Analysis Of Factors And Early Predictive Indicators Affecting The Severity Of Childhood Asthma-community Acquired Pneumonia

Objective: To summarize the clinical characteristics of childhood asthma-community acquired pneumonia(AS-CAP),analyze the risk factors affecting the severity of the disease,draw a ROC curve,and find the early prediction indicators for severe AS-CAP.Methods: The complete medical records of 332 cases of AS-CAP from the Pediatric Center of the First Affiliated Hospital of Xinjiang Medical University from June2020 to June 2022 were retrospectively collected,and the general demographic characteristics,disease severity,PIROm and PRESS score,clinical manifestations and imaging pathological changes,etiology types,clinical outcomes and other clinical characteristics of AS-CAP were analyzed,and the risk factors affecting the severity of AS-CAP disease were analyzed by single and multiple factors,and draw a ROC curve,early predictors of severe AS-CAP were found.Results: 1)The median age of AS-CAP was 5.3(3.9,7.0)years old,there were 213 males(64.2%)and 119 females(35.8%),the onset season was mostly winter(35.8%),PIROm score: 59 cases with moderate and high risk(17.7%),PRESS score: 183 cases with moderate and severe disease(55.1%),the type of imaging disease was mainly exudative change,mycoplasma pneumoniae and streptococcus pneumoniae were common pathogens,and the average length of hospital stay was 5.0(5.0,7.0)days;2)Age(OR=1.777,95% CI: 1.026-1.351),spring(OR=4.739,95% CI: 1.430-15.702)or winter(OR=5.628,95% CI: 1.646-19.248),no history of inhaled glucocorticoids in the last three months(OR=2.063,95% CI: 1.052-4.046),imaging changes appeared in both lungs(OR=3.174,95% CI: 1.325-7.598)and other factors were the risk factors for severe AS-CAP(P<0.05);3)The risk of severe AS-CAP increased by 22.541 times(OR=22.541,95%CI: 6.410-79.266)for children with moderate and high risk in PIROm score compared with those with low risk,and by 12.171 times(OR=12.171,CI: 3.98-42.347)for children with moderate and severe risk in PRESS score compared with those with mild risk;4)The PIROm score has a higher accuracy in predicting the severity of pneumonia in children with AS-CAP,and can be used as an early predictor of the risk of severe AS-CAP.Conclusion: 1)The clinical characteristics of childhood AS-CAP are basically similar to that of simple childhood CAP;2)Age,onset in spring or winter,irregular inhalation of glucocorticoids in recent 3 months,bilateral lung lesions,PIROm score≥3 and PRESS score≥2 are risk factors for severe AS-CAP;3)The PIROm score has a higher accuracy in predicting the severity of pneumonia in children with AS-CAP,and can be used as an early predictor of the risk of severe AS-CAP and provide a reference to identify severe AS-CAP in the early stage.