A Lymphocyte Subset-Based Prediction Model for Refractory Community-Acquired Pneumonia in Immunocompetent Patients
<b>Background/Objectives</b>: Refractory community-acquired pneumonia (r-CAP) has become a thorny issue in clinical practice, especially after the COVID-19 pandemic, even in immunocompetent patients, as conventionally defined. In this study, we aimed to identify the risk factors for immu...
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2025-06-01
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| author | Jingyuan Zhang Xinyu Hu Ailifeila Aili Lei Pan Xinying Xue Xiaolan Chen |
| author_facet | Jingyuan Zhang Xinyu Hu Ailifeila Aili Lei Pan Xinying Xue Xiaolan Chen |
| author_sort | Jingyuan Zhang |
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| description | <b>Background/Objectives</b>: Refractory community-acquired pneumonia (r-CAP) has become a thorny issue in clinical practice, especially after the COVID-19 pandemic, even in immunocompetent patients, as conventionally defined. In this study, we aimed to identify the risk factors for immunocompetent patients with r-CAP. <b>Methods:</b> This was a single-center retrospective study. In total, we collected clinical data from 82 patients with r-CAP in whom the first-line antibiotic therapy failed and 82 patients with general CAP (g-CAP) who recovered with first-line antibiotics, matched at a ratio of 1:1, admitted to Beijing Shijitan Hospital, Capital Medical University, from 1 January 2022, to 31 December 2023. The differences between the two groups (clinical characteristics, peripheral blood cell count, lymphocyte subsets, and regular laboratory indicators) were analyzed using paired <i>t</i>, paired Wilcoxon, Chi-square, or Fisher’s exact tests, and univariate and multivariate logistics regression analyses were conducted to identify the independent risk factors. A model for predicting indicators with statistical significance was established and proved with the receiver operating characteristic (ROC) curve. <b>Results</b>: Warm season, a history of chronic obstructive pulmonary disease, longer time from onset to admission (T<sub>O-A</sub>), higher percentages of CD4<sup>+</sup> T, CD8<sup>+</sup> T, and double-negative T (DNT) lymphocytes, as well as higher levels of C-reactive protein (CRP), low-density lipoprotein cholesterin (LDL-C), serum sodium ion (Na<sup>+</sup>), and free-calcium ion (FCa<sup>2+</sup>) were regarded as independent risk factors, while T lymphocyte percentage (T%) and total cholesterol (TC) were identified as protective factors. The combined multivariate model using all the above factors proved to be sensitive and specific (AUC = 0.8711, <i>p</i> < 0.0001, R<sup>2</sup> = 0.4235), and thus better than the respective univariate models. <b>Conclusions</b>: Increased CD4<sup>+</sup> T%Lym, CD8<sup>+</sup> T%Lym, and DNT%Lym, warm season, a history of COPD, longer T<sub>O-A</sub>, and increased levers of CRP, LDL-C, Na<sup>+</sup>, and FCa<sup>2+</sup> potentially cause CAP to be refractory, while the T lymphocyte count, namely, the overall cellular immunity, was impaired in r-CAP patients, and increased TC levels could be beneficial to pneumonia recovery. |
| format | Article |
| id | doaj-art-40a8acd8d2594ec39b84d353f874e3d0 |
| institution | Matheson Library |
| issn | 2075-4418 |
| language | English |
| publishDate | 2025-06-01 |
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| spelling | doaj-art-40a8acd8d2594ec39b84d353f874e3d02025-07-11T14:38:07ZengMDPI AGDiagnostics2075-44182025-06-011513162710.3390/diagnostics15131627A Lymphocyte Subset-Based Prediction Model for Refractory Community-Acquired Pneumonia in Immunocompetent PatientsJingyuan Zhang0Xinyu Hu1Ailifeila Aili2Lei Pan3Xinying Xue4Xiaolan Chen5Department of Respiratory and Critical Care Medicine, Emergency and Critical Care Medical Center, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, ChinaDepartment of Respiratory and Critical Care Medicine, Emergency and Critical Care Medical Center, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, ChinaDepartment of Respiratory and Critical Care Medicine, Emergency and Critical Care Medical Center, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, ChinaDepartment of Respiratory and Critical Care Medicine, Emergency and Critical Care Medical Center, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, ChinaDepartment of Respiratory and Critical Care Medicine, Emergency and Critical Care Medical Center, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, ChinaDepartment of Respiratory and Critical Care Medicine, Emergency and Critical Care Medical Center, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China<b>Background/Objectives</b>: Refractory community-acquired pneumonia (r-CAP) has become a thorny issue in clinical practice, especially after the COVID-19 pandemic, even in immunocompetent patients, as conventionally defined. In this study, we aimed to identify the risk factors for immunocompetent patients with r-CAP. <b>Methods:</b> This was a single-center retrospective study. In total, we collected clinical data from 82 patients with r-CAP in whom the first-line antibiotic therapy failed and 82 patients with general CAP (g-CAP) who recovered with first-line antibiotics, matched at a ratio of 1:1, admitted to Beijing Shijitan Hospital, Capital Medical University, from 1 January 2022, to 31 December 2023. The differences between the two groups (clinical characteristics, peripheral blood cell count, lymphocyte subsets, and regular laboratory indicators) were analyzed using paired <i>t</i>, paired Wilcoxon, Chi-square, or Fisher’s exact tests, and univariate and multivariate logistics regression analyses were conducted to identify the independent risk factors. A model for predicting indicators with statistical significance was established and proved with the receiver operating characteristic (ROC) curve. <b>Results</b>: Warm season, a history of chronic obstructive pulmonary disease, longer time from onset to admission (T<sub>O-A</sub>), higher percentages of CD4<sup>+</sup> T, CD8<sup>+</sup> T, and double-negative T (DNT) lymphocytes, as well as higher levels of C-reactive protein (CRP), low-density lipoprotein cholesterin (LDL-C), serum sodium ion (Na<sup>+</sup>), and free-calcium ion (FCa<sup>2+</sup>) were regarded as independent risk factors, while T lymphocyte percentage (T%) and total cholesterol (TC) were identified as protective factors. The combined multivariate model using all the above factors proved to be sensitive and specific (AUC = 0.8711, <i>p</i> < 0.0001, R<sup>2</sup> = 0.4235), and thus better than the respective univariate models. <b>Conclusions</b>: Increased CD4<sup>+</sup> T%Lym, CD8<sup>+</sup> T%Lym, and DNT%Lym, warm season, a history of COPD, longer T<sub>O-A</sub>, and increased levers of CRP, LDL-C, Na<sup>+</sup>, and FCa<sup>2+</sup> potentially cause CAP to be refractory, while the T lymphocyte count, namely, the overall cellular immunity, was impaired in r-CAP patients, and increased TC levels could be beneficial to pneumonia recovery.https://www.mdpi.com/2075-4418/15/13/1627refractory community acquired pneumoniaT lymphocyteCD4<sup>+</sup> T cellCD8<sup>+</sup> T celldouble negative T cell |
| spellingShingle | Jingyuan Zhang Xinyu Hu Ailifeila Aili Lei Pan Xinying Xue Xiaolan Chen A Lymphocyte Subset-Based Prediction Model for Refractory Community-Acquired Pneumonia in Immunocompetent Patients Diagnostics refractory community acquired pneumonia T lymphocyte CD4<sup>+</sup> T cell CD8<sup>+</sup> T cell double negative T cell |
| title | A Lymphocyte Subset-Based Prediction Model for Refractory Community-Acquired Pneumonia in Immunocompetent Patients |
| title_full | A Lymphocyte Subset-Based Prediction Model for Refractory Community-Acquired Pneumonia in Immunocompetent Patients |
| title_fullStr | A Lymphocyte Subset-Based Prediction Model for Refractory Community-Acquired Pneumonia in Immunocompetent Patients |
| title_full_unstemmed | A Lymphocyte Subset-Based Prediction Model for Refractory Community-Acquired Pneumonia in Immunocompetent Patients |
| title_short | A Lymphocyte Subset-Based Prediction Model for Refractory Community-Acquired Pneumonia in Immunocompetent Patients |
| title_sort | lymphocyte subset based prediction model for refractory community acquired pneumonia in immunocompetent patients |
| topic | refractory community acquired pneumonia T lymphocyte CD4<sup>+</sup> T cell CD8<sup>+</sup> T cell double negative T cell |
| url | https://www.mdpi.com/2075-4418/15/13/1627 |
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