Relationship between levels of serum activin A and pro-adrenomedullin and severity and prognosis of patients with pulmonary infection after cardiac valve replacemen

LI Wei; XU Chang-hai; LI Bao-yin; SUN Chang; CUI Yan

doi:10.3969/j.issn.1672-5301.2025.02.003

Abstract：Objective To investigate the relationship between serum activin A(ACTA)and pro-adrenomedullin(pro-ADM)and the severity and prognosis of pulmonary infection(PI)after cardiac valve replacement.Methods Consecutive enrollment of 100 patients who underwent heart valve replacement and developed PI at Northern Theater General Hospital from April 2022 to May 2023 was conducted as the PI group.Meanwhile,based on the principle of consecutive enrollment,another 100 patients who underwent heart valve replacement but did not develop PI during the same period were selected as the non-PI group.The clinical PI score(CPIS)was used to assess the condition of the PI group,which was further classified into 34 cases in the mild PI group(6-7 points),38 cases in the moderate PI group(8-9 points)and 28 cases in the severe PI group(10-12 points).According to the situation at 1 year after the operation,the PI group was further classified into the poor prognosis group(30 cases)and the good prognosis group(70 cases).The clinical data of patients with PI were collected.The fasting venous blood was collected at the time of diagnosis in the PI group and at the time of rechecking in the non-PI group,and the serum ACTA and pro-ADM were detected by enzyme linked immunosorbent assay.The effects of serum ACTA and pro-ADM on the prognosis of patients with PI after cardiac valve replacement were analyzed by multifactorial Logistic regression.ROC curves were plotted to evaluate the predictive value of serum ACTA and pro-ADM on the prognosis of patients with PI after cardiac valve replacement.Results The serum levels of ACTA and pro-ADM were higher in the PI group compared to the non-PI group[(46.24±5.66)ng/L vs.(17.29±4.67)ng/L;(3.08±0.34)nmol/L vs.(1.09±0.27)nmol/L,P＜0.05].When comparing the three subgroups within the PI group(mild,moderate,and severe PI),the serum levels of ACTA and pro-ADM increased sequentially[(40.80±4.31)ng/L vs.(47.28±3.42)ng/L vs.(51.45±3.43)ng/L;(2.75±0.21)nmol/L vs.(3.09±0.19)nmol/L vs.(3.46±0.17)nmol/L,P＜0.05].There were statistically significant differences between the two groups in terms of New York Heart Association(NYHA)functional class,the Clinical Pulmonary Infection Score(CPIS),aortic cross-clamp time and cardiopulmonary bypass time(all P＜0.05).NYHA functional class Ⅲ-Ⅳ,higher CPIS,longer aortic cross-clamp time,longer cardiopulmonary bypass time,higher ACTA levels and higher pro-ADM levels were the independent risk factors for prognosis in patients with PI following heart valve replacement(all P＜0.05).The area under the curve for predicting the prognosis in patients with PI following heart valve replacement was larger when combining serum ACTA and pro-ADM compared to using either biomarker alone[0.880 vs.0.784 vs.0.785,P＜0.05].Conclusion The increase of serum ACTA and pro-ADM levels is closely related to the aggravation and poor prognosis of patients with PI after cardiac valve replacement.The combined detection of the two has a higher predictive value for the prognosis of patients.