Abstract:

Objective To explore the relationship between tumor necrosis factor⁃α（TNF⁃α），nucleotide⁃ binding oligomerization domain⁃like receptor protein 3(NLRP3),C⁃reactive protein/albumin（CRP/ALB）and carbapenem resistance in the elderly Klebsiellapneumoniae（CRKP）and its influence on the prognosis. Methods A total of 175 elderly patients with CRKP admitted to our hospital from June 2018 to January 2021 were selected and divided into death group(n=32)and survival group(n=143)according to prognosis. Quality index,time from onset to hospital admission,degree of illness,diabetes，hypertension，coronary heart disease，hyperlipidemia， TNF⁃α，NLRP3 mRNA，CRP/ALB levels，TNF⁃α，NLRP3 mRNA，CRP/ALB were compared between the two groups. Spearman was used to analyze the relationship between TNF⁃α,NLRP3 mRNA,CRP/ALB and disease severity,Cox regression was used to analyze the prognostic related factors，and receiver operating characteristic curve （ROC）were used to analyze TNF⁃α，NLRP3 mRNA，CRP/ALB predicts the prognostic value. Results There were statistically significant differences between the death group′s condition，diabetes and the survival group（P < 0.05the death group TNF⁃α（237.89 ± 72.25）pg/mL，NLRP3 mRNA（0.78 ± 0.24），CRP/ALB（3.19 ±1.05）higher than the survival group TNF⁃α（160.33 ± 51.80）pg/mL，NLRP3 mRNA（0.51 ± 0.16），CRP/ALB（2.08 ± 0.65） （P < 0.05）；mild patients TNF⁃α（118.79 ± 33.52）pg/mL，NLRP3 mRNA（0.39 ± 0.10），CRP/ALB（1.79 ± 0.40），TNF⁃ α（179.34 ± 48.47）pg/mL，NLRP3 mRNA（0.52 ± 0.15），CRP/ALB（2.26 ± 0.54），severe patients TNF⁃α（220.14 ± 50.08）pg/mL，NLRP3 mRNA（0.78 ± 0.18），CRP/ALB（2.77 ± 0.49），each index is severe > moderate > mild（P < 0.05）；TNF⁃α，NLRP3 mRNA，CRP/ALB are positively correlated with the disease severity（P < 0.05）；after controlling the disease severity and diabetes，TNF⁃α，NLRP3 mRNA，CRP/ALB are still prognostic related factors（P < 0.05））；The prognostic AUC of TNF⁃α，NLRP3 mRNA combined with CRP/ALB is 0.955，which is higher than 0.703 of TNF ⁃ α，0.778 of NLRP3 mRNA，and 0.771 of CRP/ALB. Conclusion TNF ⁃ α，NLRP3，CRP/ALB were related to the severity and prognosis of elderly patients with CRKP infection. Combined detection could be used as an effective program to predict the prognosis and provide objective evidence for clinical decision⁃making，intervention，and management. 

Key words:

TNF ? α, NLRP3, CRP/ALB, old age, carbapenem ? resistant Klebsiellapneumoniae infection, disease severity, prognosis