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. 2022 Nov;17(8):2279-2290.
doi: 10.1007/s11739-022-03086-7. Epub 2022 Oct 14.

Serum TRAIL predicts severity and prognosis in patients with community-acquired pneumonia: a prospective cohort study

Dong-Xu Hua #  1 , Kai-Shu Ma #  1   2 , Jia-Yi Cheng  1 , Ying Liu  1 , Jing Sun  1 , Qi-Yuan He  1 , You-Peng Deng  1 , Jin Yang  1 , Lin Fu  3   4 , Hui Zhao  5
Affiliations

Serum TRAIL predicts severity and prognosis in patients with community-acquired pneumonia: a prospective cohort study

Dong-Xu Hua et al. Intern Emerg Med. 2022 Nov.

Abstract

Tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) can trigger the apoptosis pathways through binding to relative death receptors. However, the relationship of TRAIL with community-acquired pneumonia (CAP) was unclear. This study aims at exploring the relationships between circulatory TRAIL with severity and prognosis in CAP patients through a prospective cohort study. The whole of 239 CAP patients was enrolled. Demographic characteristics and clinical information were analyzed. TRAIL and inflammatory cytokines were measured using enzyme-linked immunosorbent assay (ELISA). Circulatory TRAIL was gradually increased in accord with CAP severity scores. Spearman or Pearson correlative analysis indicated that circulatory TRAIL was strongly associated with physiologic indicators among CAP patients. Mixed logistic and linear regression models revealed that circulatory TRAIL was positively correlated with the severity scores in CAP patients. After adjusting for confounders, higher levels of circulatory TRAIL on admission significantly elevated the risks of ICU admission, mechanical ventilation, longer hospital stays, or even death during hospitalization. The predictive capacities of serum TRAIL for death were higher compared with CAP severity scores, inflammatory and infectious indicators. There are obviously positive dose-response relationships between circulatory TRAIL on admission with the severity and poor prognostic outcomes in CAP patients. Circulatory TRAIL on admission may be used as a potential biomarker in predicting the severity and poor prognosis for CAP patients.

Keywords: Community-acquired pneumonia; Prognosis; Prospective cohort study; Severity; TRAIL.

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Conflict of interest statement

All authors claim there is no competing interest.

Figures

Fig. 1
Fig. 1
The levels of circulatory TRAIL in CAP patients with different severity. A-F The levels of circulatory TRAIL were detected through ELISA in CAP patients with different severity scores. A The levels of circulatory TRAIL in CAP patients with different CRB-65 scores. B The levels of circulatory TRAIL in CAP patients with different CURB-65 scores. C The levels of circulatory TRAIL in CAP patients with different SMART-COP scores. D The levels of circulatory TRAIL in CAP patients with different CURXO scores. E The levels of circulatory TRAIL in CAP patients with different PSI scores. F The levels of circulatory TRAIL in CAP patients with different APACHE II scores. *P < 0.5, **P < 0.01
Fig. 2
Fig. 2
The associations between serum TRAIL and different clinical characteristics in CAP patients. The associations between serum TRAIL and clinical characteristics were estimated through Spearman or Pearson correlative analysis. The main clinical characteristics consisted of white blood cell (WBC), neutrophil, lymphocyte, monocyte, eosinophil, basophil, uric acid, urea nitrogen, creatinine, alanine transaminase (AST), aspartate aminotransferase (AST), cardiac troponin I (cTnI), creatine kinase isoenzyme (CKMB), lactate dehydrogenase (LDH), myoglobin (Myb), D-Dimer, hemoglobin (Hb) and hematocrit (HCT)
Fig. 3
Fig. 3
The predictive capacities for severity and death among CAP patients. The predictive capacities for severity and death were analyzed through ROC curve among CAP patients. A The predictive capacity for severity was estimated among serum TRAIL, CAP severity scores, serum PCT, serum IL-6, serum IL-1β and serum CRP among CAP patients. B The predictive capacity for death was evaluated among serum TRAIL, CAP severity scores, serum PCT, serum IL-6, serum IL-1β and serum CRP among CAP patients
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