ПРОГНОСТИЧЕСКАЯ ЗНАЧИМОСТЬ ИССЛЕДОВАНИЯ УРОВНЕЙ МАРКЕРОВ АПОПТОЗА – БЕЛКОВ P53 И BCL-2 У ПАЦИЕНТОВ ПОЖИЛОГО ВОЗРАСТА С ВИРУСНОЙ ПНЕВМОНИЕЙ, ВЫЗВАННОЙ SARS-COV-2

Abstract

Abstract. Introduction. Тo date, the prognostic value has been proven for some laboratory biomarkers and biomarker panels for risk stratification in patients with viral pneumonia caused by SARS-CoV-2. In studies related to the research in the leading pathogenetic mechanisms of COVID-19, much attention is paid to apoptosis and its markers, such as proteins P53 and BCL-2. Aim: To study the levels of P53 and Bcl-2 proteins and their prognostic significance in lethal outcomes among elderly patients with viral pneumonia caused by SARS-CoV-2, hospitalized in an infectious hospital. Materials and Methods. For the period December 2021 – February 2022, in accordance with the inclusion criteria, a sample of 67 patients was formed from elderly patients (60-74 years old) hospitalized in the hospital of infectious diseases. During the follow-up, 18 patients (26.9 %) had fatal outcomes and 49 patients (73.1 %) had favorable outcomes. Biochemical markers of apoptosis, P53 and BCL-2, were detected using the enzyme immunoassay method. Results and Discussion. The analysis showed the presence of statistically significant differences when comparing the levels of both proteins, P53 (p=0.001) and BCL-2 (p=0.002) in patients with favorable outcomes, compared to those with fatal outcomes. Threshold values of the P53 and BCL-2 proteins at the cut-off point in case of death of elderly patients with viral pneumonia caused by SARS-CoV-2 were 99.3 pg/ml and 78.9 IU/ml, respectively. The classification tree includes the following lethality predictors: Threshold levels of apoptosis markers, the number of comorbid diseases, and the respiratory failure degree. Five terminal nodes were identified. Terminal nodes 6 and 8 were classified as high risk of death. Lethal outcomes were observed in 75.0 % of patients at these nodes. At terminal node 3, fatal outcome was observed in 8.1 % of patients, while there were no fatal outcomes at terminal node 7; therefore, both were classified as low-risk ones in terms of a fatal outcome. The sensitivity of the resulting model was 66.7 %, while its specificity was 91.8%. The total share of correct predictions made 85.1% among the subjects of this sample (p=0.044). Conclusions. The data obtained indicate the prognostic significance of studying the apoptosis markers, i. e., proteins P53 and BCL-2, in elderly patients with viral pneumonia caused by SARS-CoV-2. The classification tree proposed can be used as an auxiliary algorithm to optimize the personalized stratification of the lethality risk in elderly patients with viral pneumonia caused by SARS-CoV-2.