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A high α1-antitrypsin/interleukin-10 ratio predicts bacterial pneumonia in adults with community-acquired pneumonia: a prospective cohort study

BACKGROUND: Current microbiological tests fail to identify the causative microorganism in more than half of all pneumonia cases. We explored biomarkers that could be used for differentiating between bacterial and viral pneumonia in patients with community-acquired pneumonia (CAP). METHODS: In this p...

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Autores principales: Miyazaki, Taiga, Fukushima, Kiyoyasu, Hashiguchi, Kohji, Ide, Shotaro, Kobayashi, Tsutomu, Sawai, Toyomitsu, Yatera, Kazuhiro, Kohno, Yoshihisa, Fukuda, Yuichi, Futsuki, Yoji, Matsubara, Yuichi, Koga, Hironobu, Mihara, Tomo, Sasaki, Eisuke, Ashizawa, Nobuyuki, Hirayama, Tatsuro, Takazono, Takahiro, Yamamoto, Kazuko, Imamura, Yoshifumi, Kaku, Norihito, Kosai, Kosuke, Morinaga, Yoshitomo, Yanagihara, Katsunori, Mukae, Hiroshi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10599029/
https://www.ncbi.nlm.nih.gov/pubmed/37876022
http://dx.doi.org/10.1186/s41479-023-00118-4
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author Miyazaki, Taiga
Fukushima, Kiyoyasu
Hashiguchi, Kohji
Ide, Shotaro
Kobayashi, Tsutomu
Sawai, Toyomitsu
Yatera, Kazuhiro
Kohno, Yoshihisa
Fukuda, Yuichi
Futsuki, Yoji
Matsubara, Yuichi
Koga, Hironobu
Mihara, Tomo
Sasaki, Eisuke
Ashizawa, Nobuyuki
Hirayama, Tatsuro
Takazono, Takahiro
Yamamoto, Kazuko
Imamura, Yoshifumi
Kaku, Norihito
Kosai, Kosuke
Morinaga, Yoshitomo
Yanagihara, Katsunori
Mukae, Hiroshi
author_facet Miyazaki, Taiga
Fukushima, Kiyoyasu
Hashiguchi, Kohji
Ide, Shotaro
Kobayashi, Tsutomu
Sawai, Toyomitsu
Yatera, Kazuhiro
Kohno, Yoshihisa
Fukuda, Yuichi
Futsuki, Yoji
Matsubara, Yuichi
Koga, Hironobu
Mihara, Tomo
Sasaki, Eisuke
Ashizawa, Nobuyuki
Hirayama, Tatsuro
Takazono, Takahiro
Yamamoto, Kazuko
Imamura, Yoshifumi
Kaku, Norihito
Kosai, Kosuke
Morinaga, Yoshitomo
Yanagihara, Katsunori
Mukae, Hiroshi
author_sort Miyazaki, Taiga
collection PubMed
description BACKGROUND: Current microbiological tests fail to identify the causative microorganism in more than half of all pneumonia cases. We explored biomarkers that could be used for differentiating between bacterial and viral pneumonia in patients with community-acquired pneumonia (CAP). METHODS: In this prospective cohort study conducted in Japan, data obtained from adult patients with bacterial pneumonia, including bacterial and viral coinfections (bacterial pneumonia [BP] group), and purely viral pneumonia (VP group) at diagnosis were analyzed using multivariate logistic regression analysis to identify predictors of bacterial pneumonia. Furthermore, a decision tree was developed using the predictors. RESULTS: A total of 210 patients were analyzed. The BP and VP groups comprised 108 and 18 patients, respectively. The other 84 patients had no identified causative microorganism. The two groups shared similar characteristics, including disease severity; however, a significant difference (p < 0.05) was observed between the two groups regarding sputum type; sputum volume score; neutrophil counts; and serum levels of interleukin (IL)-8, IL-10, and α1-antitrypsin (AAT). Sputum volume score (p < 0.001), IL-10 (p < 0.001), and AAT (p = 0.008) were ultimately identified as predictors of BP. The area under the curve for these three variables on the receiver operating characteristic (ROC) curve was 0.927 (95% confidence interval [CI]: 0.881–0.974). The ROC curve for sputum volume score and an AAT/IL-10 ratio showed a diagnostic cutoff of 1 + and 65, respectively. Logistic regression analysis using dichotomized variables at the cutoff values showed that the odds ratios for the diagnosis of BP were 10.4 (95% CI: 2.2–50.2) for sputum volume score (absence vs. presence) and 19.8 (95% CI: 4.7–83.2) for AAT/IL-10 ratio (< 65 vs. ≥ 65). CONCLUSIONS: Considering that obtaining a definitive etiologic diagnosis with the current testing methods is difficult and time consuming, a decision tree with two predictors, namely sputum volume and the AAT/IL-10 ratio, can be useful in predicting BP among patients diagnosed with CAP and facilitating the appropriate use of antibiotics. TRIAL REGISTRATION: UMIN000034673 registered on November 29, 2018. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s41479-023-00118-4.
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spelling pubmed-105990292023-10-26 A high α1-antitrypsin/interleukin-10 ratio predicts bacterial pneumonia in adults with community-acquired pneumonia: a prospective cohort study Miyazaki, Taiga Fukushima, Kiyoyasu Hashiguchi, Kohji Ide, Shotaro Kobayashi, Tsutomu Sawai, Toyomitsu Yatera, Kazuhiro Kohno, Yoshihisa Fukuda, Yuichi Futsuki, Yoji Matsubara, Yuichi Koga, Hironobu Mihara, Tomo Sasaki, Eisuke Ashizawa, Nobuyuki Hirayama, Tatsuro Takazono, Takahiro Yamamoto, Kazuko Imamura, Yoshifumi Kaku, Norihito Kosai, Kosuke Morinaga, Yoshitomo Yanagihara, Katsunori Mukae, Hiroshi Pneumonia (Nathan) Research BACKGROUND: Current microbiological tests fail to identify the causative microorganism in more than half of all pneumonia cases. We explored biomarkers that could be used for differentiating between bacterial and viral pneumonia in patients with community-acquired pneumonia (CAP). METHODS: In this prospective cohort study conducted in Japan, data obtained from adult patients with bacterial pneumonia, including bacterial and viral coinfections (bacterial pneumonia [BP] group), and purely viral pneumonia (VP group) at diagnosis were analyzed using multivariate logistic regression analysis to identify predictors of bacterial pneumonia. Furthermore, a decision tree was developed using the predictors. RESULTS: A total of 210 patients were analyzed. The BP and VP groups comprised 108 and 18 patients, respectively. The other 84 patients had no identified causative microorganism. The two groups shared similar characteristics, including disease severity; however, a significant difference (p < 0.05) was observed between the two groups regarding sputum type; sputum volume score; neutrophil counts; and serum levels of interleukin (IL)-8, IL-10, and α1-antitrypsin (AAT). Sputum volume score (p < 0.001), IL-10 (p < 0.001), and AAT (p = 0.008) were ultimately identified as predictors of BP. The area under the curve for these three variables on the receiver operating characteristic (ROC) curve was 0.927 (95% confidence interval [CI]: 0.881–0.974). The ROC curve for sputum volume score and an AAT/IL-10 ratio showed a diagnostic cutoff of 1 + and 65, respectively. Logistic regression analysis using dichotomized variables at the cutoff values showed that the odds ratios for the diagnosis of BP were 10.4 (95% CI: 2.2–50.2) for sputum volume score (absence vs. presence) and 19.8 (95% CI: 4.7–83.2) for AAT/IL-10 ratio (< 65 vs. ≥ 65). CONCLUSIONS: Considering that obtaining a definitive etiologic diagnosis with the current testing methods is difficult and time consuming, a decision tree with two predictors, namely sputum volume and the AAT/IL-10 ratio, can be useful in predicting BP among patients diagnosed with CAP and facilitating the appropriate use of antibiotics. TRIAL REGISTRATION: UMIN000034673 registered on November 29, 2018. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s41479-023-00118-4. BioMed Central 2023-10-25 /pmc/articles/PMC10599029/ /pubmed/37876022 http://dx.doi.org/10.1186/s41479-023-00118-4 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Research
Miyazaki, Taiga
Fukushima, Kiyoyasu
Hashiguchi, Kohji
Ide, Shotaro
Kobayashi, Tsutomu
Sawai, Toyomitsu
Yatera, Kazuhiro
Kohno, Yoshihisa
Fukuda, Yuichi
Futsuki, Yoji
Matsubara, Yuichi
Koga, Hironobu
Mihara, Tomo
Sasaki, Eisuke
Ashizawa, Nobuyuki
Hirayama, Tatsuro
Takazono, Takahiro
Yamamoto, Kazuko
Imamura, Yoshifumi
Kaku, Norihito
Kosai, Kosuke
Morinaga, Yoshitomo
Yanagihara, Katsunori
Mukae, Hiroshi
A high α1-antitrypsin/interleukin-10 ratio predicts bacterial pneumonia in adults with community-acquired pneumonia: a prospective cohort study
title A high α1-antitrypsin/interleukin-10 ratio predicts bacterial pneumonia in adults with community-acquired pneumonia: a prospective cohort study
title_full A high α1-antitrypsin/interleukin-10 ratio predicts bacterial pneumonia in adults with community-acquired pneumonia: a prospective cohort study
title_fullStr A high α1-antitrypsin/interleukin-10 ratio predicts bacterial pneumonia in adults with community-acquired pneumonia: a prospective cohort study
title_full_unstemmed A high α1-antitrypsin/interleukin-10 ratio predicts bacterial pneumonia in adults with community-acquired pneumonia: a prospective cohort study
title_short A high α1-antitrypsin/interleukin-10 ratio predicts bacterial pneumonia in adults with community-acquired pneumonia: a prospective cohort study
title_sort high α1-antitrypsin/interleukin-10 ratio predicts bacterial pneumonia in adults with community-acquired pneumonia: a prospective cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10599029/
https://www.ncbi.nlm.nih.gov/pubmed/37876022
http://dx.doi.org/10.1186/s41479-023-00118-4
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