The Value Of Serum Lipoprotein In CAP Severity And Clinical Prognosis

Objective: Explore high density lipoproteins(HDL),low density lipoproteins(LDL),apolipoprotein A-1(Apo A-1),and apolipoprotein B(Apo B)levels associated with the severity of community acquired pneumonia(CAP)disease,and assessment of CAP prognosis.Methods: We retrospectively collected information of 112 patients(age>60 ye-ars old)with CAP who were admitted to the Emergency Department of Internal Medicine and Inte-nsive Care Unit(ICU)from October 2017 to December 2018 in our hospital,n-amed CAP group(n=112).During this period,112 healthy pe-ople in the physical examination center of our hospital were named as healthy group(n=112).The levels of HDL,Apo A-1,LDL and Apo B on the first day of admission in the CAP group and the healthy group were compared.All 112 patients with CAP und-erwent CURB-65 on the day of admission.The patients we-re divided into mild,moderate,and severe groups according to the scores.The HDL,Apo A-1,LDL,and Apo B on the first day of admission were compared between this three groups.According to the death of 28 days after admission,the patients were divided into the survival group and the death group.The HDL,Apo A-1,LDL and Apo B levels were compared between the death and survival groups on the 1st and 7th day,respectively.Compared HDL,Apo A-1,LDL,Apo B levels on day 1 and day 7 of the survival group and death group,respectively.The ROC curves of HDL,Apo A-1,LDL and Apo B on the first day of admission of CAP patients were analyzed,and the evaluation value of community-acquired pneumonia was evaluated.Results: According to the CURB-65 score,23 patients in the mild group,47 in the middle group,and 42 in the severe group,there was no significant difference in gender,age,and body mass index among the three groups(p>0.05).According to the death of the patient 28 days after admission,96 patients in the survival group and 16 patients in the death group.Although the age of the death group was higher than that of the survival group,the body mass index was lower than that of the survival group,but there was no significant difference in gender,age and body mass index between the two groups(p>0.05).There was no significant difference in gender,age and body mass index between the CAP group and the healthy group(p>0.05).The HDL,Apo A-1,LDL and Apo B on the 1st day of admission in the CAP group were lower than those in the healthy group(p<0.05).There were significant differences in the levels of lipoproteins between the mild group,the middle group and the severe group on the 1st day(p<0.05),and the HDL,Apo A-1,LDL and Apo B levels were the lowest in the severe group,followed by the middle group.The mild group was the highest.Respectively,the HDL,Apo A-1,LDL and Apo B on the 1st and 7th day of the death group were lower than the survival group(p<0.05).The levels of HDL and Apo A-1 on the 1st day after admission were lower than those on the 7th day(p<0.05),while the changes of LDL and Apo B were not significant(p>0.05)in the survival group.The levels of HDL and Apo A-1 on the 1st day of death group were higher than those on the 7th day(p<0.05),but the changes of LDL and Apo B were not obvious(p>0.05).The ROC curve drawn from the HDL,Apo A-1,LDL,and Apo B values on the 1st day of admission showed that the area under the ROC curve of high density lipoprotein was 0.797 [95% confidence interval0.703-0.891,p<0.05] greater than apolipoprotein A-1 which the area under the ROC curve was 0.753 [95% confidence interval 0.642-0.863,p<0.05],and its sensitivity(78.2%)and specificity(72.0%)were also higher than the sensitivity of apolipoprotein A-1(74.3%)and specificity(60.0%).The area under the ROC curve of LDL was 0.473[95% confidence interval 0.340-0.606,p>0.05,the difference was not statistically significant],the area under the ROC curve of Apo B was 0.483 [95% confidence interval0.345-0.622,p>0.05,The difference was not statistically significant].Conclusion: The levels of HDL,ApoA-1,LDL,and ApoB were decreased in patients with community acquired pneumonia.HDL,Apo A-1,LDL,and Apo B levels on the first day of admission can predict CAP severity.HDL,Apo A-1 can be used to assess the prognosis of CAP.HDL has higher ability,sensitivity,and specificity for CAP prognosis than Apo A-1.