The Condition Assessment Value Of Serum High-density Lipoprotein Levels In Community-acquired Pneumonia In Elderly Patients

Objective To investigate the characteristics of high-density lipoprotein levels in elderly patients with community-acquired pneumonia,and to compare the differences in pneumonia with different severity levels and the presence of pleural effusions.To understand its value in the assessment of community-acquired pneumonia in the elderly patients.Methods A retrospective analysis was conducted.286 elderly patients with community-acquired pneumonia admitted to the First Affiliated Hospital of Guangxi Medical University from June 2016 to May 2017 were selected as study subjects.The serum total cholesterol,triglyceride,high-density lipoprotein,and low-density lipoprotein were collected from the patients,and 286 subjects in the same period were collected and the serum lipids were included in the control group.The lipid profiles of the two groups were compared.286 elderly patients with community-acquired pneumonia were included in the pneumonia group and collected medical records.This records were general information(gender,age,body mass index),clinical signs,signs,combined underlying diseases,laboratory tests and imaging studies.Patients in the pneumonia group were divided into severe pneumonia and non-severe pneumonia,and risk factors influencing the prognosis of patients with severe pneumonia were analyzed with multivariate logistic model regression analysis.The pneumonia group was then divided into pleural effusion group and non-pleural effusion group,and risk factors and protective factors influencing the prognosis of patients with pleural effusion were analyzed with multivariate logistic model regression analysis.Pearson correlation analysis was used to correlate HDL with acute inflammation indicators.Results Results Compared with control group,the levels of plasma total cholesterol(TC),triglyceride(TG),high-density lipoprotein(HDL),and low-density lipoprotein(LDL)in the elderly patients with pneumonia were significantly lower[TC(mmol/L):3.94±1.07 vs.5.41±1.02,p< 0.001;TG(mmol/L):1.15±0.79 vs.1.38±0.69,p< 0.001;HDL(mmol/L):0.96±0.41 vs.1.57±0.37,p< 0.001;LDL(mmol/L):2.28±0.87 vs.3.23±0.85,p< 0.001].Of the 286 elderly patients with CAP,188(65.7%)were male and 98(34.3%)were female,with an average age of 75.5 ± 7.0 years.Most of the patients in the pneumonia group had typical respiratory symptoms such as cough,sputum,and fever,while some patients showed atypical symptoms such as mental status abnormalities in 28 cases(9.8%),decreased appetite in 12 cases(4.2%),and decreased physical strength in 7 cases(2.4%).121 patients in PE group and 165 patients in non-PE group.Age of PE group patients were significantly older than that those of non-PE group(77.1±7.6 years vs.74.3±6.3years,p=0.001),the levels of plasma TC,HDL,LDL were significantly lower than those of non-PE group[TC(mmol/L):3.64±0.98 vs.4.16±1.08,p< 0.001;TG(mmol/L):1.18±0.95 vs.1.13±0.66,p< 0.001;HDL(mmol/L):0.86±0.40 vs.1.04±0.40,p< 0.001;LDL(mmol/L):2.04±0.76 vs.2.46±0.90,p< 0.001].There were no statistically significant differences in sex,other biochemical indexes and the levels of TG between the two groups.Based on the results of single factor analysis,four risk factors for complications of pleural effusion(including age,TC,HDL,and LDL)as covariates into multivariate Logistic regression analysis.The results showed that age was a risk factor for pleural effusion in elderly CAP patients(OR=1.058,p=0.003).Every one year of age increased,the risk of pleural effusion increased by 5.8%;and HDL was a protective factor(OR=0.357,p = 0.016).For every unit increase in HDL,the risk of suffering from pleural effusion is reduced by 64.3%.Patients with severe pneumonia were significantly more sensitive to high-sensitivity C-reactive protein(hs-CRP)than non-severe pneumonia patients(p=0.004),the levels of plasma TC,HDL,LDL were significantly lower than those of non-severe pneumonia patients[TC(mmol/L):3.38±0.96 vs.4.04±1.06,p=0.001;HDL(mmol/L):0.8±0.41 vs.0.98±0.38,p=0.03;LDL(mmol/L):1.84±0.78 vs.2.37±0.85,p=0.01].There were no statistically significant differences in the proportions of males,age,underlying diseases,pleural effusions,and other biochemical indicators between the two groups.Based on the results of single factor analysis,four risk factors for severity of elderly patients with CAP(including age,TC,HDL,and LDL)as covariates into multivariate Logistic regression analysis.The results showed that hs-CRP was a risk factor for severe pneumonia in patients with pneumonia(OR=1.008,p=0.009).For each unit of hs-CRP increased,the risk of developing severe pneumonia increased by 0.8%.Pearson correlation analysis showed that HDL levels were inversely correlated with the acute phase reactants ESR(r=-0.334,p<0.001)and hs-CRP(r=-0.358,p<0.001).Conclusions The symptoms of onset of CAP in the elderly may be atypical.Serum HDL levels were inversely correlated with the acute phase reactants ESR and hs-CRP.When complications of pleural effusion occur,age is a risk factor.Increased serum HDL levels are protective factors and monitor serum HDL levels.There is a value in predicting complications of pleural effusion in elderly CAP.