抑瘤素M对老年社区获得性肺炎患者病情严重程度及预后的预测价值

The Predictive Value of Oncostatin M on the Severity and Prognosis of Elderly Community-Acquired Pneumonia Patients

摘要: 背景：社区获得性肺炎(Community-Acquired Pneumonia, CAP)是老年人中常见的感染性疾病，由于其高发病率和高死亡率，造成了沉重的临床及经济负担。因此寻找可靠的生物标志物以预测老年人CAP的严重程度及预后，对于优化临床决策和改善患者预后具有重要意义。目的：探讨抑瘤素M (Oncostatin M, OSM)对老年CAP患者病情严重程度及预后的预测价值。方法：对2020年11月到2021年11月入住青岛市市立医院本部呼吸与危重症医学科、急诊病区、重症监护室病区最终确诊为社区获得性肺炎的196例老年(年龄 ≥ 65岁)患者的临床资料进行前瞻性研究。将患者分为非重症组(n = 130)与重症组(n = 66)；根据1年内CAP患者转归情况分为存活组(n = 150)与死亡组(n = 46)。比较各组间一般资料、预后、生命体征、影像学特征、实验室指标有无差异，采用Logistic回归分析预测OSM与患者1年内病死率的关系，并绘制受试者工作特征曲线(Receiver Operating Characteristic, ROC)。结果：重症组OSM水平均明显高于非重症组(p < 0.001)，死亡组OSM水平均明显高于存活组，差异均有统计学意义(p < 0.001)。Logistic回归分析显示，OSM为老年CAP患者1年内死亡的独立危险因素(OR 1.006, 95% CI: 1.001~1.012)，OSM预测1年内死亡的曲线下面积(Area Under the Curve, AUC)为0.731 (95% CI: 0.646~0.790)，阈值为35.24，敏感度为78.26%，特异性为62.0% (p < 0.001)。结论：OSM对老年CAP患者的病情严重程度及预后有临床预测价值，OSM越高，病情越严重，1年内病死率越高。

Abstract: Background: Community acquired pneumonia (CAP) is a common infectious disease among the elderly. Due to its high incidence rate and mortality, it has caused a heavy clinical and economic burden. Therefore, finding reliable biomarkers to predict the severity and prognosis of CAP in elderly patients is of great significance for optimizing clinical decision-making and improving patient prognosis. Objective: To explore the predictive value of Oncostatin M (OSM) on the severity and prognosis of elderly CAP patients. Methods: A prospective study was conducted on the clinical data of 196 elderly patients (aged ≥ 65 years) who were diagnosed with community-acquired pneumonia in the Respiratory and Critical Care Medicine Department, Emergency Ward, and Intensive Care Unit of Qingdao Municipal Hospital from November 2020 to November 2021, dividing patients into non severe group (n = 130) and severe group (n = 66); According to the outcome of CAP patients within one year, they were divided into a survival group (n = 150) and a death group (n = 46), comparing the general information, prognosis, vital signs, imaging features, and laboratory indicators between groups, using logistic regression analysis to predict the relationship between OSM and patient mortality rate within one year, and drawing receiver operating characteristic (ROC) curves. Results: The OSM levels in the severe group were significantly higher than those in the non-severe group (p < 0.001). The OSM levels in the death group were significantly higher than those in the survival group, and the differences were statistically significant (p < 0.001). Logistic regression analysis showed that OSM was an independent risk factor for mortality within one year in elderly CAP patients (OR 1.006, 95% CI: 1.001~1.012). The area under the curve (AUC) for predicting mortality within one year was 0.731 (95% CI: 0.646~0.790), with a threshold of 35.24, sensitivity of 78.26%, and specificity of 62.0% (p < 0.001). Conclusion: OSM has clinical predictive value for the severity and prognosis of elderly CAP patients. The higher the OSM, the more severe the condition, and the higher the mortality rate within one year.