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Master of Public Health

Low Admission Plasma Gelsolin Concentrations Identify Community-acquired Pneumonia Patients at High Risk for Severe Outcomes

AUTHORS

Self WH , Wunderink RG , DiNubile MJ , Stossel TP , Levinson SL , Williams DJ , Anderson EJ , Bramley AM , Jain S , Edwards KM , Grijalva CG , . Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2018 12 17; ().

ABSTRACT

Background: Plasma gelsolin (pGSN) is an abundant circulating protein that neutralizes actin exposed by damaged cells, modulates inflammatory responses, and enhances alveolar macrophage antimicrobial activity. We investigated whether adults with low pGSN at hospital admission for community-acquired pneumonia (CAP) were at high risk for severe outcomes.

Methods: Admission pGSN concentrations were measured by enzyme-linked immunosorbent assay in 455 adults hospitalized with CAP. Patients were grouped into four hierarchical, mutually-exclusive categories based on maximum clinical severity experienced during their hospitalization: (1) general floor care without intensive care (ICU) unit admission, invasive respiratory or vasopressor support (IRVS), or death; (2) ICU care without IRVS or death; (3) IRVS without death; or (4) death. Admission pGSN concentrations were compared across these discrete outcome categories. Additionally, outcomes among patients in the lowest quartile of pGSN concentration were compared with those in the upper three quartiles.

Results: Overall, median (interquartile range) pGSN concentration was 38.1 (32.1, 45.7) μg/mL. Patients with more severe outcomes had lower pGSN concentrations (p=0.0001); median values were: 40.3 μg/ml for floor patients; 36.7 μg/ml for ICU patients; 36.5 μg/ml for patients receiving IRVS; and 25.7 μg/ml for patients who died. Compared with patients with higher pGSN concentrations, patients in the lowest quartile (pGSN ≤32.1 μg/ml) more often required IRVS (21.2% vs 11.7%, p=0.0114) and died (8.8% vs 0.9%, p<0.0001).

Conclusions: Among adults hospitalized with CAP, lower pGSN concentrations were associated with more severe clinical outcomes. Future studies are planned to investigate possible therapeutic benefits of recombinant human pGSN in this population.

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