The incremental value of aspartate aminotransferase/alanine aminotransferase ratio combined with CURB-65 in predicting treatment outcomes in hospitalized adult community-acquired pneumonia patients with type 2 diabetes mellitus
Abstract Background The features of community-acquired pneumonia (CAP) patients with type 2 diabetes mellitus (T2DM) differ from those without. This study aims to spot a routinely tested parameter with discriminative, predictive and prognostic value to enhance CURB-65’s prognostic accuracy in CAP pa...
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2025-01-01
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| Online Access: | https://doi.org/10.1186/s12890-025-03488-1 |
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| author | Huamei Zhou Xuelei Zhu Yi Zhang Wenjuan Xu Shiqun Li |
| author_facet | Huamei Zhou Xuelei Zhu Yi Zhang Wenjuan Xu Shiqun Li |
| author_sort | Huamei Zhou |
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| description | Abstract Background The features of community-acquired pneumonia (CAP) patients with type 2 diabetes mellitus (T2DM) differ from those without. This study aims to spot a routinely tested parameter with discriminative, predictive and prognostic value to enhance CURB-65’s prognostic accuracy in CAP patients with T2DM. Methods We retrospectively studied consecutive CAP patients from 2020 to 2021, comparing laboratory parameters between patients with and without T2DM. Receiver operating characteristic (ROC) curve analysis, univariate and multivariate logistic regression were used to identify key parameters. The area under the ROC curve (AUC), Fagan’s nomogram, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) evaluated the added predictive accuracy. Results A total of 720 patients were included, comprising 180 diabetic CAP patients and 540 non-diabetic controls after matching for age, gender, and comorbidities through propensity score matching. In diabetic CAP patients, the aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio showed the highest AUC (0.676, 95% CI, 0.575–0.776) among laboratory parameters with different distributions between the groups. AST/ALT was also identified as an independent predictor of poor treatment outcome (OR = 3.672, 95% CI, 1.455–9.268, p = 0.006). Adding AST/ALT to CURB-65 slightly increased the AUC, but remarkably enhanced NRI and IDI (AUC, 0.756 vs. 0.782, p = 0.017; continuous NRI, 0.635, 95% CI, 0.304–0.966, p < 0.001; categorical NRI, 0.175, 95% CI, 0.044–0.307, p = 0.009; IDI, 0.043, 95% CI, 0.006–0.080, p = 0.021). An AST/ALT ratio of ≥ 1.625 conferred a 74% post-test probability of poor treatment outcome, while < 1.625 predicted 21%. AST/ALT also predicted outcomes for all the CAP patients enrolled (OR = 1.771, 95% CI, 1.231–2.549, p = 0.002). Predictive accuracy improved after incorporating AST/ALP into CURB-65 in these population (AUC, 0.615 vs. 0.645, p = 0.038; continuous NRI, 0.357, 95% CI, 0.196–0.517, p < 0.001; categorical NRI, 0.264, 95% CI, 0.151–0.376, p < 0.001; IDI, 0.019, 95% CI, 0.008–0.029, p < 0.001). Conclusions AST/ALT was identified as a discriminative, predictive and prognostic factor for CAP patients with T2DM. The integration of AST/ALT into CURB-65 enhanced outcome prediction for both diabetic and non-diabetic CAP patients. |
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| institution | Kabale University |
| issn | 1471-2466 |
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| publishDate | 2025-01-01 |
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| spelling | doaj-art-eaba611790024c6a97dfbd70ab8ad63f2025-01-19T12:08:24ZengBMCBMC Pulmonary Medicine1471-24662025-01-0125111310.1186/s12890-025-03488-1The incremental value of aspartate aminotransferase/alanine aminotransferase ratio combined with CURB-65 in predicting treatment outcomes in hospitalized adult community-acquired pneumonia patients with type 2 diabetes mellitusHuamei Zhou0Xuelei Zhu1Yi Zhang2Wenjuan Xu3Shiqun Li4Department of Endocrinology, People’s Hospital of NanchuanDepartment of Endocrinology, People’s Hospital of NanchuanDepartment of Endocrinology, People’s Hospital of NanchuanDepartment of Respiratory and Critical Care Medicine, People’s Hospital of NanchuanDepartment of Public Health, People’s Hospital of NanchuanAbstract Background The features of community-acquired pneumonia (CAP) patients with type 2 diabetes mellitus (T2DM) differ from those without. This study aims to spot a routinely tested parameter with discriminative, predictive and prognostic value to enhance CURB-65’s prognostic accuracy in CAP patients with T2DM. Methods We retrospectively studied consecutive CAP patients from 2020 to 2021, comparing laboratory parameters between patients with and without T2DM. Receiver operating characteristic (ROC) curve analysis, univariate and multivariate logistic regression were used to identify key parameters. The area under the ROC curve (AUC), Fagan’s nomogram, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) evaluated the added predictive accuracy. Results A total of 720 patients were included, comprising 180 diabetic CAP patients and 540 non-diabetic controls after matching for age, gender, and comorbidities through propensity score matching. In diabetic CAP patients, the aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio showed the highest AUC (0.676, 95% CI, 0.575–0.776) among laboratory parameters with different distributions between the groups. AST/ALT was also identified as an independent predictor of poor treatment outcome (OR = 3.672, 95% CI, 1.455–9.268, p = 0.006). Adding AST/ALT to CURB-65 slightly increased the AUC, but remarkably enhanced NRI and IDI (AUC, 0.756 vs. 0.782, p = 0.017; continuous NRI, 0.635, 95% CI, 0.304–0.966, p < 0.001; categorical NRI, 0.175, 95% CI, 0.044–0.307, p = 0.009; IDI, 0.043, 95% CI, 0.006–0.080, p = 0.021). An AST/ALT ratio of ≥ 1.625 conferred a 74% post-test probability of poor treatment outcome, while < 1.625 predicted 21%. AST/ALT also predicted outcomes for all the CAP patients enrolled (OR = 1.771, 95% CI, 1.231–2.549, p = 0.002). Predictive accuracy improved after incorporating AST/ALP into CURB-65 in these population (AUC, 0.615 vs. 0.645, p = 0.038; continuous NRI, 0.357, 95% CI, 0.196–0.517, p < 0.001; categorical NRI, 0.264, 95% CI, 0.151–0.376, p < 0.001; IDI, 0.019, 95% CI, 0.008–0.029, p < 0.001). Conclusions AST/ALT was identified as a discriminative, predictive and prognostic factor for CAP patients with T2DM. The integration of AST/ALT into CURB-65 enhanced outcome prediction for both diabetic and non-diabetic CAP patients.https://doi.org/10.1186/s12890-025-03488-1Community-acquired pneumonia (CAP)Type 2 diabetes mellitus (T2DM)Prognostic modelAspartate aminotransferase/alanine aminotransferase ratio (AST/ALT)CUBR-65 |
| spellingShingle | Huamei Zhou Xuelei Zhu Yi Zhang Wenjuan Xu Shiqun Li The incremental value of aspartate aminotransferase/alanine aminotransferase ratio combined with CURB-65 in predicting treatment outcomes in hospitalized adult community-acquired pneumonia patients with type 2 diabetes mellitus BMC Pulmonary Medicine Community-acquired pneumonia (CAP) Type 2 diabetes mellitus (T2DM) Prognostic model Aspartate aminotransferase/alanine aminotransferase ratio (AST/ALT) CUBR-65 |
| title | The incremental value of aspartate aminotransferase/alanine aminotransferase ratio combined with CURB-65 in predicting treatment outcomes in hospitalized adult community-acquired pneumonia patients with type 2 diabetes mellitus |
| title_full | The incremental value of aspartate aminotransferase/alanine aminotransferase ratio combined with CURB-65 in predicting treatment outcomes in hospitalized adult community-acquired pneumonia patients with type 2 diabetes mellitus |
| title_fullStr | The incremental value of aspartate aminotransferase/alanine aminotransferase ratio combined with CURB-65 in predicting treatment outcomes in hospitalized adult community-acquired pneumonia patients with type 2 diabetes mellitus |
| title_full_unstemmed | The incremental value of aspartate aminotransferase/alanine aminotransferase ratio combined with CURB-65 in predicting treatment outcomes in hospitalized adult community-acquired pneumonia patients with type 2 diabetes mellitus |
| title_short | The incremental value of aspartate aminotransferase/alanine aminotransferase ratio combined with CURB-65 in predicting treatment outcomes in hospitalized adult community-acquired pneumonia patients with type 2 diabetes mellitus |
| title_sort | incremental value of aspartate aminotransferase alanine aminotransferase ratio combined with curb 65 in predicting treatment outcomes in hospitalized adult community acquired pneumonia patients with type 2 diabetes mellitus |
| topic | Community-acquired pneumonia (CAP) Type 2 diabetes mellitus (T2DM) Prognostic model Aspartate aminotransferase/alanine aminotransferase ratio (AST/ALT) CUBR-65 |
| url | https://doi.org/10.1186/s12890-025-03488-1 |
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