Prognostic significance of ischemia-modified albumin (İM) levels in community acquired pneumonia

Community acquired pneumonia, is a major public health problem due to its frequency, leading to high morbidity and mortality, and high cost of treatment. In recent years, the introduction of new biomarkers, rapid results with new molecular tests have enabled both the initiation of appropriate treatment in the early period as well as cost savings. In addition, patient mortality and morbidity can be reduced by determining the prognosis early and quickly, and cost is reduced by preventing unnecessary hospital and intensive care hospitalizations. Ischemia modified albumin is a marker associated with the commonly used oxidant-antioxidant mechanism recently and has been found to increase in many inflammatory states, especially in the case of ischemia. There is no comprehensive study in the literature of its relationship with ischemiamodified albumin (IMA) and the severity and etiopathogenesis of pneumonia except in a small number of patients in the emergency department. In this study, we aimed to investigate the relationship between IMA levels and pneumonia severity index, hospitalization decision and the need for intensive care in pneumonia cases. In our study; IMA, hemogram, biochemistry, arterial blood gas, postero-anterior (PA) chest X-ray and thorax computed tomography (CT) values of 150 patients who have the diagnosis of community acquired pneumonia (CAP) and 150 healthy volunteers were compared. Background, comorbidities and physical examinations of patients were recorded. Patients with pneumonia were grouped according to their outpatient, hospitalization and intensive care unit admission. In addition, the patients were divided into five groups according to the pneumonia severity index. The mean age of the 150 patients with CAP was 61.03 ± 1.7 years, and the mean age of the control group was 58.0 ± 10.6 years. 38% (n = 57) of the pneumonia group were female and 62% (n = 93) were male, 47.3% (n = 71) of the control group were female and 52.7% (n = 79) male (respectively p values; p = 0.082, p = 0.102). In our study, there was a positive correlation between IMA and CRP in pneumonia group (p = 0.0001). There was no statistically significant difference between the pneumonia group and control group in terms of IMA values (p˃0.05). The level of IMA in outpatient patients was found to be less than inpatients in service and intensive care unit, while inpatients in service were less than intensive care patients. (p = 0.001). There was no statistically significant difference in mean IMA value according to pneumonia severity (p>0.05). When we evaluated the patients in two groups as outpatient and inpatient, the cut-off value was 77.60 ABSU, sensitivity = 64.9% specificity = 75.0% positive predictive value = 89.2%, negative predictive value = 40.3%. As a conclusion IMA which is the new biomarker, is useful in decision whether a pneumonia patient should be treated ambulatory or hospitalized, also whether the patient should be admitted to the service or intensive care. More extensive studies are needed on this subject. Key words: Community-acquired pneumonia, ischemia-modified albumin, biomarker, prognosis