Correlation between nuclear factor-κB expression in bronchoalveolar lavage fluid and computed tomography imaging features in patients with severe pneumonia and its predictive value for clinical outcomes

doi:10.3877/cma.j.issn.1674-1358.2026.01.008

Abstract

Abstract:

Objective

To investigate the correlation between nuclear factor-κB (NF-κB) expression in bronchoalveolar lavage fluid (BALF) and computed tomography (CT) imaging features, and its predictive value for prognosis of patients with severe pneumonia.

Methods

Total of 128 patients with severe pneumonia admitted to the Emergency Department and Emergency Intensive Care Unit (EICU) of 3201 Hospital from February 2022 to January 2024 were enrolled, according to the clinical outcomes after treatment, they were divided into improved group (86 cases) and deterioration group (42 cases). Clinical data including age, maximum body temperature, hypertension, tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT) and CT imaging features were compared between the two groups, respectively. The dynamic changes of NF-κB levels during treatment were analyzed by repeated-measuressis of variance. The relationship between CT imaging features and NF-κB level were analyzed by multiple linear regression. The probability curve of NF-κB level associated with clinical deterioration was ploted by the Logistic regression model, and the correlation between NF-κB level and disease deterioration were analyzed by generalized mixed-effects model. The predictive efficacy of NF-κB level for disease deterioration was evaluated by receiver operating characteristic (ROC) curve analysis. The association between NF-κB expression and survival prognosis was assessed by Kaplan-Meier analysis.

Results

Age [(63.58±8.07) years old vs. (59.26±7.73) years old: t=2.926, P=0.004], maximum body temperature [(38.64±2.58) ℃ vs. (37.26±2.14) ℃: t=3.198, P=0.002], proportion of hypertension (30.95% vs. 13.95% : χ²=5.188, P=0.023), TNF-α [(2.15±0.46) pg/ml vs. (1.68±0.32) pg/ml: t=6.723, P<0.001], CRP [(35.67±6.85) mg/L vs. (25.48±5.19) mg/L: t=9.361, P<0.001], IL-6 [(15.64±2.09) pg/ml vs. (11.75±1.36) pg/ml: t=12.648, P<0.001] and PCT [(7.89±1.43) µg/L vs. (6.84±1.26) µg/L: t=4.233, P<0.001] of patients in deterioration group were significantly higher than those of improved group, all with significant differences. The deterioration group also showed significantly higher frequencies of CT imaging features: patchy opacities (78.57% vs. 60.47%: χ²=4.147, P=0.042), lung consolidation (61.90% vs. 41.86%: χ²=4.539, P=0.033), ground-glass like changes (64.29% vs. 39.53%: χ²=6.930, P=0.008), involvement of≥2 lung lobes (69.05% vs. 40.70%: χ²=9.072, P=0.003), bronchial wall thickening (66.67% vs. 36.05%: χ²=10.648, P=0.001), patellar consolidation shadow (42.86% vs. 24.42%: χ²=4.529, P=0.033), hilar lymph node enlargement (33.33% vs. 12.79%: χ²=7.577, P=0.006), pleural effusion (59.52% vs. 31.40%: χ²=9.256, P=0.002) and atelectasis (45.24% vs. 18.60%: χ²=10.075, P=0.002) than those of improved group, all with significant differences. The results of repeated measurement ANOVA showed that the time effect, intergroup effect and interaction effect of NF-κB level in both groups were statistically significant (all P<0.001). The results of multiple linear regression analysis showed that NF-κB level was independently correlated with patchy opacities (OR=1.614, P=0.033), lung consolidation (OR=1.846, P=0.009), ground glass change (OR=1.889, P=0.012), involvement of≥2 lung lobes (OR=1.436, P=0.007), bronchial wall thickening (OR=1.428, P=0.008), lamella consolidation shadow (OR=2.106, P=0.020), hilar lymph node enlargement (OR=1.862, P=0.001), pleural effusion (OR=1.731, P=0.005) and atelectasis (OR=1.895、P=0.014), all with significant differences. Logistic regression analysis indicated that distinct NF-κB values corresponded to specific probabilities of disease deterioration, and vice versa. Elevated NF-κB level (NF-κB: 14.57-17.14 ng/L: OR=1.171, 95%CI: 1.024-1.579, P=0.014; NF-κB>17.14 ng/L: OR=1.162, 95%CI: 1.059-2.857, P=0.005) was risk factor for increased deterioration in patients with severe pneumonia (P=0.014, 0.005). ROC analysis demonstrated that NF-κB expression had a certain predictive value for the deterioration of patients with severe pneumonia (AUC=0.896, sensitivity and specificity were 84.25% and 80.79%, respectively). The one-year overall survival of patients with NF-κB low expression was higher than that of patients with NF-κB high expression (89.06% vs. 48.44%: Log-rank χ²=24.582, P<0.001).

Conclusions

NF-κB high expression in BALF is associated with an increased risk of clinical deterioration of patients with severe pneumonia, and NF-κB expression is closely correlated with CT imaging features.

Key words: Severe pneumonia, Broncho alveolar lavage fluid, Nuclear factor κB, Computed tomography, Imaging feature

Qiuju Pang, Can Chen, Baoheng Ren, Juling Han, Jing Wang. Correlation between nuclear factor-κB expression in bronchoalveolar lavage fluid and computed tomography imaging features in patients with severe pneumonia and its predictive value for clinical outcomes[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2026, 20(01): 46-53.

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Figures/Tables 8

指标	恶化组（42例）	好转组（86例）	统计量	P值
性别			χ²=0.429	0.512^a
男	26（61.90）	48（55.81）
女	16（38.10）	38（44.19）
年龄（ $x ¯$ ±s，岁）	63.58±8.07	59.26±7.73	t=2.926	0.004
BMI（ $x ¯$ ±s，kg/m²）	23.56±1.82	23.38±1.76	t=0.537	0.592
入住ICU时间（ $x ¯$ ±s，d）	15.31±2.74	15.08±2.36	t=0.491	0.625
机械通气时间（ $x ¯$ ±s，d）	13.86±2.33	13.45±1.68	t=1.137	0.258
收缩压（ $x ¯$ ±s，mmHg）	111.39±9.55	112.21±9.74	t=0.450	0.653
舒张压（ $x ¯$ ±s，mmHg）	81.53±6.09	81.29±5.78	t=0.217	0.829
最高体温（ $x ¯$ ± s，℃）	38.64±2.58	37.26±2.14	t=3.198	0.002
吸烟史 [例（%）]	18（42.86）	34（39.53）	χ²=0.129	0.719^a
饮酒史 [例（%）]	29（69.05）	52（60.47）	χ²=0.895	0.344^a
糖尿病史 [例（%）]	3（7.14）	8（9.30）	χ²=0.168	0.682^b
高血压 [例（%）]	13（30.95）	12（13.95）	χ²=5.188	0.023^a
高脂血症 [例（%）]	9（21.43）	14（16.28）	χ²=0.508	0.476^a
病原体种数 [例（%）]			χ²=2.255	0.133^a
＜2种	18（42.86）	49（56.98）
≥2种	24（57.14）	37（43.02）
肺部病变 [例（%）]			χ²=0.445	0.505^a
单侧	15（35.71）	36（41.86）
双侧	27（64.29）	50（58.14）
RBC（ $x ¯$ ±s，×10¹²/L）	5.24±0.42	5.36±0.58	t=1.195	0.234
WBC（ $x ¯$ ±s，×10¹²/L）	12.87±2.45	12.24±2.18	t=1.473	0.143
TNF-α（ $x ¯$ ± s，pg/ml）	2.15±0.46	1.68±0.32	t=6.723	＜0.001
CRP（ $x ¯$ ±s，mg/L）	35.67±6.85	25.48±5.19	t=9.361	＜0.001
IL-6（ $x ¯$ ±s，pg/ml）	15.64±2.09	11.75±1.36	t=12.648	＜0.001
Hb（ $x ¯$ ±s，×10¹²/L）	146.93±18.96	146.27±18.75	t=0.186	0.853
PCT（ $x ¯$ ±s，µg/L）	7.89±1.43	6.84±1.26	t=4.233	＜0.001
PLT（ $x ¯$ ±s，×10⁹/L）	314.06±25.17	305.48±22.76	t=1.934	0.055
BUN（ $x ¯$ ±s，mmol/L）	4.39±0.46	4.26±0.42	t=1.593	0.114

指标	恶化组（42例）	好转组（86例）	统计量	P值
性别			χ²=0.429	0.512^a
男	26（61.90）	48（55.81）
女	16（38.10）	38（44.19）
年龄（ $x ¯$ ±s，岁）	63.58±8.07	59.26±7.73	t=2.926	0.004
BMI（ $x ¯$ ±s，kg/m²）	23.56±1.82	23.38±1.76	t=0.537	0.592
入住ICU时间（ $x ¯$ ±s，d）	15.31±2.74	15.08±2.36	t=0.491	0.625
机械通气时间（ $x ¯$ ±s，d）	13.86±2.33	13.45±1.68	t=1.137	0.258
收缩压（ $x ¯$ ±s，mmHg）	111.39±9.55	112.21±9.74	t=0.450	0.653
舒张压（ $x ¯$ ±s，mmHg）	81.53±6.09	81.29±5.78	t=0.217	0.829
最高体温（ $x ¯$ ± s，℃）	38.64±2.58	37.26±2.14	t=3.198	0.002
吸烟史 [例（%）]	18（42.86）	34（39.53）	χ²=0.129	0.719^a
饮酒史 [例（%）]	29（69.05）	52（60.47）	χ²=0.895	0.344^a
糖尿病史 [例（%）]	3（7.14）	8（9.30）	χ²=0.168	0.682^b
高血压 [例（%）]	13（30.95）	12（13.95）	χ²=5.188	0.023^a
高脂血症 [例（%）]	9（21.43）	14（16.28）	χ²=0.508	0.476^a
病原体种数 [例（%）]			χ²=2.255	0.133^a
＜2种	18（42.86）	49（56.98）
≥2种	24（57.14）	37（43.02）
肺部病变 [例（%）]			χ²=0.445	0.505^a
单侧	15（35.71）	36（41.86）
双侧	27（64.29）	50（58.14）
RBC（ $x ¯$ ±s，×10¹²/L）	5.24±0.42	5.36±0.58	t=1.195	0.234
WBC（ $x ¯$ ±s，×10¹²/L）	12.87±2.45	12.24±2.18	t=1.473	0.143
TNF-α（ $x ¯$ ± s，pg/ml）	2.15±0.46	1.68±0.32	t=6.723	＜0.001
CRP（ $x ¯$ ±s，mg/L）	35.67±6.85	25.48±5.19	t=9.361	＜0.001
IL-6（ $x ¯$ ±s，pg/ml）	15.64±2.09	11.75±1.36	t=12.648	＜0.001
Hb（ $x ¯$ ±s，×10¹²/L）	146.93±18.96	146.27±18.75	t=0.186	0.853
PCT（ $x ¯$ ±s，µg/L）	7.89±1.43	6.84±1.26	t=4.233	＜0.001
PLT（ $x ¯$ ±s，×10⁹/L）	314.06±25.17	305.48±22.76	t=1.934	0.055
BUN（ $x ¯$ ±s，mmol/L）	4.39±0.46	4.26±0.42	t=1.593	0.114

CT影像特征	恶化组（42例）	好转组（86例）	χ²值	P值
斑片影像改变	33（78.57）	52（60.47）	4.147	0.042
肺实变	26（61.90）	36（41.86）	4.539	0.033
磨玻璃样改变	27（64.29）	34（39.53）	6.930	0.008
累及肺叶数			9.072	0.003
≥2个	29（69.05）	35（40.70）
＜2个	13（30.95）	51（59.30）
支气管壁增厚	28（66.67）	31（36.05）	10.648	0.001
片状实变影	18（42.86）	21（24.42）	4.529	0.033
肺门淋巴结肿大	14（33.33）	11（12.79）	7.577	0.006
胸腔积液	25（59.52）	27（31.40）	9.256	0.002
肺不张	19（45.24）	16（18.60）	10.075	0.002

组别	例数	插管后2天	插管后6天	撤机后2天	F值	P值
好转组	86	15.12±3.05	10.36±1.47	6.25±0.48	52.974	＜0.001
恶化组	42	16.38±3.34	18.14±4.28	24.76±4.95	44.492	0.022
t值		2.127	15.174	34.488
P值		0.035	＜0.001	＜0.001

CT影像特征	调整前			调整后
CT影像特征	OR值	95%CI	P值	OR值	95%CI	P值
斑片影像改变	1.426	1.115～1.764	0.031	1.614	1.362～2.747	0.033
肺实变	1.459	1.133～1.827	0.006	1.846	1.487～2.334	0.009
磨玻璃样改变	1.639	1.216～2.323	0.014	1.889	1.401～2.989	0.012
累及肺叶数≥2个	1.391	1.163～1.985	0.009	1.436	1.221～1.847	0.007
支气管壁增厚	1.428	1.014～2.693	0.005	1.428	1.149～1.634	0.008
片状实变影	1.022	1.003～1.756	0.017	2.106	1.952～3.019	0.020
肺门淋巴结肿大	1.679	1.328～2.966	0.002	1.862	1.329～2.056	0.001
胸腔积液	1.452	1.283～1.894	0.004	1.731	1.208～2.379	0.005
肺不张	1.621	1.178～2.253	0.011	1.895	1.247～2.804	0.014

NF-κB（ng/L）	β值	S.E.值	Wald χ²值	OR值	95%CI	P值
≤14.57	—	—	—	Ref（1.00）	Ref（1.00）	—
14.57～17.14	0.158	0.121	1.702	1.171	1.024～1.579	0.014
≥17.14	0.150	0.112	1.797	1.162	1.059～2.857	0.005

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