Analysis on distribution characteristics of pathogens, nutritional status and changes of serum inflammatory factors in elderly patients with acute respiratory failure and pulmonary infection

doi:10.19871/j.cnki.xfcrbzz.2023.03.010

Abstract

Abstract: Objective To explore the distribution characteristics of pathogens, nutritional status, changes and clinical significance of serum procalcitonin (PCT) and interleukin-17 (IL-17) levels in elderly patients with acute respiratory failure and pulmonary infection. Method A total of 70 elderly patients with acute respiratory failure and pulmonary infection admitted to Zhongshan Hospital Affiliated to Dalian University were enrolled as observation group between June 2017 and June 2021, while other 50 elderly patients only with pulmonary infection during the same period were enrolled as control group. After admission, all were scored by short-form mini-nutritional assessment (MNA-SF). The fasting venous blood was collected to detect serum PCT and IL-17. The application value of serum PCT and IL-17 in evaluating prognosis of elderly patients with acute respiratory failure and pulmonary infection was evaluated by ROC curves. Result In the 70 elderly patients with acute respiratory failure and pulmonary infection, there were 83 strains of pathogens, including 20 strains of Gram-positive bacteria (24.10%), 62 strains of Gram-negative bacteria (74.70%) and 1 strain of fungus (1.20%). No significant difference was found in mortality rate between the two groups (P>0.05). MNA-SF score, malnutrition rate and serum PCT and IL-17 levels were significantly higher in observation group (P<0.05). The mortality rate in the elderly patients with acute respiratory failure and pulmonary infection was 14.29% (10/70). Serum PCT and IL-17 levels in dead patients were significantly higher than those in survived patients (P<0.05). AUC of serum PCT combined with IL-17 for assessing the prognosis was greater than that of PCT alone (P<0.05), and there was no significant difference between combined detection and IL-17 alone (P>0.05). Conclusion In elderly patients with acute respiratory failure and pulmonary infection, main pathogen is Gram-negative bacteria, incidence of malnutrition is higher, and levels of serum PCT and IL-17 significantly up-regulate. Combined detection of serum PCT and IL-17 is of good application value for prognosis assessment.

Key words: Acute respiratory failure, Pulmonary infection, Gram-negative bacteria, Nutritional status, Procalcitonin, Interleukin-17

CLC Number:

R653.8

Hao Yuhua, Zhang Xiaoqing, Jiang Bin, Xu Lulu. Analysis on distribution characteristics of pathogens, nutritional status and changes of serum inflammatory factors in elderly patients with acute respiratory failure and pulmonary infection[J]. Electronic Journal of Emerging Infectious Diseases, 2023, 8(3): 49-52.

References

[1] BAHAREH K, AHMADREZA Y, HOSEIN M.Evaluating the efficacy of nanosil mouthwash on the preventing pulmonary infection in intensive care unit: a randomized clinical trial[J]. Med Arch, 2018, 72(3):206-209.
[2] HOGEA SP, TUDORACHE E, FILDAN AP, et al.Risk factors of chronic obstructive pulmonary disease exacerbations[J]. Clin Respir J, 2020, 14(3):183-197.
[3] MARC M, ANTONIO A.Chronic respiratory infection in patients with chronic obstructive pulmonary disease: what is the role of antibiotics?[J]. Int J Molr Sci, 2017, 18(7):1344.
[4] SUN S, WANG F, YU M, et al.Clinical study of serum procalcitonin level in patients with myocardial infarction complicated by pulmonary infection[J]. Exp Ther Med, 2018, 16(6):5210-5214.
[5] 刘巍, 马青松. 血清IL-6, IL-17水平对AECOPD合并肺部感染的早期诊断价值及病原菌分析[J]. 分子诊断与治疗杂志, 2022, 14(1):82-85.
[6] LUO Y, LI C, ZHOU Z, et al.Biological functions of IL-17-producing cells in mycoplasma respiratory infection[J]. Immunology, 2021, 164(2):223-230.
[7] 陈琳玲, 唐卫东, 陈琪, 等. 营养治疗及质量改进对县级ICU慢性阻塞性肺疾病患者预后影响[J]. 中华急诊医学杂志, 2019, 28(4):463-466.
[8] MEHTA A, BREWINGTON R, CHATTERJI M, et al.Infection-induced modulation of m1 and m2 phenotypes in circulating monocytes: role in immune monitoring and early prognosis of sepsis.[J]. Shock, 2004, 22(5):423-430.
[9] 中华医学会呼吸病学分会. 社区获得性肺炎诊断和治疗指南[J]. 中国实用乡村医生杂志, 2006, 20(3):158-160.
[10] 叶任高, 陆再英, 谢毅, 等. 内科学[M]. 7版.北京:人民卫生出版社, 2009:143.
[11] 李君, 姚蓉, 易春梅, 等. 便携式纤维支气管镜肺泡灌洗对老年呼吸衰竭合并肺部感染患者Th1/Th2细胞因子的影响[J]. 中华医院感染学杂志, 2020, 30(21):3268-3271.
[12] 封占辉. ICU呼吸衰竭并肺部感染患者的病原学及耐药性分析[J]. 中华养生保健, 2020, 38(2):50-51.
[13] EZZELL L, JENSEN GL.Malnutrition in chronic obstructive pulmonary disease[J]. Am J Clinl Nutr, 2000, 72(6):1415-1416.
[14] HOONG JM, FERGUSON M, HUKINS C, et al.Economic and operational burden associated with malnutrition in chronic obstructive pulmonary disease[J]. Clin Nutr, 2017,36(4):1105-1109.
[15] PRESCOTT HC, SJODING MW, LANGA KM, et al.Late mortality after acute hypoxic respiratory failure[J]. Thorax, 2017, 73(7):618-625.
[16] 陈晓珊, 李希, 杨荀. 影响老年重症肺炎合并急性呼吸衰竭预后的危险因素分析[J]. 实用老年医学, 2019, 33(11):1117-1120.
[17] BRANCHE A, NEESER O, MUELLER B, et al.Procalcitonin to guide antibiotic decision making[J]. Curr Opin Infect Dis, 2019, 32(2):130-135.
[18] 杨海燕, 付朝晖, 王喜春, 等. 降钙素原及C反应蛋白在高龄慢性阻塞性肺疾病急性加重期患者中的诊断价值[J]. 重庆医学, 2014, 43(32):4314-4315,4319.
[19] 荆梦君. PCT, IL-6, D-D水平与脓毒症严重程度和预后的相关性分析[J]. 中外医学研究, 2022, 20(3):66-70.
[20] FITZGERALD KA, KAGAN JC.Toll-like receptors and the control of immunity[J]. Cell, 2020, 180(6):1044-1066.
[21] 贾国泉, 沈桂权, 张权, 等. TOLL受体介导的MYD88/TRAF6/NF-κB研究[J/CD]. 新发传染病电子杂志, 2017, 2(2):104-107.
[22] MILLS KHG.IL-17 and IL-17-producing cells in protection versus pathology[J]. Nat Rev Immunol, 2023, 23(1):38-54.
[23] ONISHI RM, GAFFEN SL.Interleukin-17 and its target genes: mechanisms of interleukin-17 function in disease[J]. Immunology, 2010, 129(3):311-321.