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Prognostic Value of dynamic sST2 and immune-Coagulation Biomarkers in Severe Community-Acquired Pneumonia: A Prospective Cohort Study

emergency-and-critical-care
geriatrics
internal-medicine
respiratory-medicine

Abstract

Abstract
Background : Accurate disease severity stratification and prognostic assessment in community-acquired pneumonia (CAP) are crucial for effective management. This study evaluates the diagnostic and prognostic value of soluble suppression of tumorigenicity 2 (sST2) and its dynamic changes in CAP.
Methods : This prospective cohort study included 146 severe CAP patients, 135 mild CAP patients, and 50 healthy controls. Serum sST2 levels were measured at admission (T1) and pre-discharge (T2) in CAP patients, with dynamic changes (ΔsST2 = sST2(T2) - sST2(T1)) calculated. Healthy controls were assessed only at baseline. Clinical parameters, including laboratory data, were collected. The primary endpoint was 90-day adverse outcomes (mortality or readmission) for severe CAP patients. Receiver operating characteristic (ROC) curves assessed biomarker discriminatory ability, and Cox regression identified independent prognostic factors. Several predictive models, including sST2-based and traditional clinical scoring models, were compared using AUC, Brier score, and decision curve analysis (DCA).
Results : At admission, severe CAP patients had significantly higher sST2 levels compared to mild CAP patients and healthy controls, with an AUC of 0.780 (95% CI: 0.691–0.870) for distinguishing severe CAP. ΔsST2 analysis revealed distinct inflammatory resolution patterns between severe and mild CAP patients.A model combining pre-discharge sST2, D-dimer, and LYM% (Model A) showed the best predictive performance for 90-day adverse outcomes, with an AUC of 0.79 (95% CI: 0.69–0.88), optimal calibration (Brier score = 0.228), and the highest clinical net benefit in DCA, outperforming traditional models like PSI, SOFA, and CURB-65. Multivariable Cox analysis confirmed that admission sST2 was an independent risk factor for 90-day adverse outcomes (HR = 1.89, 95% CI: 1.24–2.89, p = 0.003). Sustained high levels of pre-discharge sST2, rather than ΔsST2, were strongly linked to poor outcomes.
Conclusions : sST2 is a reliable biomarker for distinguishing CAP severity and predicting poor prognosis. A predictive model combining pre-discharge sST2, D-dimer, and lymphocyte percentage outperforms traditional clinical scores in identifying high-risk severe CAP patients. Monitoring pre-discharge sST2 levels helps identify patients needing enhanced follow-up and intervention.
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