| Background and purposeCommunity-acquired pneumonia(CAP)is one of the most common lower respiratory tract infections.Although great progress has been made in the prevention and treatment of CAP in recent years,the morbidity and mortality of CAP remain high.Therefore,timely and accurate assessment of the severity of the patient’s condition and corresponding treatment measures are very important to improve the prognosis of patients.The CURB-65 score has advantages in the rapid evaluation of a patient’s condition,but it has few laboratory indicators and relatively low sensitivity for the early identification of critically ill patients.Biomarkers can assist clinicians in assessing the condition of patients.In the current clinical work,ideal biomarkers which can accurately evaluate the severity of a patient’s condition and predict prognosis have not been found.Galectin1(Gal-1)is closely related to inflammation,and several studies have demonstrated its role in infectious diseases.However,there are no studies on the expression level of Gal-1 in patients with CAP.Therefore,this study will investigate the value of Gal-1 combined with the CURB-65 score in evaluating the severity and predicting the prognosis of adult CAP patients.MethodsUsing a prospective study method,144 patients with CAP admitted to the Department of Respiratory and Critical Care Medicine,Second Hospital of Shandong University between September 2021 and November 2022 were recruited,14 patients with incomplete data,7 patients lost to follow-up and 5 patients who withdrew from the study were excluded,and finally 118 patients with CAP were included in the study.According to the Chinese Guidelines for the Diagnosis and Treatment of Community-Acquired Pneumonia in Adults(2016 Edition),118 patients with CAP were divided into severe community-acquired pneumonia(SCAP)group(n=32)and non-severe community-acquired pneumonia(NSCAP)group(n=86).According to the 28-day survival outcome,the patients in the SCAP group were divided into the death group(n=12)and the survival group(n=20).At the same time,58 cases were included in the control group in the same period.All the included subjects met the inclusion and exclusion criteria.Fasting peripheral blood specimens were collected from the NSCAP group before treatment on the day of admission,from the SCAP group before treatment on the day of admission and the third day after treatment,and from the control group,and bronchoalveolar lavage fluid(BALF)specimens were collected from CAP patients on the second day of admission.The Gal-1 and interleukin-6(IL-6)levels were determined by enzyme-linked immunosorbent assay(Elisa).All patients’ clinical data,laboratory parameters,pathogenic and imaging results were collected on the day of admission.The indicators were compared among the groups.The correlation between Gal-1 and inflammatory indexes and clinical scores was analyzed.The correlation between Gal-1 and inflammatory indexes and clinical scores was analyzed.Logistic regression was used to analyze the relationship between Gal-1 and SCAP diagnosis and death risk.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of Gal-1,Gal-1 combined with CURB-65 score and other indicators on diagnostic efficacy and mortality risk of SCAP,and the area under the curve(AUC)of each indicator was compared.Results1.IL-6,PCT,CRP,WBC,NEU,NLR,CURB-65 score,PSI score,and length of hospital stay in the SCAP group were higher than those in the NSCAP group,with statistical significance(P<0.05),but there was no statistical difference in LYM between the two groups(P>0.05).2.The serum Gal-1 level at admission was 11.80(9.68,13.69)ng/ml in the SCAP group,which was higher than the serum Gal-1 level at admission of 4.85(3.70,6.09)ng/ml in the NSCAP group,which was higher than the serum Gal-1 level of 2.56±0.46 ng/ml in the control group,and the difference was statistically significant(P<0.001).3.The serum Gal-1 level at admission was 13.61(12.71,14.58)ng/ml in the death group,which was higher than the serum Gal-1 level at admission of 10.35±2.57 ng/ml in the survival group,and the difference was statistically significant(P<0.05).The serum Gal-1 level in the survivor group was 7.13±2.34 ng/ml after treatment,which was lower than that at admission(P<0.001),and the serum Gal-1 level in the death group was 12.89±3.14 ng/ml after treatment,which was not statistically different compared with that at admission(P>0.05).4.The serum Gal-1 levels were not identical in CAP patients with different pathogenic infections(P<0.001),bacterial infections were higher than atypical pathogenic and unspecified pathogenic infections,mixed pathogenic infections were higher than atypical pathogenic infections(P<0.05),and there was no statistical difference in serum Gal-1 levels between CAP patients with other pathogenic infections(P>0.05).5.The levels of Gal-1 and IL-6 in BALF of the SCAP group were 239.58(121.15319.77)ng/ml and 26.54(12.01,40.87)pg/ml respectively,which were higher than those of Gal-1 and IL-6 in BALF of NSCAP group.The levels of Gal-1 and IL-6 in BALF of the dead group were 288.75(217.77,377.17)ng/ml and 38.24(26.54,47.02)pg/ml respectively,which were significantly higher than those of Gal-1 and IL-6 in BALF of survival group.There was a positive correlation between Gal-1 and IL-6 in BALF(r=0.838,P<0.001).6.Serum Gal-1 in CAP patients was positively correlated with IL-6,PCT,CRP,WBC,NEU,NLR,CURB-65 score,and PSI score(P<0.001),and the correlation with LYM was not statistically significant(P>0.05).7.Logistic regression analysis showed that serum Gal-1 was an independent risk factor for the diagnosis of SCAP.The AUC of SCAP diagnosed by ROC curve analysis was 0.978,which was comparable to the PSI score(AUC=0.947)and higher than IL-6,PCT,CRP,WBC,NEU,NLR,and CURB-65 scores(P<0.05).The AUC of serum Gal-1 combined with CURB-65 score for the diagnosis of SCAP was 0.999,with a sensitivity of 96.9%and specificity of 96.5%,which was higher than the AUC of any single index and IL-6 combined with CURB-65 score,PCT combined with CURB-65 score,CRP combined with CURB-65 score(P<0.05).8.Logistic regression analysis showed that serum Gal-1 was an independent risk factor for predicting the risk of SCAP death.ROC curve analysis showed that the AUC for predicting the risk of SCAP death was 0.896,with a sensitivity of 83.3%and specificity of 85.0%(P<0.05).The AUC of Gal-1 in BALF for predicting the risk of SCAP death was 0.739,the sensitivity was 81.8%,and the specificity was 62.5%(P<0.05).Conclusion1.The serum Gal-1 levels were elevated in CAP patients on admission and increased with the severity of the disease,and the serum Gal-1 was positively correlated with IL-6,PCT,CRP,WBC,NEU,NLR,PSI score and CURB-65 score.2.Gal-1 levels in BALF of CAP patients increased with increasing severity of the disease.3.The expression levels of serum Gal-1 were not identical in CAP patients with different pathogenic infections;bacterial infections were higher than atypical pathogenic and unspecified pathogenic infections,mixed pathogenic infections were higher than atypical pathogenic infections,and there was no statistical difference in serum Gal-1 levels between CAP patients with other pathogenic infections.4.Serum Gal-1 is an independent risk factor for the diagnosis and the risk of death in SCAP,and the combination of serum Gal-1 and CURB-65 score is more effective than a single indicator in the diagnosis of SCAP. |
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