Abstract:

Objective　To investigate the value of neutrophil CD64 index combined with tricuspid annular plane systolic excursion (TAPSE) in prediction of prognosis of elderly patients with severe pneumonia. Methods　A total of 145 patients over 85 years old with severe pneumonia who were hospitalized in Lianyungang Second People's Hospital, Kangda College, Nanjing Medical University from November 2019 to November 2022 were selected. The TAPSE was measured by bedside echocardiography; the CD64 index was detected within 24 hours after admission. According to the 28-day short-term follow-up results, the patients were divided into a survival group and a death group. The gender and proportions of the patients with hypertension, diabetes, coronary heart disease, cerebral infarction, and chronic lung disease in both groups were recorded. The white blood cell counts, platelet counts, levels of hemoglobin (Hb), creatine kinase isoenzyme (CK-MB), albumin (ALB), glomerular filtration rate (e-GFR), neutrophil CD64 index, interleukin-6 (IL-6), procalcitonin (PCT) troponin T (cTnT), and lactic acid (Lac), TAPSE, and left ventricular ejection fractions (LVEF) were compared between these two groups. t, rank sum, and χ² tests were applied. The death risk factors of the patients were screened by binary logistic regression analysis. The receiver operating characteristics curves were drawn to analyze the abilities of CD64 index and TAPSE in prediction of death risk. The Kaplan-Meier survival analysis was used to analyze neutrophil CD64 index and TAPSE in the prediction of death risk. Results　Among the 145 patients, 41 died and 104 survived, with a mortality rate of 28.28%. The CD64 index and levels of IL-6, PCT, cTnT, and Lac in the death group were significantly higher than those in the survival group (all P<0.05), while the TAPSE and LVEF in the death group were significantly lower than those in the survival group (both P<0.05). The binary logistic regression analysis showed that chronic lung disease, neutrophil CD64 index, and TAPSE were the main risk factors for death in the elderly patients (all P<0.05). The area under the curve (AUC) of TAPSE was 0.757 (95%CI 0.662-0.851), and the cut-off point was 2.025; the sensitivity was 80.50%; the specificity was 62.50%. The AUC of neutrophil CD64 index was 0.846 (95%CI 0.772-0.919), and the cut-off point was 4.130; the sensitivity was 82.90%; the specificity was 83.70%. The AUC of TAPSE+CD64 was 0.899 (95%CI 0.840-0.958); the sensitivity was 90.20%; the specificity was 79.80%. The patients were divided into two groups according to whether the neutrophil CD64 index was higher than the cut-off point of 4.130; the Kaplan-Meier curve analysis showed that the 28-day survival rates of the two groups were statistically different [88.17% (82/93) vs. 42.31% (22/52); χ²=37.737, P<0.001]. The patients were divided into two groups according to whether TAPSE was greater than the cut-off point of 2.025; the Kaplan-Meier curve analysis showed that there was a statistical difference in the 28-day survival rate between the two groups [87.67% (64/73) vs. 55.56% (40/72); χ²=18.722, P<0.001]. Conclusions　CD64 index combined with TAPSE can be used to evaluate the prognosis of elderly patients with severe pneumonia and guide the classification of treatment.

Key words:

The elderly, Severe pneumonia, CD64 index, Tricuspid annular plane systolic excursion, Prognosis

摘要：

目的　探讨中性粒细胞CD64指数联合三尖瓣环收缩期位移（TAPSE）对高龄重症肺炎患者预后的预测价值。方法　选取2019年11月至2022年11月在南京医科大学康达学院附属连云港第二人民医院住院的重症肺炎患者145例，年龄≥80周岁。床旁心脏彩超获得TAPSE，入院24 h内行CD64指数检测，根据28 d短期随访结果，分为生存组和死亡组。记录两组患者的性别、高血压、糖尿病、冠心病、脑梗死、慢性肺疾病比例，比较两组患者的白细胞计数（WBC）、血小板计数（PLT）、血红蛋白（Hb）、肌酸激酶同工酶（CK-MB）、白蛋白（ALB）、肾小球滤过率（e-GFR）、CD64指数、白细胞介素-6（IL-6）、降钙素原（PCT）、肌钙蛋白T（cTnT）、乳酸（Lac）、TAPSE、左心室射血分数（LVEF）情况。采用t检验、秩和检验、χ²检验，二元logistic回归分析筛选80岁以上高龄重症肺炎患者死亡危险因素，绘制受试者工作特征曲线（ROC）分析CD64指数及TAPSE预测28 d短期预后的能力，Kaplan-Meier（K-M）生存分析CD64指数、TAPSE对死亡风险预测。结果　145例重症肺炎患者中死亡41例，生存104例，病死率为28.28%。死亡组的CD64指数、IL-6、PCT、cTnT、Lac均显著高于生存组，TAPSE、LVEF均显著低于生存组（均P<0.05）。二元logistic回归分析：慢性肺疾病、CD64指数及TAPSE是高龄重症肺炎患者死亡的主要危险因素（均P<0.05）。TAPSE预后预测的曲线下面积（AUC）为0.757（95%CI 0.662～0.851），截点值为2.025，灵敏度80.50%，特异度62.50%；CD64指数预测预后的AUC为0.846（95%CI 0.772～0.919），截点值为4.13，灵敏度82.90%，特异度83.70%；TAPSE+CD64联合检测时，AUC为0.899（95%CI 0.840～0.958），灵敏度90.20%，特异度79.80%。根据CD64指数是否大于截点值4.13分为两组，K-M曲线分析：两组28 d存活率差异有统计学意义［88.17%（82/93）比42.31%（22/52），χ²=37.737，P<0.001］；根据TAPSE是否大于截点2.025分为两组，K-M曲线分析：两组28 d存活率差异有统计学意义［87.67%（64/73）比55.56%（40/72），χ²=18.722，P<0.001］。结论　对于高龄重症肺炎患者，CD64指数联合TAPSE可用于预后评估，指导重症肺炎患者的分类救治。

关键词:

高龄老人, 重症肺炎, CD64指数, 三尖瓣环收缩期位移, 预后