{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T19:24:46Z","timestamp":1793215486680,"version":"4.5.0"},"reference-count":30,"publisher":"IMR Press","issue":"7","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br. J. Hosp. Med. (Lond)"],"abstract":"<jats:p>Aims\/Background:Acute respiratory failure (ARF) may develop in some patients with community-acquired pneumonia (CAP), resulting in a significantly increased mortality rate. Early identification of high-risk patients is essential for improving prognosis. This study aimed to investigate the predictive value of inflammatory and immune markers for acute respiratory failure in patients with community-acquired pneumonia.Methods:This single-center retrospective cohort study included 334 patients with community-acquired pneumonia admitted at Zhuji Sixth People\u2019s Hospital, between January 2021 and December 2024. Patients were divided into a CAP-only (non-event) group and a CAP-ARF (event) group based on the development of acute respiratory failure. Inflammatory markers (white blood cell count, neutrophil count, tumor necrosis factor-\u03b1, etc.) and immune markers (complement components 3 and 4[C3andC4], immunoglobulins A and G [IgAand IgG], etc.) were collected within 24 hours of admission. Univariate and multivariate logistic regression analyses were performed to identify independent predictive factors, and the predictive performance of individual and combined indicators was evaluated using receiver operating characteristic (ROC) curves.Results:Multivariate analysis showed that elevated white blood cell count, neutrophil count, and tumor necrosis factor-\u03b1 levels were independent risk factors for acute respiratory failure, while decreased levels of complement C3 and C4, and IgA and IgG, were independent protective factors. The combined predictive model incorporating these indicators demonstrated excellent predictive performance for acute respiratory failure, with an area under the curve (AUC) of 0.853.Conclusion:In patients with community-acquired pneumonia, inflammatory and immune markers exhibit significant predictive value for the development of acute respiratory failure. A combined assessment of white blood cell count, neutrophil count, tumor necrosis factor-\u03b1, complement C3 and C4, and IgA and IgG may facilitate early identification of high-risk patients and inform clinical decision-making.<\/jats:p>","DOI":"10.31083\/bjhm56282","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T07:59:43Z","timestamp":1785398383000},"source":"Crossref","is-referenced-by-count":1,"title":["Predictive Value of Inflammatory and Immune Markers for Acute Respiratory Failure in Patients With Community-Acquired Pneumonia"],"prefix":"10.31083","volume":"87","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6050-8634","authenticated-orcid":true,"given":"Jinping","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Zhuji Sixth People\u2019s Hospital, 311801 Shaoxing, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Zhuji Sixth People\u2019s Hospital, 311801 Shaoxing, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Martin-Loeches I, Reyes LF, Rodriguez A. Severe community-acquired pneumonia (sCAP): advances in management and future directions. Thorax. 2025; 80: 565\u2013575.","DOI":"10.1136\/thorax-2024-222296"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Vaughn VM, Dickson RP, Horowitz JK, Flanders SA. Community-Acquired Pneumonia: A Review. JAMA. 2024; 332: 1282\u20131295.","DOI":"10.1001\/jama.2024.14796"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Aliberti S, Cruz CSD, Amati F, Sotgiu G, Restrepo MI. Community-acquired pneumonia. The Lancet. 2021; 398: 906\u2013919.","DOI":"10.1016\/S0140-6736(21)00630-9"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Liu YN, Zhang YF, Xu Q, Qiu Y, Lu QB, Wang T, et al. Infection and co-infection patterns of community-acquired pneumonia in patients of different ages in China from 2009 to 2020: a national surveillance study. The Lancet. Microbe. 2023; 4: e330\u2013e339.","DOI":"10.1016\/S2666-5247(23)00031-9"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Chaudhuri D, Nei AM, Rochwerg B, Balk RA, Asehnoune K, Cadena R, et al. 2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia. Critical Care Medicine. 2024; 52: e219\u2013e233.","DOI":"10.1097\/CCM.0000000000006172"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Ullah AR, Masood A, Amin S, Ali I. Predictive factors and outcomes of severe community acquired pneumonia in patients with respiratory failure. Pakistan Journal of Medical Sciences. 2022; 38: 1031\u20131037.","DOI":"10.12669\/pjms.38.4.5312"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Pan J, Bu W, Guo T, Geng Z, Shao M. Development and validation of an in-hospital mortality risk prediction model for patients with severe community-acquired pneumonia in the intensive care unit. BMC Pulmonary Medicine. 2023; 23: 303.","DOI":"10.1186\/s12890-023-02567-5"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Ferriero AM, Di Lella R, Farroni C, Aiello A, Giarratano A, Todaro M, et al. Host-pathogen interaction in community-acquired pneumonia: a focus on the immune response. Frontiers in Cellular and Infection Microbiology. 2026; 16: 1731074.","DOI":"10.3389\/fcimb.2026.1731074"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Niederman MS, Torres A. Severe community-acquired pneumonia. European Respiratory Review. 2022; 31: 220123.","DOI":"10.1183\/16000617.0123-2022"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Fan L, Xu N, Guo Y, Li L. Enhanced insights into the neutrophil-driven immune mechanisms during Mycoplasma pneumoniae infection. Heliyon. 2024; 10: e38950.","DOI":"10.1016\/j.heliyon.2024.e38950"},{"key":"ref11","unstructured":"Chai DD, Wang XM, Xing B. Predictive value of systemic immunity index for sepsis in low-medium risk community-acquired pneumonia. Journal of Hainan Medical University. 2024; 30: 113\u2013119. (In Chinese)"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Viasus D, Simonetti AF, Estupi\u00f1an-Boh\u00f3rquez AF, Carratal\u00e0 J. Effects of age and comorbidities on serum levels of inflammatory markers in community-acquired pneumonia. European Journal of Clinical Investigation. 2021; 51: e13480.","DOI":"10.1111\/eci.13480"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Rombauts A, Abelenda-Alonso G, Cuervo G, Gudiol C, Carratal\u00e0 J. Role of the inflammatory response in community-acquired pneumonia: clinical implications. Expert Review of Anti-infective Therapy. 2022; 20: 1261\u20131274.","DOI":"10.1080\/14787210.2021.1834848"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Wang J, Pei L, Zhao T, Liu X, Wang Q, Zhang S, et al. CD4+ T cells related to disease severity in elderly and frailty community-acquired pneumonia patients: A retrospective cohort study. Immunity, Inflammation and Disease. 2023; 11: e1009.","DOI":"10.1002\/iid3.1009"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Kuikel S, Pathak N, Poudel S, Thapa S, Bhattarai SL, Chaudhary G, et al. Neutrophil-lymphocyte ratio as a predictor of adverse outcome in patients with community-acquired pneumonia: A systematic review. Health Science Reports. 2022; 5: e630.","DOI":"10.1002\/hsr2.630"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Xu Z, Hou XF, Feng CM, Zheng L, Xu DX, Zhao H, et al. The association between serum complement C3a and severity in patients with community-acquired pneumonia. Frontiers in Immunology. 2023; 14: 1034233.","DOI":"10.3389\/fimmu.2023.1034233"},{"key":"ref17","unstructured":"Dv P, Ov M, Iu V P, Ln S. Community-acquired pneumonia: immune and metabolic disorders before and after treatment. Journal of Pharmaceutical Negative Results. 2022; 13."},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America\/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clinical Infectious Diseases. 2007; 44: S27\u2013S72.","DOI":"10.1086\/511159"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S, et al. Official ERS\/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. The European Respiratory Journal. 2017; 50: 1602426.","DOI":"10.1183\/13993003.02426-2016"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Peduzzi P, Concato J, Feinstein AR, Holford TR. Importance of events per independent variable in proportional hazards regression analysis. II. Accuracy and precision of regression estimates. Journal of Clinical Epidemiology. 1995; 48: 1503\u20131510.","DOI":"10.1016\/0895-4356(95)00048-8"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Grudzinska FS, Brodlie M, Scholefield BR, Jackson T, Scott A, Thickett DR, et al. Neutrophils in community-acquired pneumonia: parallels in dysfunction at the extremes of age. Thorax. 2020; 75: 164\u2013171.","DOI":"10.1136\/thoraxjnl-2018-212826"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Nutautiene R, Aleksa I, Janulaityte I, Skrodeniene E, Bieksiene K, Zaliaduonyte D, et al. Role of Inflammatory Markers as a Risk Factor for Community-Acquired Pneumonia Management. Medicina. 2025; 61: 1078.","DOI":"10.3390\/medicina61061078"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"Yesildag M, Bakd\u0131k B, Balasar B, Ero\u011flu E. Evaluation of the relationship between biomarkers and disease severity in patients with community-acquired pneumonia. European Journal of Therapeutics. 2024; 30: 354\u2013361.","DOI":"10.58600\/eurjther1976"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"Dao BN, Le HDT, Nguyen KX, Viet TT, Tran CT, Luong TC, et al. Relationship between serum TNF-\u03b1, IL-6, and IL-10 levels and disease severity, and changes in the cytokines after treatment in patients with bacterial community-acquired pneumonia. Pneumon. 2023; 36: 1\u20138.","DOI":"10.18332\/pne\/170181"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Jayaraman A, Walachowski S, Bosmann M. The complement system: A key player in the host response to infections. European Journal of Immunology. 2024; 54: 2350814.","DOI":"10.1002\/eji.202350814"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"Wang H, Liu M. Complement C4, Infections, and Autoimmune Diseases. Frontiers in Immunology. 2021; 12: 694928.","DOI":"10.3389\/fimmu.2021.694928"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Wang Y, Huang X, Li F, Jia X, Jia N, Fu J, et al. Serum-integrated omics reveal the host response landscape for severe pediatric community-acquired pneumonia. Critical Care. 2023; 27: 79.","DOI":"10.1186\/s13054-023-04378-w"},{"key":"ref28","unstructured":"Shaldoum F. C3 and C4 in Patients Suffering from Lung Diseases. Sciences. 2016; 6: 559\u2013566."},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"Zinellu A, Mangoni AA. Serum Complement C3 and C4 and COVID-19 Severity and Mortality: A Systematic Review and Meta-Analysis With Meta-Regression. Frontiers in Immunology. 2021; 12: 696085.","DOI":"10.3389\/fimmu.2021.696085"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"Rademaker E, Vernooij LM, van der Poll T, Bonten MJM, Leavis H, Cremer OL, et al. Longitudinal assessment of immunoglobulin response and disease progression in critically ill patients with community acquired pneumonia. Critical Care. 2024; 28: 405.","DOI":"10.1186\/s13054-024-05197-3"}],"container-title":["British Journal of Hospital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.imrpress.com\/journal\/BJHM\/87\/7\/10.31083\/BJHM56282","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T07:59:54Z","timestamp":1785398394000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.imrpress.com\/journal\/BJHM\/87\/7\/10.31083\/BJHM56282"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":30,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026]]}},"alternative-id":["S1750-8460(26)03340-0"],"URL":"https:\/\/doi.org\/10.31083\/bjhm56282","relation":{},"ISSN":["1750-8460","1759-7390"],"issn-type":[{"value":"1750-8460","type":"print"},{"value":"1759-7390","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]},"article-number":"56282"}}