Predictive Value of Lysophosphatidylcholine for Determining the Disease Severity and Prognosis of Elderly Patients with Community-Acquired Pneumonia

Abstract

Purpose

To investigate the clinical value of serum lysophosphatidylcholine (LPC) as a predictive biomarker for determining disease severity and mortality risk in hospitalized elderly patients with community-acquired pneumonia (CAP).

Methods

This prospective, single-center study enrolled 208 elderly patients, including 67 patients with severe CAP (SCAP) and 141 with non-SCAP between November 1st, 2020, and November 30th, 2021 at the Qingdao Municipal Hospital, Shandong Province, China. The demographic and clinical parameters were recorded for all the included patients. Serum LPC levels were measured on day 1 and 6 after admission using ELISA. Propensity score matching (PSM) was used to balance the baseline variables between SCAP and non-SCAP patient groups. Receiver operative characteristic (ROC) curve analysis was used to compare the predictive performances of LPC and other clinical parameters in discriminating between SCAP and non-SCAP patients and determining the 30-day mortality risk of the hospitalized CAP patients. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors associated with SCAP. Cox proportional hazard regression analysis was used to determine if serum LPC was an independent risk factor for the 30-day mortality of CAP patients.

Results

The serum LPC levels at admission were significantly higher in the non-SCAP patients than in the SCAP patients (P = 0.011). Serum LPC level <24.36 ng/mL, and PSI score were independent risk factors for the 30-day mortality in the elderly patients with CAP. The risk of 30-day mortality in the elderly CAP patients with low serum LPC levels (< 24.36ng/mL) was >5-fold higher than in the patients with high serum LPC levels (≥ 24.36ng/mL).

Conclusion

Low serum LPC levels were associated with significantly higher disease severity and 30-day mortality in the elderly patients with CAP. Therefore, serum LPC is a promising predictive biomarker for the early identification of elderly CAP patients with poor prognosis.

Keywords:

• lysophosphatidylcholine
• community-acquired pneumonia
• biomarker
• severity
• mortality
• propensity score matching

Abbreviations

AUC, Area under the ROC curve; CAP, Community-acquired pneumonia; CRP, C-reactive protein; HR, Hazard ratio; ICU, Intensive Care Unit; NLR, Neutrophil-to-lymphocyte ratio; OR, Odds ratios; PSI, Pneumonia severity index; PSM, Propensity score matching; ROC, Receiver operative characteristic; SOFA, Sequential Organ Failure Assessment; WBC, White blood cell.

Data Sharing Statement

The datasets generated and analyzed during the current study are not publicly available due to health privacy concerns but are available from the corresponding author upon reasonable request.

Ethics Approval and Informed Consent

The protocol of this study was approved by the Ethics Committee of the Qingdao Municipal Hospital (Approval No. 2020CXJJ001-052). This study was in compliance with the Declaration of Helsinki and informed consent was obtained from all patients or their families before this study.

Acknowledgments

The authors thank all the patients who participated in this study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests in this work.

Additional information

Funding

This study was funded by the Qingdao Municipal Hospital Clinical Diagnosis and Treatment Technology Innovation Fund (Grant No. CXJJ-034). The funding agency did not play any role in the design of the study, collection, analyses, or interpretation of data, writing of the manuscript, and the decision regarding publishing the results.