| Objective:Inquire into the coherence between red blood cell distribution width(RDW),D-dimer(DD),prealbumin(PA)with the severity of severe community-acquired pneumonia(SCAP)in children,as well as the shortterm post-treatment,to provide a theoretical reference value for the diagnosis and treatment of the children with SCAP,the assessment of the condition and the judgment of the recent prognosis.Methods:A total of 113 children with SCAP(SCAP group)admitted to the pediatric ward of The First Affiliated Hospital of Henan University from September 2019 to September 2022 were retrospectively collected by retrieval of the inpatient medical record system.In addition,113 children with mild community-acquired pneumonia(CAP)admitted to the pediatric ward of the hospital during the same period were collected(mild CAP group)according to the matching method.Hospitalization number,gender,age,respiration,heart rate,blood pressure and other related clinical data of children in the SCAP group and the mild CAP group were recorded.Fasting venous blood and arterial blood gas analysis and imaging(including chest X-ray or chest CT)before and after treatment were collected and recorded in children with SCAP within 24 hours after admission,blood routine(including White blood cell(WBC),RDW,etc.),C-reactive protein(CRP),procalcitonin(procalcitonin),etc.)of the subjects were recorded.PCT),PA,DD,Fibrinogen(FBG),Lactate dehydrogenase,LDH),Alpha hydroxybutyrate dehydrogenase(HBDH),liver and kidney function,electrolytes and other test values.The collected laboratory indicators are the first test values within 24 hours after admission.The worst pediatric critical case score(PCIS)of SCAP children within 24 hours was calculated.According to the PCIS score,the children in the SCAP group were split into critical group(47 cases)(PCIS≤80 points)and non-critical group(66 cases)(PCIS>80 points);According to the prognosis of children with Community Acquired Pneumonia(2019 Edition)after 1 week of treatment,children in the SCAP group were split into a poor prognosis group of 27 cases and a fine prognosis group of 86 cases.Through spss25.0 software,we analyze the general data and laboratory data of the children between the groups,and further analyze the value of each blood biochemical test index to evaluate the severity of the condition and judge the recent prognosis of the children with SCAP,and screen the sensitive and specific laboratory test index to evaluate the severity of the condition and the recent prognosis of the children with SCAP,so as to provide a theoretical reference value for the diagnosis and treatment of the children with SCAP,the assessment of the condition and the judgment of the recent prognosis.Results:1.In the SCAP group(113 cases,61 boys,54.0%vs 52 females,46.0%),the in-between age was 2.8(0.9,5.0)years,in the mild CAP group(113 cases,68 boys,60.2%vs 45 females,39.8%),the in-between age was 3.0(1.2,4.9)years,and the two groups in gender or age showed no significant difference(P>0.05);SCAP group were taking place at an enhanced level in WBC,CRP,PCT,RDW,DD,LDH,HBDH,FBG(P<0.05),while the serum PA was smaller those in the mild CAP group,difference between the two groups has statistical significance.2.There were 47 children with SCAP in the critical group,26 boys(55.3%)and 21 girls(44.7%),the in-between age was 1.8(0.6,4.0)years.There were 66 children and 35 boys(53.0%),and 31 girls(47.0%),the in-between age was 3.5(1.3,6.2)years at non-critical group.The two groups in gender showed no significant difference(P>0.05),while the two groups t in liver and kidney function impairment,age,respiratory failure,electrolyte imbalance,duration of hospital stay showed significant difference(P<0.05),and children in the critical group were younger than those in the non-critical group(P=0.004),the share of respiratory failure,hepatic and renal impairment,and electrolyte imbalance are greater percentage of patients than the non-critical group(x2=17.538,22.361,14.316,P<0.001),and duration of hospital stay was greater than that of the non-critical group(P<0.001).3.The RDW,DD,LDH and HBDH levels of the critical group were higher than the non-critical group,while the PA level was lower than the non-critical group,difference between the two groups has statistical significance(P<0.05).There existed no dramatic difference in WBC,CRP,PCT and FBG levels among the two groups(P>0.05).4.The correlation analysis of RDW,DD,PA and PCIS scores in SCAP children showed that the detection values of RDW and DD in SCAP children were negatively correlated with PCIS scores(r=-0.334,P<0.001;r=-0.311,P=0.001),suggesting that the higher the detection values of RDW and DD,the worse the condition of SCAP;There is a positive correlation between PA and PCIS(r=0.487,P<0.001),suggesting that the lower the detection value of PA,the worse the condition of SCAP.5.In univariate analysis,RDW,DD,PA,LDH,HBDH were correlated with the severity of SCAP,while CRP,PCT,RDW,DD,PA,LDH,HBDH were correlated with the short-term prognosis of SCAP.Multivariate logistic regression analysis showed that RDW,DD and PA were risk factors for evaluating the severity and short-term prognosis of children with SCAP.6.RDW,DD and PA levels were positively correlated with the short-term prognosis of children with SCAP(r=0.396,P<0.001;r=0.400,P<0.001),PA was negatively correlated with the short-term prognosis(r=-0.361,P<0.001),suggesting that the higher the level of RDW and DD acquired for the first time after admission,the lower the level of PA,and the more likely children with SCAP have poor short-term prognosis.7.ROC curve analysis of RDW,DD,PA for predicting the severity of illness in children with SCAP showed that the area under the ROC curve(AUC)of RDW,DD,PA for assessing the severity of illness in children with SCAP was 0.714[95%confidence interval(95%CI):0.622-0.795],0.713(95%CI:0.6210.795),0.756(95%CI:0.667-0.832),and the most promising diagnostic boundary value were 41fL,1.18 mg/L,and 96.00 mg/L,respectively,with corresponding sensitivity and specificity of 74.74%,63.64%,72.34%,66.67%,68.09%,and 75.76%,respectively;The AUC of the combined assessment of severity of SCAP by RDW,DD,and PA was 0.886(95%CI:0.812-0.938),with relative sensitivity and specificity of 85.10%and 83.30%.8.There were 27 SCAP children in the poor prognosis group(15 boys,55.6%vs.12 girls,44.4%vs.44.4%),the in-between age was 2.9(0.9,5.6)years and 86 SCAP children in the fine prognosis group(46 boys,53.5%vs.53.5%)and 40 girls(46.5%),the in-between age was 2.8(0.9,5.0)years.The two groups in gender and age showed no significant difference(P>0.05),and the two groups showed dramatic difference in respiratory failure,duration of hospital stay,hepatic or renal impairment,electrolyte imbalance(P<0.05),the share of respiratory failure,hepatic and renal impairment,and electrolyte imbalance are greater percentage of patients than the fine prognosis group(χ2=8.621,12.705,6.984,P<0.05),and duration of hospital stay was greater than that of the poor prognosis group(P<0.001).9.The detection values of RDW,DD,WBC,CRP,PCT,LDH,and HBDH obtained for the first time within 24 hours of hospitalization in the poor prognosis group overtopped those in the fine prognosis group(P<0.05),and the scores of PA and PCIS were smaller those in the fine prognosis group(P<0.001),showed significant difference(P<0.05),the two groups in FBG showed no significant difference(P>0.05).10.The AUCs of RDW,DD,and PA for predicting poor recent outcome in children with SCAP were 0.767(95%CI:0.678-0.841),0.770(95%CI:0.682-0.844),0.745(95%CI:0.654-0.822),and their corresponding the most promising diagnostic boundary value were 43 FL,3.57 mg/L,87.00 mg/L,with respective sensitivity and specificity values of 70.37%,75.58%,70.37%,79.07%,66.67%,73.26%;The AUC of the three indexes combined to assess recent poor outcome in children with SCAP was 0.944(95%CI:0.885-0.979),with relative sensitivity and specificity of 92.59%and 87.21%.Conclusion:1.The RDW,DD,PA measurements obtained for the first time within 24 hours after admission can assess the severity of illness and predict the recent prognosis of children with SCAP,and the combined detection of the three indexes has the best accuracy for predicting the severity of illness and the recent prognosis of children with SCAP.2.RDW and DD were negatively correlated with PCIS score in children with SCAP,while PA was positively correlated with PCIS score,suggesting that the higher the RDW and DD test values obtained for the first time after admission,the lower the serum PA test values were,and the more serious the condition of children with SCAP.3.RDW and DD levels are positively correlated with the short-term prognosis of children with SCAP,while PA levels are negatively correlated with the short-term prognosis of children with SCAP,suggesting that the higher the RDW and DD levels obtained for the first time after admission,the lower the PA level,and the more likely the children with SCAP will have poor short-term prognosis.4.The PCIS score has a certain suggestive effect on the short-term prognosis of children with SCAP,and a lower PCIS score is associated with poor prognosis. |
PDF Full Text Request