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A Lymphocyte Subset-Based Prediction Model for Refractory Community-Acquired Pneumonia in Immunocompetent Patients.

Jingyuan Zhang1, Xinyu Hu1, Ailifeila Aili1

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Diagnostics (Basel, Switzerland)
|July 12, 2025
PubMed
Summary

Refractory community-acquired pneumonia (r-CAP) in immunocompetent patients is linked to specific immune cell changes and clinical factors. Identifying these risk factors, like increased CD4+ T, CD8+ T, and DNT lymphocytes, aids in better r-CAP management.

Keywords:
CD4+ T cellCD8+ T cellT lymphocytedouble negative T cellrefractory community acquired pneumonia

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Area of Science:

  • Immunology
  • Infectious Diseases
  • Pulmonology

Background:

  • Refractory community-acquired pneumonia (r-CAP) poses a significant clinical challenge, particularly in immunocompetent individuals post-COVID-19.
  • Understanding risk factors for r-CAP is crucial for improving patient outcomes and treatment strategies.

Purpose of the Study:

  • To identify independent risk factors associated with refractory community-acquired pneumonia (r-CAP) in immunocompetent patients.
  • To develop a predictive model for r-CAP using identified clinical and immunological indicators.

Main Methods:

  • A single-center retrospective study compared 82 r-CAP patients with 82 general CAP (g-CAP) patients.
  • Clinical data, peripheral blood cell counts, lymphocyte subsets, and laboratory indicators were analyzed.
  • Univariate and multivariate logistic regression analyses identified independent risk factors; a predictive model was validated using ROC curve analysis.

Main Results:

  • Independent risk factors for r-CAP included warm season, chronic obstructive pulmonary disease history, longer time from onset to admission, and elevated CD4+ T, CD8+ T, and double-negative T (DNT) lymphocytes.
  • Higher levels of C-reactive protein (CRP), low-density lipoprotein cholesterol (LDL-C), serum sodium (Na+), and free calcium (FCa2+) were also risk factors.
  • T lymphocyte percentage and total cholesterol (TC) were identified as protective factors; a combined predictive model showed high sensitivity and specificity (AUC = 0.8711).

Conclusions:

  • Increased CD4+ T, CD8+ T, and DNT lymphocyte percentages, along with specific clinical and laboratory markers, are associated with refractory CAP.
  • Impaired overall cellular immunity, indicated by T lymphocyte count, is characteristic of r-CAP patients.
  • Higher total cholesterol levels may be beneficial for pneumonia recovery.