Relationships between CD40L level and EVLWI and the severity and prognosis of patients with severe pneumonia complicated with respiratory failure
Objective To investigate the relationships between the level of cluster of differentiation 40 ligand(CD40L)and extravascular lung water index(EVLWI)and the severity and prognosis of patients with severe pneumonia complicated with respiratory failure.Methods Totally 121 patients with severe pneumonia complicated with respiratory failure were selected and were divided into the low-risk(31 cases),medium-risk(49 cases)and high-risk(41 cases)groups according to acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ).After enrollment,standard treatment and 30-day follow-up were performed,and 37 patients died and 84 survived according to their survival status.The internal and external venous blood of all subjects was collected after 24 h in the intensive care unit,serum was collected by centrifu-gation,and serum CD40L was detected by ELISA.EVLWI was measured by pulmonary thermodilution using an indignant catheter placed in the femoral artery,brachial artery or axillary artery and was connected to a PiCCO monitor.The levels of serum CD40L and EVLWI in patients with severe pneumonia complicated with respiratory failure were compared.Spear-man correlation analysis was used to analyze the relationships between serum CD40L level,EVLWI and APACHE Ⅱ score in patients with severe pneumonia complicated with respiratory failure.Multivariate Logistic regression template was used to analyze the risk factors of poor prognosis in patients with severe pneumonia complicated with respiratory failure.Receiv-er operating characteristic(ROC)curve was used to analyze the predictive value of serum CD40L level and EVLWI on death in patients with severe pneumonia complicated with respiratory failure.Results The levels of serum CD40L and EVLWI increased in the low-risk,medium-risk and high-risk patients with severe pneumonia complicated with respiratory failure(all P<0.01).Spearman correlation analysis showed that serum CD40L level and EVLWI were positively correlated with APACHE Ⅱ score in patients with severe pneumonia complicated with respiratory failure(all P<0.01).Multivariate Logistic regression analysis showed that increasing age,≥2 extrapulmonary complications,increased APACHE Ⅱ score,and increased serum CD40L level and EVLWI were independent risk factors for poor prognosis in patients with severe pneu-monia combined with respiratory failure(all P<0.05).ROC curve analysis showed that the area under the curve of serum CD40L level,EVLWI alone and combined in assessment of death in patients with severe pneumonia complicated with re-spiratory failure was 0.773,0.779 and 0.880,respectively.The area under the curve of serum CD40L level and EVLWI combined in predicting the death of severe pneumonia complicated with respiratory failure was greater than that of serum CD40L level or EVLWI alone(all P<0.05).Conclusions The increased serum CD40L and EVLWI levels are related to the increase of severe pneumonia complicated with respiratory failure,and are independent risk factors for poor prognosis.Serum CD40L level and EVLWI have certain predictive value for death of patients with severe pneumonia complicated with respiratory failure,but the predictive value of them combined is higher.
severe pneumoniarespiratory failurecluster of differentiation 40 ligandextravascular lung water in-dexthe degree of illnessprognosis
万方数据
维普
