Abstract
Early determination of the severity of Community-Acquired Pneumonia (CAP) is essential for better disease prognosis. Current predictors are suboptimal, and their clinical utility remains to be defined, highlighting the need for developing biomarkers with efficacious prognostic value. Sphingosine-1-phosphate (S1P) is a bioactive sphingolipid with a documented regulatory role in immune defense and maintenance of endothelial barrier integrity. For early diagnose of CAP and recognition of severe CAP patients, we conduct this pilot study to access the potential utility of the circulating S1P in an Emergency department setting. In the prospective study, plasma S1P levels were quantified in healthy controls and patients with CAP. Also, their discriminating power was assessed by receiver operating characteristic analysis. The association between S1P levels and disease severity indices was assessed by Spearman correlation and logistic regression tests. Patients with CAP had significantly higher plasma S1P levels than healthy individuals (CAP: 27.54 ng/ml, IQR = 14.37–49.99 ng/ml; Controls: 10.58 ng/ml, IQR = 4.781–18.91 ng/ml; p < 0.0001). S1P levels were inversely correlated with disease severity in patients with CAP. Based on multivariate logistic regression analysis, the plasma S1P concentrations showed significant predicting power for mortality (OR: 0.909; CI: 0.801–0.985; p < 0.05), intensive care unit admission (OR: 0.89; CI: 0.812–0.953; p < 0.005) and long hospital stay (OR: 0.978; CI: 0.961–0.992; p < 0.005). Interestingly, significantly elevated levels of S1P were noted in patients who received methylprednisolone treatment during hospitalization. These results suggest that S1P may be associated with the pathogenesis of CAP and may have prognostic utility in CAP and its therapy, especially in the Emergency Department setting.
Highlights
Lower respiratory tract infections are the most frequent infectious cause of death worldwide [1] and impose a considerable burden on healthcare resources
A total of 215 individuals were included in the analysis, and the age significantly differed between the controls and community-acquired pneumonia (CAP) patients
The CAP patients were assigned to different risk levels [Low: 43(31.39%), Moderate: 64(46.71%) and High: 30(21.90%)] according to the pneumonia severity index (PSI) score
Summary
Lower respiratory tract infections are the most frequent infectious cause of death worldwide [1] and impose a considerable burden on healthcare resources. The pneumonia severity index (PSI) [5] and CURB-65 [3] are two well-known clinical CAP specific scores for identifying low-risk individuals who are candidates for outpatient care, but these scores do not perform well in predicting the need for ICU admission [6]. PCT, another inflammatory biomarker, has been extensively evaluated as a marker for bacterial infectious disease severity and progression [11,12]. Several meta-analyses have suggested that both biomarkers perform no better than the CAP-specific scores in prognostic prediction [14,15] and that these biomarkers are suggested to have better value in monitoring the treatment response than as a single point-of-care prognostic assessment tool [16]. Developing new biomarkers for predicting CAP severity in the early disease phase would be needed
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