Abstract：Objective To analyze the clinical characteristics and prognostic factors of children with severe pneumonia (SP), and to provide evidence for clinical treatment of SP children. Methods A prospective study was conducted among 195 SP children from Children's Hospital of Nanjing Medical University from June 2019 to June 2022. The SP children's clinical characteristics and prognoses after 3 months of illness were statistically analyzed, and then they were divided into the good prognosis group and the poor prognosis group according to their prognoses. The two groups' clinical data were compared, and the factors influencing their prognoses were analyzed. A line graph prediction model was constructed based on the influencing factors, and the value and clinical utility of the model in predicting poor prognosis in the SP children were evaluated. Results The 195 SP children had cough, fever, sputum and pulmonary wheezing when they sought medical treatment. Among them, 22.05% were accompanied by tachycardia, 9.74% by tachypnea, 5.64% by trisfoveal sign, and 55.90% by multiple organ failure. The age of the poor prognosis group was younger than that of the good prognosis group, and the proportion of 71-80 score based on Pediatric Critical Illness Score (PCIS) was lower in the poor prognosis group than in the good prognosis group. The proportions of children with a history of pulmonary infection, ≥ 5 d from illness to treatment, complications, Krebs von den lungen-6 (KL-6), tissue inhibitor of metalloproteinase-1 (TIMP-1) and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) levels in the poor prognosis group were all higher than those in the good prognosis group, with statistically significant differences (all P< 0.05). Multi-factor logistic regression analysis revealed that age, previous history of pulmonary infection, time interval from symptom onset to hospital visiting, PCIS score and serum levels of KL-6, TIMP-1 and sTREM-1 were factors influencing the SP children's prognoses (all P<0.05). A histogram prediction model for poor prognosis of the SP children was established based on the influencing factors. The area under the curve (ACU) of this model for predicting poor prognosis of the SP children was 0.922 (95%CI:0.807-0.958), and the prediction sensitivity and specificity were 96.81% and 88.64% respectively, showing good clinical efficacy. Conclusion The SP children's clinical characteristics are complex and varied. Age, history of previous pulmonary infection, time interval from symptom onset to hospital visiting, PCIS score and serum levels of KL-6, TIMP-1 and sTREM-1 are factors affecting the SP children's prognoses. The line graph prediction model constructed based on the influencing factors has good predictive efficacy and clinical utility in forecasting the SP children's poor prognoses.
吕月华, 赵丽, 李婷. 重症肺炎患儿临床特征及影响患儿预后的危险因素分析[J]. 实用预防医学, 2024, 31(3): 314-318.
LYU Yuehua, ZHAO Li, LI Ting. Clinical characteristics of children with severe pneumonia and risk factors affecting their prognoses. , 2024, 31(3): 314-318.
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