Evaluation of various biomarkers in diagnostic and prognostic value of severe community-acquired pneumonia_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

QIN Yalan ,  TONG Jin

Department of Respiratory Medicine, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China;

Corresponding?author：

TONG Jin, Email: tongjin01234@163.com

Keywords：

Pneumonia; Biomarkers; Diagnosis; Prognosis

DOI：

10.7507/1671-6205.201810052

Video：

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Objective To evaluate the value of carcinoembryonic antigen (CEA), ferritin, D-dimer, fibrinogen degradation product (FDP), white blood cell (WBC) and C-reactive protein (CRP) in diagnosis and prognosis of severe community-acquired pneumonia (SCAP).Methods This was a prospective observational study. One hundred and seventy-seven candidates were divided into 3 groups: SCAP group including 61 SCAP patients, CAP group including 56 patients with normal community-acquired pneumonia group and HP group including 60 healthy people. Initial level of above biomarkers was compared and analyzed in the three groups. Then the efficiency of diagnosing and predicting the outcome of SCAP by single and combined index were evaluated by receiver operating characteristic (ROC) curve. Meanwhile the patients in SCAP group were divided into two groups according to the CEA level named CEA increasing group and normal group, between which the differences in prognosis and biomarker level were compared.Results The initial level of all biomarkers increased in two pneumonia groups and exceeded the HP group (P< 0.01) while between SCAP and CAP groups, all indexes in SCAP group were higher than the CAP group (P< 0.001). The areas under the ROC of CEA, ferritin, D-dimer, CRP, WBC and united respectively were 0.800, 0.834, 0.769, 0.898, 0.756 and 0.956. The sensitivity of united index was 91.8% while specificity was 90.5%. Among SCAP group, only CEA level made sense to predict the prognosis (P< 0.01). There were significant differences in intubation rate, mortality, length of RICU stay and FDP, D-dimer between CEA increasing group and normal group (P< 0.05).Conclusions High level CEA, ferritin, D-dimer, CRP and WBC have significant value in diagnosis of SCAP. And the combined index has higher diagnostic value than single one. SCAP with increased CEA level indicates more serious condition and poor prognosis.

Citation： QIN Yalan, TONG Jin. Evaluation of various biomarkers in diagnostic and prognostic value of severe community-acquired pneumonia. Chinese Journal of Respiratory and Critical Care Medicine, 2019, 18(3): 224-230. doi: 10.7507/1671-6205.201810052 Copy

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12.	Arosio P, Elia L, Poli M. Ferritin, cellular iron storage and regulation. IUBMB Life, 2017, 69(6): 414-422.
13.	徐麒麟, 康波, 姜冬梅. 鐵蛋白介導細胞凋亡的作用機制. 中國生物化學與分子生物學報, 2016, 32(11): 1213-1218.
14.	中國醫藥教育協會感染疾病專業委員會. 感染相關生物標志物臨床意義解讀專家共識. 中華結核和呼吸雜志, 2017, 40(4): 243-257.
15.	Wu JJ, Jin Y, Li HL, et al. Evaluation and significance of C-reactive protein in the clinical diagnosis of severe pneumonia. Exp Ther Med, 2015, 10(1): 175-180.
16.	Chou SC, Ko HW, Lin YC. CRP/IL-6/IL-10 single-nucleotide polymorphisms correlate with the susceptibility and severity of community-acquired pneumonia. Genet Test Mol Biomarkers, 2016, 20(12): 732-740.
17.	Wu M, Jiang ZF, Xie JL, et al. Role of the fibrinogen degradation products and D-dimer in the differential diagnosis of pulmonary tuberculosis and community-acquired pneumonia. Clin Lab, 2018, 64(1): 135-140.
18.	徐悅利, 張陽, 姜鋒. 不同嚴重程度社區獲得性肺炎患者凝血及纖溶相關指標的比較. 中華醫學雜志, 2015, 95(24): 1925-1929.

1. Chalmers JD. Identifying severe community-acquired pneumonia: moving beyond mortality. Thorax, 2015, 70(6): 515-516.
2. Torres A, Loeches M, Menéndez R. Research in community-acquired pneumonia: the next steps. Intensive Care Med, 2017, 43(9): 1395-1397.
3. 瞿介明, 曹彬, 中華醫學會呼吸病學分會. 中國成人社區獲得性肺炎診斷和治療指南(2016 年版). 中華結核和呼吸雜志, 2016, 39(4): 253-279.
4. Frenzen FS, Kutschan U, Meiswinkel N, et al. Admission lactate predicts poor prognosis independently of the CRB/CURB-65 scores in community-acquired pneumonia. Clin Microbiol Infect, 2018, 24(3): 301-306.
5. 孔慶華, 白久武, 王曉如, 等. 三種評分系統在老年社區獲得性肺炎危險度分層及病情評估中的應用. 中國呼吸與危重監護雜志, 2018, 17(2): 138-143.
6. 劉波, 單南冰. ICU 危重患者 APACHEⅡ評分變化率和臨床預后的關系. 內科急危重癥雜志, 2017, 23(2): 142-144.
7. Brabrand M, Henriksen DP. CURB-65 score is equal to NEWS for identifying mortality risk of pneumonia patients: an observational study. Lung, 2018, 196(3): 359-361.
8. Bramswig KH, Poettler M, Unseld M, et al. Soluble carcinoembryonic antigen activates endothelial cells and tumor angiogenesis. Cancer Res, 2013, 73(22): 6584-6596.
9. Jiang ZF, Wang M, Xu JL. Thymidine kinase 1 combined with CEA, CYFRA21-1 and NSE improved its diagnostic value for lung cancer. Life Sci, 2018, 194(1): 1-6.
10. Bacac M, Klein C, Umana P. CEA TCB: a novel head-to-tail 2: 1 T cell bispecific antibody for treatment of CEA-positive solid tumors. Oncoimmunology, 2016, 5(8): e1203498.
11. Noguchi T, Yamamoto K, Moriyama G, et al. Evaluation of serum levels of carcinoembryonic antigen in allergic bronchopulmonary aspergillosis. J Nippon Med Sch, 2013, 80(6): 404-409.
12. Arosio P, Elia L, Poli M. Ferritin, cellular iron storage and regulation. IUBMB Life, 2017, 69(6): 414-422.
13. 徐麒麟, 康波, 姜冬梅. 鐵蛋白介導細胞凋亡的作用機制. 中國生物化學與分子生物學報, 2016, 32(11): 1213-1218.
14. 中國醫藥教育協會感染疾病專業委員會. 感染相關生物標志物臨床意義解讀專家共識. 中華結核和呼吸雜志, 2017, 40(4): 243-257.
15. Wu JJ, Jin Y, Li HL, et al. Evaluation and significance of C-reactive protein in the clinical diagnosis of severe pneumonia. Exp Ther Med, 2015, 10(1): 175-180.
16. Chou SC, Ko HW, Lin YC. CRP/IL-6/IL-10 single-nucleotide polymorphisms correlate with the susceptibility and severity of community-acquired pneumonia. Genet Test Mol Biomarkers, 2016, 20(12): 732-740.
17. Wu M, Jiang ZF, Xie JL, et al. Role of the fibrinogen degradation products and D-dimer in the differential diagnosis of pulmonary tuberculosis and community-acquired pneumonia. Clin Lab, 2018, 64(1): 135-140.
18. 徐悅利, 張陽, 姜鋒. 不同嚴重程度社區獲得性肺炎患者凝血及纖溶相關指標的比較. 中華醫學雜志, 2015, 95(24): 1925-1929.

Chinese Journal of Respiratory and Critical Care Medicine

Evaluation of various biomarkers in diagnostic and prognostic value of severe community-acquired pneumonia

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