Value of plasma monocyte chemoattractant protein-1, soluble triggering receptor expressed on myeloid cells-1 and high mobility group box 1 in evaluating the condition and prognosis of patients with acute lung injury

doi:10.3877/cma.j.issn.1674-6880.2021.01.005

Abstract

Abstract:

Objective

To investigate the value of plasma monocyte chemoattractant protein-1 (MCP-1), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and high mobility group box 1 (HMGB1) levels in evaluating the condition and prognosis of patients with acute lung injury (ALI).

Methods

A total of 120 patients with ALI admitted to the Third People's Hospital of Haikou City from January 2016 to December 2019 were divided into a survival group (n=78) and a death group (n=42) according to their survival status. The age, gender, body mass index, underlying disease, heart rate, respiratory rate, positive end-expiratory pressure, acute physiology and chronic health evaluation (APACHE) Ⅱ score, plasma MCP-1, sTREM-1 and HMGB1 were recorded for all patients. Multivariate Logistic regression was used to analyze independent risk factors affecting the prognosis of patients with ALI. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of plasma MCP-1, sTREM-1 and HMGB1 levels on their prognosis, and the area under the curve (AUC) was compared by the Z test. Pearson correlation was used to investigate the correlation between the plasma MCP-1, sTREM-1, HMGB1 and APACHE Ⅱ score in patients with ALI.

Results

The levels of end-expiratory positive pressure [(14.2 ± 3.7) cmH₂O vs. (9.4 ± 2.9) cmH₂O], APACHE Ⅱ score [(27 ± 6) vs. (14 ± 4)], plasma MCP-1 [(41 ± 7) ng/L vs. (28 ± 5) ng/L], sTREM-1 [(73 ±11) ng/L vs. (49 ± 6) ng/L] and HMGB1 [(43 ± 12) μg/L vs. (18 ± 5) μg/L] in the death group were significantly higher than those in the survival group (t=7.226, 9.813, 10.252, 13.805, 12.724; all P < 0.001). Multivariate Logistic regression analysis showed that the APACHE Ⅱ score [odds ratio (OR)=2.973, 95% confidence interval (CI) (2.120, 6.215), P=0.013], MCP-1 [OR=2.216, 95%CI (1.552, 4.517), P < 0.001], sTREM-1 [OR=2.550, 95%CI (1.713, 5.106), P < 0.001] and HMGB1 [OR=1.894, 95%CI (1.172, 3.195), P < 0.001] were independent risk factors for the prognosis of patients with ALI. ROC curve analysis showed that the APACHE Ⅱ score [AUC=0.770, 95%CI (0.712, 0.834), P=0.012], MCP-1 [AUC=0.812, 95%CI (0.756, 0.873), P < 0.001], sTREM-1 [AUC=0.840, 95%CI (0.781, 0.902), P < 0.001], HMGB1 [AUC=0.793, 95%CI (0.734, 0.851), P=0.005] and the four combinations [AUC=0.926, 95%CI (0.870, 0.988), P < 0.001] all had predictive value for their prognosis, and the AUC of the four combinations was significantly higher than the single APACHE Ⅱ score (Z=5.938, P < 0.001), MCP-1 (Z=5.310, P=0.006), sTREM-1 (Z=4.783, P=0.013) and HMGB1 (Z=5.672, P < 0.001). Pearson correlation analysis showed that the plasma MCP-1, sTREM-1 and HMGB1 levels were positively correlated with APACHE Ⅱ scores in patients with ALI (r=0.783, 0.824, 0.750; all P < 0.001).

Conclusion

The MCP-1, sTREM-1 and HMGB1 levels are correlated with the severity and prognosis of patients with ALI, and their combinations with the APACHE Ⅱ score have good value in predicting the prognosis.

Key words: Acute lung injury, Monocyte chemoattractant protein-1, Soluble triggering receptor expressed on myeloid cells-1, High mobility group box 1, Acute physiology and chronic health evaluation

Yigui Huang, Yu Chen, Zhenggao Fu, Peixiong Zhong, Jiusha Xu, Jinxiang Hao. Value of plasma monocyte chemoattractant protein-1, soluble triggering receptor expressed on myeloid cells-1 and high mobility group box 1 in evaluating the condition and prognosis of patients with acute lung injury[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2021, 14(01): 25-29.

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References 20

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组别	例数	年龄（岁）	性别（例，男/女）	体质量指数（kg/m²）	呼吸频率（次/min）	心率（次/min）	呼气末正压（cmH₂O）	APACHEⅡ评分（分）
存活组	78	58 ± 11	46/32	23.3 ± 2.2	24 ± 5	104 ± 16	9.4 ± 2.9	14 ± 4
死亡组	42	59 ± 11	28/14	23.2 ± 2.2	25 ± 5	106 ± 16	14.2 ± 3.7	27 ± 6
t/χ²值		1.502	0.683	0.695	0.528	0.791	7.226	9.813
P值		0.163	0.408	0.554	0.642	0.495	< 0.001	< 0.001
组别	例数	糖尿病[例（%）]	高血压[例（%）]	冠状动脉粥样硬化性心脏病[例（%）]	病因[例（%）]
组别	例数	糖尿病[例（%）]	高血压[例（%）]	冠状动脉粥样硬化性心脏病[例（%）]	感染	创伤	胰腺炎	肺挫伤
存活组	78	11（14.1）	21（26.9）	3（3.8）	56（71.8）	14（17.9）	6（7.7）	2（2.6）
死亡组	42	8（19.0）	14（33.3）	4（9.5）	28（66.7）	11（26.2）	2（4.8）	1（2.4）
t/χ²值		0.501	0.543	1.602	0.342
P值		0.479	0.461	0.206	0.559

组别	例数	年龄（岁）	性别（例，男/女）	体质量指数（kg/m²）	呼吸频率（次/min）	心率（次/min）	呼气末正压（cmH₂O）	APACHEⅡ评分（分）
存活组	78	58 ± 11	46/32	23.3 ± 2.2	24 ± 5	104 ± 16	9.4 ± 2.9	14 ± 4
死亡组	42	59 ± 11	28/14	23.2 ± 2.2	25 ± 5	106 ± 16	14.2 ± 3.7	27 ± 6
t/χ²值		1.502	0.683	0.695	0.528	0.791	7.226	9.813
P值		0.163	0.408	0.554	0.642	0.495	< 0.001	< 0.001
组别	例数	糖尿病[例（%）]	高血压[例（%）]	冠状动脉粥样硬化性心脏病[例（%）]	病因[例（%）]
组别	例数	糖尿病[例（%）]	高血压[例（%）]	冠状动脉粥样硬化性心脏病[例（%）]	感染	创伤	胰腺炎	肺挫伤
存活组	78	11（14.1）	21（26.9）	3（3.8）	56（71.8）	14（17.9）	6（7.7）	2（2.6）
死亡组	42	8（19.0）	14（33.3）	4（9.5）	28（66.7）	11（26.2）	2（4.8）	1（2.4）
t/χ²值		0.501	0.543	1.602	0.342
P值		0.479	0.461	0.206	0.559

影响因素	回归系数	标准误	Wald值	P值	OR值	95%CI
呼气末正压（cmH₂O）	0.158	0.040	1.794	0.151	1.195	0.948～1.739
APACHEⅡ评分（分）	1.284	0.912	4.875	0.013	2.973	2.120～6.215
MCP-1（ng/L）	0.980	0.684	7.527	< 0.001	2.216	1.552～4.517
sTREM-1（ng/L）	1.191	0.802	9.116	< 0.001	2.550	1.713～5.106
HMGB1（μg/L）	0.813	0.293	6.830	< 0.001	1.894	1.172～3.195

影响因素	回归系数	标准误	Wald值	P值	OR值	95%CI
呼气末正压（cmH₂O）	0.158	0.040	1.794	0.151	1.195	0.948～1.739
APACHEⅡ评分（分）	1.284	0.912	4.875	0.013	2.973	2.120～6.215
MCP-1（ng/L）	0.980	0.684	7.527	< 0.001	2.216	1.552～4.517
sTREM-1（ng/L）	1.191	0.802	9.116	< 0.001	2.550	1.713～5.106
HMGB1（μg/L）	0.813	0.293	6.830	< 0.001	1.894	1.172～3.195

影响因素	AUC	95%CI	敏感度（%）	特异度（%）	P值	阳性预测值（%）	阴性预测值（%）
APACHEⅡ评分（分）	0.770	0.712～0.834	79.2	73.4	0.012	77.0	75.8
MCP-1（ng/L）	0.812	0.756～0.873	82.8	77.5	< 0.001	80.2	81.3
sTREM-1（ng/L）	0.840	0.781～0.902	85.3	81.6	< 0.001	84.0	83.5
HMGB1（μg/L）	0.793	0.734～0.851	80.6	75.0	0.005	78.3	77.4
四项联合	0.926	0.870～0.988	96.2	87.5	< 0.001	92.0	90.7

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