Abstract
Monocyte chemoattractant protein (MCP)-1 increases in the serum of immunocompetent patients with community-acquired pneumonia (CAP). However, the correlation between the circulating level of MCP-1 and severity of CAP remains unclear. This study investigated differential changes in the plasma MCP-1 levels of patients with CAP before and after an antibiotic treatment and further analyzes the association between the CAP severity and MCP-1 levels. We measured the plasma MCP-1 levels of 137 patients with CAP and 74 healthy controls by using a commercial enzyme-linked immunosorbent assay. Upon initial hospitalization, Acute Physiology and Chronic Health Evaluation II (APACHE II); confusion, urea level, respiratory rate, blood pressure, and age of >64 years (CURB-65); and pneumonia severity index (PSI) scores were determined for assessing the CAP severity in these patients. The antibiotic treatment reduced the number of white blood cells (WBCs) and neutrophils as well as the level of C-reactive protein (CRP) and MCP-1. The plasma MCP-1 level, but not the CRP level or WBC count, correlated with the CAP severity according to the PSI (r = 0.509, p < 0.001), CURB-65 (r = 0.468, p < 0.001), and APACHE II (r = 0.360, p < 0.001) scores. We concluded that MCP-1 levels act in the development of CAP and are involved in the severity of CAP.
Highlights
Community-acquired pneumonia (CAP) is caused by exposure to bacterial agents outside of a healthcare setting
In contrast to Monocyte chemoattractant protein-1 (MCP-1), neither C-reactive protein (CRP) levels nor white blood cell (WBC) counts correlated with the CAP severity in patients, as evidenced from the statistically non-significant correlations among pneumonia severity index (PSI), CURB-65, and APACHE Acute Physiology and Chronic Health Evaluation II (II) scores and CRP levels (p = 0.926, 0.824, and 0.968, respectively) and WBC counts (p = 0.973, 0.544, and 0.416, respectively; Table 2)
The pretreatment CRP levels and WBC and neutrophil counts were significantly higher in patients with CAP before treatment than in the controls; the antibiotic treatment significantly reduced those parameters in the same patients
Summary
Community-acquired pneumonia (CAP) is caused by exposure to bacterial agents outside of a healthcare setting. The confusion, urea level, respiratory rate, blood pressure, and age of >64 years (CURB-65) scores and the pneumonia severity index (PSI) are the most CAP-specific scoring systems for predicting CAP outcomes; these systems are subjective and have some limitations [7]. PSI is highly complex, disadvantaging its dissemination and execution, in routine clinical practice The disadvantages of both CURB-65 and PSI scores include the usage of the most routine clinical and laboratory data, which require assessments of patients with CAP without delay. MCP-1 has been demonstrated to be a potent monocyte and macrophage [13], neutrophil [14], and T-cell [15] chemoattractant against bacterial pulmonary infection; this effect is due to MCP-1 binding to its sole receptor chemokine C–C motif receptor 2 (CCR2) [16]. We measured the plasma MCP-1 levels in a CAP cohort and in healthy controls for evaluating whether MCP-1 could be a beneficial biochemical marker to aid differentiation between controls and patients with CAP, as well as clarify any association between the circulating MCP-1 levels and CAP severity
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