The Predictive Value Of RDW For ARDS In Children With Pneumonia And Its Correlation With LIPS And PCIS

ObjectiveThe clinical data of children with pneumonia who were admitted to the pediatric department of Qilu Hospital of Shandong University was retrospectively analyzed to investigate the predictive value of red blood cell distribution width(RDW)and look for predictors on the occurrence of acute respiratory distress syndrome(ARDS)in children with pneumonia.The correlation between RDW and lung injury prediction score(LIPS)and pediatric critical illness score(PCIS)was analyzed to provide a better basis for the assessment,prevention and management of ARDS in children with pneumonia.MethodsOn the basis of the Code for the Diagnosis and Treatment of Community-Acquired Pneumonia in Children 2019,160 children with pneumonia who were admitted to pediatric department of Qilu Hospital of Shandong University from August 2019 to August 2021 were selected and divided into acute respiratory distress syndrome group and non-acute respiratory distress syndrome group according to whether acute respiratory distress syndrome occurred 48 hours after admission,aged from 3 months to 18 years.They were selected to collect the basic information and related medical history of the children.The records included the name,sex,age,height,weight and imaging data of the children.Peripheral venous blood and arterial blood gas werecollected for analysis,the blood routine,C-reactive protein(CRP),blood biochemistry,liver function,renal function,lactate dehydrogenase(LDH)and lactate were collected,and the results of body mass index(BMI),LIPS and PCIS were calculated.We compared the differences of RDW,CRP,WBC,N%,LAC level,LDH level,LIPS and PCIS between the two groups and the value of various indexes in serum to predict ARDS by SPSS 25.0 software.In order to screen out sensitive and specific indicators for predicting the development of ARDS in children with pneumonia.To provide evidence for the prevention,diagnosis and treatment of ARDS.Results1.Finally,160 children with pneumonia were enrolled,including 76 children in the ARDS group and 84 children in the non-ARDS group.The children included 98 males and 62 females,including 49 males and 27 females in the ARDS group,49 males and 35 females in the non-ARDS group.By nonparametric test,there were no significant differences inage,sex and BMI(P>0.05),but there were significant differences in hospital stay,LIPS and PCIS(P<0.001).2.There were significant differences in RDW,WBC,RDW/ALB and PaO2/FiO2 between ARDS group and non-ARDS group(P<0.05);The RDW,WBC and RDW/ALB of ARDS group were higher than those of non-ARDS group,while PaO2/FiO2 was lower than that of non-ARDS group.3.Through correlation analysis,RDW was positively correlated with LIPS,WBC Lac and RDW/ALB(r=0.658,P<0.001;r=0.210,P=0.008;r=0.192,P=0.015;r=0.882,P<0.001),and negatively correlated with PCIS and PaO2/FiO2(r=-0.417,P<0.001;r=-0.662,P<0.001).4.The single factor Logistic regression screened that RDW,LIPS,PCIS and WBC were related to the prognosis of ARDS(P<0.05).Multivariate binary logistic regression analysis showed that RDW and LIPS were independent predictors of ARDS in children with pneumonia(OR=21.244,175.346;P<0.05).5.The area under the ROC curve of RDW was the largest,which was 0.967(95%CI 0.945～0.989),and the best cut-off value was 13.25%.At this time,the sensitivity was 0.974 and the specificity was 0.810;The area under ROC curve of LIPS was 0.954(95%CI 0.926～0.983),which was second only to RDW.When the optimal cut-off value was 3.25 scores,the sensitivity was 0.829 and the specificity was 0.952.which was higher than RDW.When the two were combined,the area under the ROC curve was 0.997,which was higher than that of LIPS or RDW alone.RDW/ALB,PCIS and WBC were the most important indexes to predict the occurrence of ARDS in pneumonia.Conclusion1.RDW,LIPS,PCIS and RDW/ALB within 24 hours after admission were of great value in predicting the occurrence of ARDS in children with pneumonia.2.RDW and LIPS were independent predictors of the occurrence of ARDS in children with pneumonia.3.RDW was positively correlated with LIPS and negatively correlated with PCIS.4.The combination of RDW and LIPS had the highest accuracy in predicting the occurrence of ARDS in children with pneumonia.