Analysis Of Risk Factors Associated With Severe Lobar Pneumonia In Children

Objetive:Lobar pneumonia in children is a serious community-acquired pneumonia,and its incidence has increased significantly in recent years.Lobar pneumonia in children often involves more than one lung segment of the lung tissue,the nature of the lesion is cellulose inflammation,and mainly in the alveoli,is a common clinical lower respiratory tract infectious diseases.In recent years,the pathogen spectrum of children with lobar pneumonia has undergone a great change,the lobar pneumonia caused by Streptococcus pneumoniae infection gradually decreased,and the lobar pneumonia caused by mycoplasma pneumoniae and other bacteria infection gradually increased.When children with lobar pneumonia are attacked by pathogens,they can activate macrophages,neutrophils and other cells,damage alveolar walls,cause local inflammation and lung consolidation,and the lesions can gradually spread from alveolar to the entire lung lobe and cause inflammation.If cytokines are released excessively,the inflammatory balance may be broken and the inflammatory response may be aggravated.Therefore,It is important to evaluate the inflammatory level of patients during treatment.Common intra-pulmonary complications of lobar pneumonia include pleural effusion,pleuritis,atelectasis,necrotizing pneumonia,etc.,while extra-pulmonary complications include myocardial damage,liver damage,anemia,rash,etc.Due to severe lung infection,fibrobronchoscopy,thoracic puncture,or lumbar puncture are required.More than a few children have undergone multiple fibrobronchoscopy operations.This has a great impact on the physical and mental health of the children,but also to the children’s families,especially rural families brought heavy economic burden.Therefore,the purpose of this study was to explore the risk factors of severe lobar pneumonia in children through comparative analysis of the general conditions,clinical characteristics and laboratory examination of mild lobar pneumonia and severe lobar pneumonia,so as to provide clinicians with more accurate diagnosis and treatment plans,reduce the fatality rate and improve the therapeutic effect.Method:Children with lobar pneumonia who were hospitalized in the Department of Pediatrics of the First Affiliated Hospital of Henan University from January 2018 to October 2022 were collected through the electronic medical record system.According to the inclusion and exclusion criteria,284 cases of lobar pneumonia were selected.According to the criteria for the Diagnosis and Treatment of Community-acquired pneumonia in Children(2019 Edition),the subjects were divided into mild lobar pneumonia group(n = 131)and severe lobar pneumonia group(n = 153).The general data,clinical characteristics,and laboratory indicators of the children were collected.(1)General information included: gender,age;(2)Clinical characteristics: days of hospitalization,fever and cough;(3)Laboratory examination indicators: white blood cell count,percentage of neutrophils,percentage of lymphocytes,percentage of monocytes,C-reactive protein,erythrocyte sedimentation rate,D-dimer,lactate dehydrogenase,serum globulin G,serum globulin A,serum globulin M,serum globulin E,CD4+/CD8+.spss26.0 software was used for statistical analysis,and univariate analysis was performed on the laboratory examination data of the two groups.The indicators with statistical significance in univariate analysis were analyzed by multivariate binary Logistic regression analysis to construct the prediction model,and the receiver operating characteristic(ROC)curve was drawn to evaluate the efficacy of the model.P < 0.05 was considered statistically significant.Results:1.Among the 284 children with lobar pneumonia,131 cases were in the mild lobar pneumonia group,including 71 males and 60 females,and 153 cases were in the severe lobar pneumonia group,including 82 males and 71 females.There was no significant difference between the two groups(χ2=0.01,P > 0.05).The median ages of children with mild lobar pneumonia and severe lobar pneumonia were 7.1 years and 7 years,respectively.There was no significant difference in age between the two groups(Z=-0.801,P > 0.05).2.The hospitalization days,fever days and cough days in the severe lobular pneumonia group were significantly longer than those in the mild lobular pneumonia group,and the comparison between the two groups was statistically significant(P < 0.05).3.Unifactor analysis results of laboratory examination: the percentage of neutrophil granulocyte,Creactive protein,erythrocyte sedimentation,D-dimer and lactate dehydrogenase in severe lobar pneumonia group were higher than those in mild lobar pneumonia group,and the difference between the two groups was statistically significant(P < 0.05).The percentage of lymphocyte,serum globulin G and CD4+/CD8+ in the severe group were lower than those in the mild group,and the difference between the two groups was statistically significant(P < 0.05).There were no significant differences in the percentages of leukocytes,monocytes,serum globulin A,serum globulin M and serum globulin E between the severe lobar pneumonia group and the mild lobar pneumonia group(P > 0.05).4.Results of multivariate analysis of laboratory tests: seven significant single factor indicators including percentage of neutrophils,percentage of lymphocytes,C-reactive protein,erythrocyte sedimentation rate,Ddimer,lactate dehydrogenase,serum globulin G and CD4+/CD8+ were screened out for multivariate binomial Logistic regression.The model prediction classification table showed that the correct rate of regression model to predict mild lobar pneumonia was 90.1%,the correct rate of severe lobar pneumonia was 85.0%,and the overall accurate prediction rate of the model was 87.3%.The results showed that Creactive protein,erythrocyte sedimentation,lactate dehydrogenase and CD4+/CD8+ were independent risk factors for severe lobar pneumonia(P < 0.05).Although the differences in neutrophil percentage,lymphocyte percentage,D-dimer and serum globulin G were statistically significant in univariate analysis,there were no statistically significant differences in binomial Logistic regression multivariate analysis(P > 0.05).The prediction probability model Logistic(Y)established in this study was-4.897+0.036× C-reactive protein+0.038× sedimentation +0.004× lactate dehydrogenase +0.528×CD4+/CD8+.The AUC under ROC curve was 0.934(95%CI 0.905～0.962)(P < 0.05),the Yoden index was 0.769,the sensitivity was 83%,and the specificity was 93.9%.Conclusion:1.Neutrophil percentage,lymphocyte percentage,C-reactive protein,erythrocyte sedimentation rate,D dimer,lactate dehydrogenase,serum globulin G,CD4+/CD8+ may be the influencing factors for the development of severe lobar pneumonia.2.C-reactive protein,erythrocyte sedimentation,lactate dehydrogenase and CD4+/CD8+ are independent risk factors for severe lobar pneumonia.3.The model established in this study has a correct prediction rate of 90.1% for mild lobar pneumonia and85.0% for severe lobar pneumonia,and the overall accurate prediction rate of the model is 87.3%.It has certain reference value in predicting the disease development of children in clinic.4.When the four independent risk factor indexes were tested together,the area under the curve was 0.934,with high sensitivity and specificity,even using the established prediction model.