Distribution of pathogenic bacteria in elderly patients with diabetes complicated with pulmonary infection and the re-lationship between serum levels of HSP70 and HMGB1 with the severity and prognosis of the disease
Objective To investigate the distribution of pathogenic bacteria in elderly patients with diabetes com-plicated with pulmonary infection,and analyze the relationship between serum levels of heat shock protein 70(HSP70)and high mobility group B1(HMGB1)with the severity and prognosis of the disease.Methods A total of 253 patients with type 2 diabetes mellitus(T2DM)combined with pulmonary infection admitted to First Affiliated Hospital of Xi'an Jiaotong University from January 2021 to November 2023 were selected as the study objects.According to the prognosis at dis-charge,they were divided into good prognosis group(n=191)and poor prognosis group(n=62).The pathogenic bacteria in sputum were identified and serum HSP70 and HMGB1 levels were detected.The prognostic factors of elderly T2DM pa-tients with pulmonary infection were analyzed using multivariate logistic regression.ROC analysis was used to predict the predictive value of serum HSP70 and HMGB1 levels for the prognosis of elderly T2DM patients with pulmonary infection.Results The proportion of age,fasting blood glucose(FBG),hypertension,chronic obstructive pulmonary disease(COPD)and severity in the poor prognosis group was significantly higher than that in the good prognosis group(t/x2/P=6251/＜0.001,14.949/＜0.001,4.666/0.031,5.827/0.016,16.530/＜0001).A total of 298 pathogenic strains were detected in 253 patient specimens,of which gram-negative bacteria accounted for 65.10％,gram-positive bacteria accounted for 28.86％,and fungi accounted for 6.04％.Serum HSP70 and HMGB1 levels in the poor prognosis group were significantly higher than those in the good prognosis group(t=11.672,13.069,all P＜0.001).Serum HSP70 and HMGB1 levels were higher in patients with se-vere disease than those with moderate or mild disease(F=54.146,231.257,all P＜0.001).Multivariate Logistic regression showed that high HSP70,high HMGB1,high age,high FBG,COPD and severity were the prognostic factors of elderly T2DM patients with pulmonary infection[OR(95％CI)=1.993(1.336-2.973),1.754(1.302-2.363),1.322(1.015-1.722),1.876(1.401-2.512),3.016(1.798-5.060),3.956(2.208-7.718),all P＜0.05].The Area under the curve(AUC)of serum HSP70,HMGB1 and their combination in predicting the prognosis of elderly T2DM patients with pulmonary infection were 0.785,0.772 and 0.897,respectively,and the combined efficacy of the two was superior to that of each alone(the difference was compared by DeLong method)(Z=3.452,3297,all P＜0.001).Conclusion The levels of serum HSP70 and HMGB1 are closely related to the severity and prognosis of pulmonary infection in elderly T2DM patients,and their combination has high predictive value for prognosis.
DiabetesPulmonary infectionDistribution of pathogenic bacteriaHeat shock protein 70High mobili-ty group B1Elderly
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