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<p>Accurate risk stratification in community-acquired pneumonia (CAP) is essential for guiding timely and effective clinical management. This study evaluated whether the combined assessment of circulating T-lymphocyte subsets (T-cell subsets) and serum procalcitonin (PCT) enhances diagnostic accuracy and severity classification in CAP. T-cell subsets, as markers of immune response, may complement traditional inflammatory biomarkers. A retrospective analysis was conducted on 320 adult CAP patients admitted to a tertiary hospital in Zhejiang, China, between February 2020 and November 2021. Patients were stratified using the Clinical Pulmonary Infection Score (CPIS ≤ 6 vs. &gt; 6) and platelet-to-lymphocyte ratio (PLR ≤ 163 vs. &gt; 163). Laboratory assessments included serum PCT, white blood cell count (WBC), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), interleukin-6 (IL-6), and T-cell subsets (CD3⁺, CD4⁺, CD8⁺ counts, and CD4/CD8 ratio). Pathogens were identified from 79 positive sputum or blood cultures. Patients with CPIS &gt; 6 had significantly higher levels of PCT, PLR, WBC, CRP, NLR, and IL-6, along with lower CD3⁺ and CD4⁺ T-cell counts, a reduced CD4/CD8 ratio, and elevated CD8⁺ counts (all <i>P</i> &lt; 0.05). Similar trends were observed in patients with PLR &gt; 163. Acinetobacter baumannii was significantly more prevalent in patients classified as moderate-to-high risk or non-survivors (<i>P</i> &lt; 0.05). T-cell subsets monitoring demonstrated a sensitivity of 93.2%, while PCT showed a specificity of 95.6% for predicting CAP severity. Combined evaluation of T-lymphocyte subsets and serum procalcitonin levels enhances the accuracy of CAP severity stratification. The elevated prevalence of Acinetobacter baumannii in severe cases highlights the importance of host–pathogen interactions. Integrated immune and inflammatory profiling may facilitate precision-based management strategies in CAP.</p>

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Assessment of T-cell subsets and procalcitonin for diagnosing and stratifying severity in community acquired pneumonia

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月17日

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  • Fuquan Qi,
  • Yaoyao Zheng,
  • Shuxian Zhang,
  • Hua Yang

摘要

Accurate risk stratification in community-acquired pneumonia (CAP) is essential for guiding timely and effective clinical management. This study evaluated whether the combined assessment of circulating T-lymphocyte subsets (T-cell subsets) and serum procalcitonin (PCT) enhances diagnostic accuracy and severity classification in CAP. T-cell subsets, as markers of immune response, may complement traditional inflammatory biomarkers. A retrospective analysis was conducted on 320 adult CAP patients admitted to a tertiary hospital in Zhejiang, China, between February 2020 and November 2021. Patients were stratified using the Clinical Pulmonary Infection Score (CPIS ≤ 6 vs. > 6) and platelet-to-lymphocyte ratio (PLR ≤ 163 vs. > 163). Laboratory assessments included serum PCT, white blood cell count (WBC), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), interleukin-6 (IL-6), and T-cell subsets (CD3⁺, CD4⁺, CD8⁺ counts, and CD4/CD8 ratio). Pathogens were identified from 79 positive sputum or blood cultures. Patients with CPIS > 6 had significantly higher levels of PCT, PLR, WBC, CRP, NLR, and IL-6, along with lower CD3⁺ and CD4⁺ T-cell counts, a reduced CD4/CD8 ratio, and elevated CD8⁺ counts (all P < 0.05). Similar trends were observed in patients with PLR > 163. Acinetobacter baumannii was significantly more prevalent in patients classified as moderate-to-high risk or non-survivors (P < 0.05). T-cell subsets monitoring demonstrated a sensitivity of 93.2%, while PCT showed a specificity of 95.6% for predicting CAP severity. Combined evaluation of T-lymphocyte subsets and serum procalcitonin levels enhances the accuracy of CAP severity stratification. The elevated prevalence of Acinetobacter baumannii in severe cases highlights the importance of host–pathogen interactions. Integrated immune and inflammatory profiling may facilitate precision-based management strategies in CAP.