标志物趋势确定关键干预窗口。
这些发现揭示了高血糖对炎症的全身影响，并表明针对血糖控制的营养干预对调节老年CAP患者炎症反应的潜在益处。总体而言，本研究强调了将代谢监测与营养策略相结合以改善这一脆弱人群预后的重要性。
