Lipoproteins abnormalities and prognostic value of blood urea nitrogen/lipoprotein(a)ratio in patients with severe community-acquired pneumonia
Objective:To observe the changes in blood lipid levels in patients with severe community-acquired pneumonia(SCAP),and to explore the predictive value of blood urea nitrogen/lipoprotein(a)ratio(BUN/Lp[a])for mortality in intensive care unit(ICU)of SCAP patients.Methods:A total of seventy-two patients with SCAP hospitalized in the emergency intensive care unit(EICU)from March 2021 to March 2023 were included.Blood test results were collected within the first 12 h of EICU admission.The plasma lipid and lipoprotein levels in the morning of the first day after EICU admission were collected.The patients were divided into a survival group(55 cases)and a death group(17 cases).The predictive value was evaluated by using receiver operating characteristic curve and the area under the curve(AUC).Results:Compared to patients in the survival group,the interleukin-6(IL-6),BUN,and BUN/Lp(a)ratio were significantly increased in patients with the death group(P＜0.05).Pa-tients in the death group had significantly lower PaO2/FiO2,platelet count,Lp(a)than those in patients with the survival group(P＜0.05).The proportion of septic shock in patients in the death group was higher than that in the survival group(P=0.05).IL-6,BUN,and BUN/Lp(a)ratio showed a weak positive correlation with ICU death in patients with SCAP(P＜0.05).PaO2/FiO2 and Lp(a)showed a weak negative correlation with ICU death in patients with SCAP(P＜0.05).Lp(a)was positively correlated with platelet count,low-density lipopro-tein cholesterol,and apolipoprotein B(P＜0.05),and Lp(a)was negatively correlated with IL-6 in SCAP patients(P＜0.05).The AUCs of platelet count,PaO2/FiO2,IL-6,BUN,Lp(a)levels,and BUN/Lp(a)ratio for pre-dieting ICU death in patients with SCAP were 0.665(95％CI 0.544-0.772),0.709(95％CI 0.590-0.810),0.660(95％CI 0.539-0.768),0.678(95％CI 0.558-0.783),0.776(95％CI 0.662-0.866)and 0.809(95％CI 0.699-0.892),respectively(P＜0.05).A pairwise comparison of AUCs showed that the predictive value of BUN/Lp(a)ratio was significantly better than that of BUN(P=0.007 9).The sensitivity and specificity of the BUN/Lp(a)ratio in predicting ICU mortality were 65.45％and 88.24％,respectively,with a cut-off value of 0.60.Conclusion:Compared with the survival group,the Lp(a)level in the death group of SCAP patients de-creased upon admission.The BUN/Lp(a)ratio is a good predictor of ICU mortality in SCAP patients and may be-come a good alternate option for evaluating the prognosis of patients.
blood urea nitrogenlipoprotein(a)severe community-acquired pneumoniaintensive care unitprognosis
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