Prognostic value of Th1/Th2/Th17-related cytokines in severe pneumonia

Abstract

Background To investigate the value of Th1/Th2/Th17-related cytokine expression in the prognosis of patients with severe pneumonia (SP). Methods The observational group consisted of 106 patients diagnosed with severe pneumonia who were admitted to the Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University or the Affiliated Hospital of Xuzhou Medical University between June 2018 and July 2022. On the day of admission, flow cytometry was used to evaluate serum levels of Th1/Th2/Th17 cytokines, including tumor necrosis factor-α (TNF-α), interferon-γ (INF-γ), interleukin (IL)-2, IL-4, IL-6, IL-10, IL-17A, procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP). Meanwhile, Pneumonia Severity Index (PSI) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were assessed in all patients within 24 hours of admission. The clinical outcomes of patients with severe pneumonia on the 30th day were followed up. According to the results, the participants were categorized into two groups based on their survival status: the survival group and the deceased group. Subsequently, an analysis was conducted to identify the risk factors that significantly influenced the outcome. Results According to the 30th day outcome, 106 patients were divided into the survival group and the deceased group. The levels of IL-6, IL-10, and IL-17A were significantly elevated in the deceased group compared to the survival group (P<0.05). Univariate logistic regression analysis identified age, diabetes, high PSI score and APACHE II score at admission, as well as elevated levels of IL-6, IL-10, IL-17A, PCT and hs-CRP as significant prognostic risk factors (P < 0.05). The area under the Receiver Operating Characteristic (ROC) curve for IL-6, PCT, IL-17A, IL-10, and hs-CRP was 0.862, 0.714, 0.673, 0.639, and 0.642,respectively, indicating that IL-6 exhibited superior predictive value for mortality. Significant indicators in single-factor regression analysis included age, diabetes, APACHE II score, PSI score, Th17/Th1/Th2 cytokines, PCT and hs-CRP. After controlling for confounding variables using multivariate logistic regression analysis, high APACHE II score, high PSI score and elevated IL-6 levels at admission were identified as independent risk factors affecting patient outcomes (OR=1.305, 1.093 and 1.054; 95% CI: 1.009-1.687, 1.040-1.148 and 1.026-1.082). Based on the results of multivariate regression analysis, ROC curves were generated to predict the clinical outcome of SP patients using three factors alone and in combination. The area under the curve (AUC) values for IL-6, APACHE II score, PSI score, and their combination were 0.862, 0.826, 0.872, and 0.963 respectively, indicating that the incorporation of these three factors in a combined prediction model demonstrated superior efficacy. Conclusions IL-6, IL-10, and IL-17A are prognostic risk factors for patients with severe pneumonia, with IL-6 being an independent factor. The combination of IL-6, PSI score and APACHE II score has greater clinical significance in predicting the prognosis of SP patients.