Objective To analyze the relationship between serum micro ribonucleic acid(miRNA)-27a,forkhead framing protein O3(FOXO3),and the severity of the disease and the prognosis of elderly patients with severe pneumonia complicated by acute respiratory distress syndrome(ARDS).Methods One hundred and eight elderly patients with severe pneumonia complicating ARDS(ARDS group)and 72 elderly patients with severe pneumonia not complicating ARDS(non-ARDS group)admitted to the Department of Intensive Care Medicine,Jing'an District Central Hospital,Shanghai,China,from October 2022 to September 2023 were selected,and the patients in the ARDS group were divided into a mild subgroup of 26 cases and a moderate subgroup of 34 cases according to the oxygenation index.The patients in the ARDS group were further divided into 26 cases in the mild subgroup,34 cases in the moderate subgroup,and 48 cases in the severe subgroup according to the oxygenation index,and were divided into 33 cases in the death subgroup and 75 cases in the survival sub-group according to the prognosis at 28 d.In addition,60 healthy volunteers who had medical checkups during the same pe-riod were selected as the healthy control group.Real-time fluorescence quantitative polymerase chain reaction was used to detect serum miR-27a and FOXO3 levels,and TargetScan database predicted the binding sites of miR-27a and FOXO3.The correlation between serum miR-27a and FOXO3 mRNA levels was analyzed by Pearson/Spearman correlation,multifactorial logistic regression was used to analyze the prognostic factors of elderly patients with severe pneumonia complicated by ARDS,and the subject work characteristics(ROC)curves were used to analyze the effects of serum miR-27a and FOXO3 mRNA levels on the prognosis of elderly patients with severe pneumonia complicated by The predictive value of death in patients with ARDS.Results Serum miR-27a level decreased and FOXO3 mRNA level increased in healthy control group,non-ARDS group and ARDS group(F/P=77.352/<0.001,62.956/<0.001);serum miR-27a level decreased and FOXO3 mR-NA level increased in mild,moderate and severe subgroups,and serummiR-27a level decreased and FOXO3 mRNA level in-creased in mild,moderate and severe subgroups.subgroups serum miR-27a level decreased and FOXO3 mRNA level in-creased sequentially(F/P=83.597/<0.001,111.833/<0.001);there was a binding site between miR-27a and the 3'-untranslated region of FOXO3 from3257～3264 Sites.Serum miR-27a was negatively correlated with FOXO3 mRNA levels in elderly pa-tients with severe pneumonia complicating ARDS(r/P=-0.736/<0.001),and oxygenation index was positively correlated with serum miR-27a levels and negatively correlated with FOXO3 mRNA levels(r/P=0.751/<0.001,-0.785/<0.001).The 28-d mortality rate of elderly patients with severe pneumonia complicated by ARDS was 30.56%(33/108).Increasing age,pro-longed duration of mechanical ventilation,and elevated FOXO3 mRNA were independent risk factors affecting the prognosis of elderly patients with severe pneumonia complicating ARDS,and elevated oxygenation index and elevated miR-27a were independent protective factors[OR(95%CI)=1.199(1.033-1.393),1.547(1.009-2.373),1.108(1.040-1.180),0.973(0.958-0.989),and 0.903(0.844-0.965)];the areas under the curves of serummiR-27a,FOXO3 mRNA levels and the combination of the two in predicting death in elderly patients with severe pneumonia complicating ARDSwere respectively was 0.784,0.786,0.879,and the AUC of the combination of the two was greater than that predicted by serum miR-27a and FOXO3 mRNA levels alone(Z/P=2.550/0.011,2.963/0.003).Conclusions The decrease of serum miR-27a level and the increase of FOXO3 mRNA level in elderly patients with severe pneumonia complicating ARDS are closely related to the disease exacerbation and poor prognosis,and the combination of the two is of high value in predicting the death of elderly patients with severe pneumonia complicating ARDS.
Severe pneumoniaAcute respiratory distress syndromemicroRNA-27aForkhead box protein O3Disease severityPrognosisElderly
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