Predictive value of peripheral blood levels of soluble Fas protein, soluble Fas protein ligand and myeloperoxidase on poor prognosis in children with severe pneumonia

doi:10.3877/cma.j.issn.1674-1358.2022.04.008

Abstract

Abstract:

Objective

To investigate the changes of soluble Fas protein (sFas), soluble Fas protein ligand (sFasL) and myeloperoxidase (MPO) in peripheral blood of children with severe pneumonia, and to explore the predictive value on poor prognosis.

Methods

Total of 182 cases of severe pneumonia, 196 cases of mild pneumonia and 178 healthy children in Mianyang Fulin hospital, Sichuan College of traditional Chinese Medicine were enrolled as severe group, mild group and control group, respectively; Children in severe group were then divided into poor prognosis group (29 cases) and good prognosis group (153 cases). The levels of sFas, sFasL and MPO in peripheral blood were compared among cases of severe group and mild group before treatment with those of control group by one way ANOVA. The risk factors for poor prognosis in severe group were determined by univariate and multivariate Logistic regression analysis, and the value of peripheral blood sFasL, sFasL, MPO levels and the combination of the three indexes on predicting poor prognosis in severe group were explored by receiver operating characteristic curve (ROC).

Results

There was no significant difference in gender, age and weight among cases in the three groups; distribution of pathogenic microorganisms and stages of pneumonia between cases in severe group and mild group were also without significant difference (all P > 0.05). The levels of sFas, sFasL and MPO in peripheral blood of cases in severe group were (104.63 ± 19.75) ng/L, (1 062.36 ± 179.85) ng/L, (1 020.26 ± 59.71) U/L, which were (80.52 ± 13.66) ng/L, (703.57 ± 127.66) ng/L and (796.75 ± 43.02) U/L in cases of mild group, while (58.78 ± 10.16) ng/L, (577.83 ± 121.22) ng/L and (632.59 ± 38.71) U/L in cases of control group, respectively; and the levels of the above indexes of cases in severe group and mild group before treatment were significantly higher than those of the control group (sFas: severe group vs. control group: t = 27.605, P < 0.001; mild group vs. control group: t = 17.322, P < 0.001. sFasL: severe group vs. control group: t = 29.908、P < 0.001; mild group vs. control group: t = 9.744, P < 0.001. MPO: severe group vs. control group: t = 71.920, P < 0.001; mild group vs. control group: t = 38.647, P < 0.001), which were significantly higher in severe group than those of the mild group (t = 13.885, 22.488, 41.973, all P < 0.001). The incidence of poor prognosis in severe group was 15.93% (29/182). The proportions of double/multiple infection (χ² = 12.081, P = 0.001), multiple lobe infection (χ² = 32.378, P < 0.001) and white blood cell (WBC) (t = 6.432, P < 0.001), percentage of neutrophils (N%) (t = 3.658, P = 0.001), C-reactive protein (CRP) (t = 19.415, P < 0.001), procalcitonin (PCT) (t = 26.101, P < 0.001), sFas (t = 13.717, P < 0.001), sFasL (t = 5.357, P < 0.001) and MPO (t = 5.435, P < 0.001) levels in peripheral blood of cases with poor prognosis were significantly higher than those with good prognosis; which were all independent risk factors of poor prognosis in severe group by multivariate Logistic regression analysis (OR = 5.969, 95%CI: 4.857-6.304, P = 0.029; OR = 7.485, 95%CI: 6.785-8.126, P = 0.014; OR = 5.332, 95%CI: 4.593-5.567, P = 0.010; OR = 4.959, 95%CI: 4.246-5.337, P = 0.015; OR = 5.143, 95%CI: 4.879-5.695, P = 0.003; OR = 6.126, 95%CI: 5.630-6.558, P = 0.008; OR = 8.325, 95%CI: 6.452-9.902, P = 0.005; OR = 8.469, 95%CI: 7.879-8.653, P = 0.001; OR = 9.132, 95%CI: 8.882-9.594, P = 0.003). The Cut-off values of peripheral blood sFas, sFasL and MPO levels predicting poor prognosis in severe group were 125.07 ng/L, 171.21 ng/L and 1 053.04 U/L, respectively. The area under ROC curve (AUC) predicted by peripheral blood sFas, sFasL and MPO and the three indicators combination were 0.875, 0.890, 0.897 and 0.955, respectively, and the AUC of combination prediction was significantly higher than that of sFas, sFasL and MPO alone (Z = 5.693, P = 0.005; Z = 5.192, Z = 0.007; Z = 4.982, P = 0.009).

Conclusions

The levels of sFas, sFasL and MPO in peripheral blood of children with severe pneumonia are high, especially higher in children with severe pneumonia with poor prognosis, which can be used to predict poor prognosis.

Key words: Severe pneumonia, Soluble Fas protein, Soluble Fas protein ligand, Myeloperoxidase

Yang Shen, Haibo Yu, Qiangying Zeng. Predictive value of peripheral blood levels of soluble Fas protein, soluble Fas protein ligand and myeloperoxidase on poor prognosis in children with severe pneumonia[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2022, 16(04): 268-274.

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References 26

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一般资料		重症组（182例）	轻症组（196例）	对照组（178例）	统计量	P值
性别[例（%）]					χ² = 0.146^a	0.897
	男	103（56.59）	109（55.61）	98（55.06）
	女	79（43.41）	87（44.39）	80（44.94）
年龄（± s，岁）		5.10 ± 1.05	5.20 ± 1.02	5.15 ± 1.00	F = 0.451	0.638
体重（± s，kg）		18.45 ± 3.22	18.25 ± 3.20	18.40 ± 3.25	F = 0.199	0.820
病原微生物分布[例（%）]					χ² = 0.356	0.548^b
	肺炎支原体	29（15.93）	34（17.35）
	呼吸道合胞病毒	26（14.29）	23（11.73）
	肺炎链球菌	24（13.19）	27（13.78）
	其他	103（56.59）	113（57.65）
肺炎分期[例（%）]					χ² = 1.126	0.248^a
	充血期	71（39.01）	75（38.27）
	实变期	111（60.99）	121（61.73）

一般资料		重症组（182例）	轻症组（196例）	对照组（178例）	统计量	P值
性别[例（%）]					χ² = 0.146^a	0.897
	男	103（56.59）	109（55.61）	98（55.06）
	女	79（43.41）	87（44.39）	80（44.94）
年龄（± s，岁）		5.10 ± 1.05	5.20 ± 1.02	5.15 ± 1.00	F = 0.451	0.638
体重（± s，kg）		18.45 ± 3.22	18.25 ± 3.20	18.40 ± 3.25	F = 0.199	0.820
病原微生物分布[例（%）]					χ² = 0.356	0.548^b
	肺炎支原体	29（15.93）	34（17.35）
	呼吸道合胞病毒	26（14.29）	23（11.73）
	肺炎链球菌	24（13.19）	27（13.78）
	其他	103（56.59）	113（57.65）
肺炎分期[例（%）]					χ² = 1.126	0.248^a
	充血期	71（39.01）	75（38.27）
	实变期	111（60.99）	121（61.73）

影响因素		预后不良（29例）	预后良好（153例）	统计量	P值
双重/多重感染				χ² = 12.081	0.001^a
	是	15（51.72）	32（20.92）
	否	14（48.28）	121（79.08）
多肺叶感染				χ² = 32.378	< 0.001^b
	是	13（44.83）	10（6.54）
	否	16（55.17）	143（93.46）
WBC（± s，× 10⁹/L）		18.38 ± 3.63	15.25 ± 2.10	t = 6.432	< 0.001
N%（± s，%）		83.49 ± 8.15	78.15 ± 7.02	t = 3.658	0.001
CRP（± s，mg/L）		22.29 ± 4.57	12.09 ± 2.03	t = 19.415	< 0.001
PCT（± s，μg/L）		5.46 ± 1.20	1.87 ± 0.53	t = 26.101	< 0.001
sFas水平（± s，ng/L）		145.86 ± 22.78	99.68 ± 15.22	t = 13.717	< 0.001
sFasL水平（± s，ng/L）		1 236.54 ± 192.86	1 053.59 ± 163.75	t = 5.357	< 0.001
MPO水平（± s，U/L）		1 185.95 ± 176.30	1 012.11 ± 154.29	t = 5.435	< 0.001
机械通气				χ² = 2.030	0.154^b
	是	22（75.86）	132（86.27）
	否	7（24.14）	21（13.73）
规范抗感染治疗				χ² = 1.124	0.289^b
	是	26（89.66）	145（94.77）
	否	3（10.34）	8（5.23）

影响因素		预后不良（29例）	预后良好（153例）	统计量	P值
双重/多重感染				χ² = 12.081	0.001^a
	是	15（51.72）	32（20.92）
	否	14（48.28）	121（79.08）
多肺叶感染				χ² = 32.378	< 0.001^b
	是	13（44.83）	10（6.54）
	否	16（55.17）	143（93.46）
WBC（± s，× 10⁹/L）		18.38 ± 3.63	15.25 ± 2.10	t = 6.432	< 0.001
N%（± s，%）		83.49 ± 8.15	78.15 ± 7.02	t = 3.658	0.001
CRP（± s，mg/L）		22.29 ± 4.57	12.09 ± 2.03	t = 19.415	< 0.001
PCT（± s，μg/L）		5.46 ± 1.20	1.87 ± 0.53	t = 26.101	< 0.001
sFas水平（± s，ng/L）		145.86 ± 22.78	99.68 ± 15.22	t = 13.717	< 0.001
sFasL水平（± s，ng/L）		1 236.54 ± 192.86	1 053.59 ± 163.75	t = 5.357	< 0.001
MPO水平（± s，U/L）		1 185.95 ± 176.30	1 012.11 ± 154.29	t = 5.435	< 0.001
机械通气				χ² = 2.030	0.154^b
	是	22（75.86）	132（86.27）
	否	7（24.14）	21（13.73）
规范抗感染治疗				χ² = 1.124	0.289^b
	是	26（89.66）	145（94.77）
	否	3（10.34）	8（5.23）

影响因素	β值	SE值	Wald χ²值	P值	OR值	95%CI
双重/多重感染	1.689	0.867	3.795	0.029	5.969	4.857~6.304
多肺叶感染	1.753	0.842	4.335	0.014	7.485	6.785~8.126
WBC	1.996	0.883	5.110	0.010	5.332	4.593~5.567
N%	1.432	0.695	4.245	0.015	4.959	4.246~5.337
CRP	1.674	0.647	6.694	0.003	5.143	4.879~5.695
PCT	1.858	0.756	6.040	0.008	6.126	5.630~6.558
sFas	2.034	0.810	6.306	0.005	8.325	6.452~9.902
sFasL	2.169	0.825	6.912	0.001	8.469	7.879~8.653
MPO	2.155	0.837	6.629	0.003	9.132	8.882~9.594

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