The levels of serum Gal-3,MICA,and 25(OH)D in elderly patients with severe pneumonia complicated by respira-tory failure and their impacts on the disease condition and prognosis

Chen Yin; Xu Ping; Guo Zhiling; Duan Weiwei; He Saifei

doi:10.3969/j.issn.1671-6450.2025.01.007

Abstract：Objective To investigate the levels of serum galectin-3(Gal-3),major histocompatibility complex class I-related chain A(MICA),and 25 hydroxyvitamin D[25(OH)D]in elderly patients with severe pneumonia(SP)complicated by respiratory failure(RF),and their impacts on the disease condition and prognosis.Methods Three hundred and forty-two cases of elderly SP patients admitted to the Department of Intensive Care Medicine of Beidahuang Group General Hos-pital from August 2022 to July 2024 were selected for the study,and the patients were categorized into 171 cases in the RF group and 171 cases in the non-RF group according to whether or not they were combined with RF.According to the Acute Physiology and Chronic Health Status Score Ⅱ(APACHE Ⅱ),the elderly SP patients with RF were divided into 41 ca-ses in the low-risk subgroup,77 cases in the medium-risk subgroup,and 53 cases in the high-risk subgroup;and according to the prognosis of the 28-d follow-up,the elderly SP patients with RF were divided into 51 cases in the death subgroup and 120 cases in the survival subgroup.Serum Gal-3 and MICA levels were measured by ELISA,and serum 25(OH)D levels were measured by high performance liquid chromatography-tandem mass spectrometry(LC-MS/MS);the correlation be-tween serum Gal-3,MICA,and 25(OH)D levels and the degree of the disease was analyzed by the Spearman's method;the factors influencing the prognosis of death of the elderly patients with SP and RF were analyzed by multifactorial logistic analysis;the factors influencing the prognosis of death of the elderly patients with SP and RF were analyzed by multifactori-al logistic analysis.The influencing factors of prognostic death in patients;the predictive value of serum Gal-3,MICA,and 25(OH)D levels on prognostic death in elderly SP combined with RF patients was evaluated by subject work characteristics(ROC)curves.Results Serum Gal-3 and MICA levels were higher in the RF group than in the non-RF group,and serum25(OH)D levels were lower than in the non-RF group(t/P=12.674/＜0.001,20.954/＜0.001,22.872/＜0.001);along with the ag-gravation of the disease,the levels of serum Gal-3 and MICA in the elderly patients with SP combined with RF were gradu-ally increased,and serum 25(OH)D levels gradually decreased(F/P=41.512/＜0.001,221.162/＜0.001,165.574/＜0.001);Spearman's correlation analysis showed a positive correlation between the severity of the disease in elderly SP combined with RF patients and the serum Gal-3 and MICA levels(r=0.682,0.726,both P＜0.001)and negatively correlated with serum 25(OH)D levels(r=-0.733,P＜0.001);at 28 d of follow-up,the incidence of prognostic death in 171 elderly SP combined with RF patients was 29.82％(51/171).The oxygenation index(PaO2/FiO2)and serum25(OH)D levels were lower in the death subgroup than in the survival subgroup,and the mechanical ventilation time,APACHE Ⅱ score,serum Gal-3,and MICA lev-els were higher than those in the survival subgroup(t/P=2.392/0.018,13.242/＜0.001,2.235/0.027,10.805/＜0.001,7.852/＜0.001,16.923/＜0.001);and the results of multifactorial logistic regression analysis showed that prolonged mechanical ventila-tion,high APACHE Ⅱ score,high Gal-3,and high MICA were the independent risk factors for prognostic mortality in elderly patients with SP combined with RF[OR(95％CI)=2.518(1.385-4.578),3.157(1.849-5.391),3.264(1.863-5.717),and 4.116(2.025-8.368)],and high PaO2/FiO2 and high 25(OH)D were independent protective factors[OR(95％CI)=0.549(0.346-0.870),0.426(0272-0.667)];the area under the curve(AUC)of serum Gal-3,MICA,and 25(OH)D levels and the combination of the three for predicting prognostic death in elderly patients with SP combined with RF were 0.855,0.850,0.835,and 0.968,respectively,and the AUC of the combination of the three was greater than that of serum Gal-3,MICA,and 25(OH)D levels alone AUC predicted by serum Gal-3,MICA,and 25(OH)D levels alone(Z=3.600,3.652,4.001,all P=0.000).Conclusion Serum Gal-3 and MICA were up-regulated and 25(OH)D was down-regulated in elderly SP combined with RF patients,and the expression levels of the three were closely correlated with the severity of the disease in elderly SP combined with RF pa-tients,and the value of the combination of the three in predicting the prognosis of death in elderly SP combined with RF pa-tients was high.