关键词:

急性呼吸窘迫综合征, 老年重症肺炎, 多配体聚糖-1, 内皮细胞特异分子-1, 葡萄糖调节蛋白78, 预后

Abstract:

Objective　To analyze the relationships between serum Syndecan-1 (multiligand proteoglycan-1), Endocan-1 (endothelial cell-specific molecule-1), and GRP78 (glucose-regulated protein 78) levels and the disease severity and prognosis in elderly patients with severe pneumonia complicated by acute respiratory distress syndrome (ARDS). Methods　This retrospective study included 120 elderly patients with severe pneumonia complicated by ARDS (ARDS group) admitted to Weinan First Hospital from January 2023 to May 2024, consisting of 71 males and 49 females, with an age of (73.35±7.60) years old. Additionally, 84 elderly patients with severe pneumonia without ARDS (non-ARDS group) were included, consisting of 50 males and 34 females, with an age of (72.68±6.54) years old. According to the oxygenation index, the ARDS group was subdivided into a mild group [33 cases, oxygenation index > 200-300 mmHg (1 mmHg=0.133 kPa)], a moderate group (39 cases, oxygenation index of 100-200 mmHg), and a severe group (48 cases, oxygenation index ≤100 mmHg). According to the 28-day prognosis of the ARDS group, the patients were subdivided into a death group (36 cases) and a survival group (84 cases). A total of 80 healthy volunteers, including 45 males and 35 females, with an age of (71.29±7.20) years old, were selected as a control group. Serum levels of Syndecan-1, Endocan-1, and GRP78 were measured. Multivariate logistic regression analysis was conducted to identify factors affecting prognosis in elderly patients with severe pneumonia complicated by ARDS, and the receiver operating characteristic curve (ROC) was performed to assess the predictive values of serum biomarkers for mortality risk. t test and χ² test were used for statistical analysis. Results　Serum levels of Syndecan-1, Endocan-1, and GRP78 in the control group, non-ARDS group, and ARDS group increased sequentially (all P<0.05). In the mild, moderate, and severe groups, serum levels of Syndecan-1, Endocan-1, and GRP78 showed a gradual increasing trend (all P<0.05). The age, mechanical ventilation time, C-reactive protein, Syndecan-1, Endocan-1, and GRP78 levels in the death group were higher than those in the survival group [(76.72±8.20) years old vs. (71.90±7.42) years old, (4.78±1.12) d vs. (3.29±0.83) d, (113.97±42.98) mg/L vs. (85.74±33.03) mg/L, (97.45±10.48) g/L vs. (80.35±8.58) g/L, (4.80±0.88) ng/L vs. (3.40±0.52) ng/L, (30.37±5.57) µg/L vs. (23.84±4.40) µg/L], but the oxygenation index was lower than that in the survival group [(74.92±27.60) mmHg vs. (164.27±48.50) mmHg], with statistically significant differences (t=3.159, 8.081, 3.907, 9.346, 8.903, 6.862, and 12.743, all P<0.05). Age, mechanical ventilation time, Syndecan-1, Endocan-1, and GRP78 were independent risk factors for prognosis in elderly severe pneumonia patients complicated by ARDS (all P<0.05). The sensitivities of Syndecan-1, Endocan-1, and GRP78 for predicting poor prognosis in elderly severe pneumonia patients complicated by ARDS were 88.9%, 88.9%, and 72.2%, the specificities were 75.0%, 89.9%, and 85.7%, and the areas under the curves were 0.896, 0.921, and 0.823. When Syndecan-1, Endocan-1, and GRP78 were combined, the sensitivity and specificity were 94.4% and 92.9%, respectively, and the area under the curve was 0.987. Conclusion　Serum Syndecan-1, Endocan-1, and GRP78 are closely related to the severity and prognosis of elderly patients with severe pneumonia complicated by ARDS and serve as independent risk factors that significantly impact patient prognosis.

Key words:

Acute respiratory distress syndrome, Elderly severe pneumonia, Syndecan-1, Endocan-1, GRP78, Prognosis