Low Admission Plasma Gelsolin Concentrations Identify Community-acquired Pneumonia Patients at High Risk for Severe Outcomes
Low Admission Plasma Gelsolin Concentrations Identify Community-acquired Pneumonia Patients at High Risk for Severe Outcomes
复制标题
DOI：
10.1093/cid/ciy1049
复制
发表时间：
2019-10-01
影响因子：
11.8
通讯作者：
Grijalva, Carlos G.
中科院分区：
文献类型：
--
作者：
Self, Wesley H.;Wunderink, Richard G.;Grijalva, Carlos G.
背景血浆凝溶胶蛋白（pGSN）是一种丰富的循环蛋白，可中和受损细胞暴露的肌动蛋白，调节炎症反应，并增强肺泡巨噬细胞的抗微生物活性。我们调查了因社区获得性肺炎（CAP）入院时pGSN低的成人是否为严重结局的高危人群。采用酶联免疫吸附试验测定455例CAP患者入院时的pGSN浓度。根据患者住院期间经历的最大临床严重程度，将患者分为以下4个分层、互斥的类别：无重症监护室（ICU）入院、有创呼吸或血管加压剂支持（IRVS）或死亡的一般地面护理;无IRVS或死亡的ICU护理;无死亡的IRVS;或死亡。在这些离散的结果类别中比较入院pGSN浓度。此外，将pGSN浓度最低四分位数患者的结局与上三个四分位数患者的结局进行比较。总体而言，中位数（四分位距）pGSN浓度为38.1（32.1，45.7）μ g/mL。结果更严重的患者pGSN浓度较低（P = 0.0001）;中位值为40.3 μ g/mL的地板患者，36.7 μ g/mL的ICU患者，36.5 μ g/mL的患者接受IRVS，25.7 μ g/mL的患者死亡。与具有较高pGSN浓度的患者相比，处于最低四分位数（pGSN
Background. Plasma gelsolin (pGSN) is an abundant circulating protein that neutralizes actin exposed by damaged cells, modulates inflammatory responses, and enhances alveolar macrophage antimicrobial activity. We investigated whether adults with low pGSN at hospital admission for community-acquired pneumonia (CAP) were at high risk for severe outcomes.Methods. Admission pGSN concentrations in 455 adults hospitalized with CAP were measured using enzyme-linked immunosorbent assay. Patients were grouped into the following 4 hierarchical, mutually exclusive categories based on maximum clinical severity experienced during their hospitalization: general floor care without intensive care unit (ICU) admission, invasive respiratory or vasopressor support (IRVS), or death; ICU care without IRVS or death; IRVS without death; or death. Admission pGSN concentrations were compared across these discrete outcome categories. Additionally, outcomes among patients in the lowest quartile of pGSN concentration were compared to those in the upper 3 quartiles.Results. Overall, median (interquartile range) pGSN concentration was 38.1 (32.1, 45.7) mu g/mL. Patients with more severe outcomes had lower pGSN concentrations (P = .0001); median values were 40.3 mu g/mL for floor patients, 36.7 mu g/mL for ICU patients, 36.5 mu g/mL for patients receiving IRVS, and 25.7 mu g/mL for patients who died. Compared to patients with higher pGSN concentrations, patients in the lowest quartile (pGSN