重症肺炎患儿临床特征及影响患儿预后的危险因素分析

Clinical characteristics of children with severe pneumonia and risk factors affecting their prognoses

目的分析重症肺炎(severe pneumonia,SP)患儿临床特征及预后影响因素,为临床治疗SP患儿提供依据。方法选取2019年6月—2022年6月南京医科大学附属儿童医院195例SP患儿,开展前瞻性研究。统计分析SP患儿临床特征及患病3个月后预后情况,根据预后情况分为预后良好组和预后不良组。比较两组临床资料,分析预后影响因素。基于影响因素构建列线图预测模型,评价该模型预测SP患儿预后不良的价值及临床效用。结果195例SP患儿就诊时均表现出咳嗽、发热、咳痰、肺部哮鸣音,其中22.05%伴有心动过速,9.74%伴有呼吸急促,5.64%伴有三凹征,55.90%发生多脏器衰竭;预后不良组年龄小于预后良好组,小儿危重病例评分(pediatric critical illness score,PCIS)71~80分占比低于预后良好组,有既往肺部感染病史占比、患病至就诊时间≥5 d占比、有并发症占比、血清涎液化糖链抗原-6(krebsvon den lungen-6,KL-6)、基质金属蛋白酶抑制剂-1(tissue inhibitor of metalloproteinase-1,TIMP-1)、可溶性髓系细胞表达的触发受体-1(soluble triggering receptor expressed on myeloid cells-1,sTREM-1)水平均高于预后良好组,差异均有统计学意义(P<0.05);多因素logistic回归分析年龄、既往肺部感染病史、患病至就诊时间、PCIS、血清KL-6、TIMP-1、sTREM-1水平均为SP患儿预后的影响因素(P<0.05);基于影响因素构建SP患儿预后不良的列线图预测模型,该模型预测SP患儿预后不良的曲线下面积为0.922(95%CI:0.807~0.958),预测敏感度、特异度分别为96.81%、88.64%,具有良好临床效用。结论SP患儿临床特征复杂多样,年龄、既往肺部感染病史、患病至就诊时间、PCIS、血清KL-6、TIMP-1、sTREM-1水平均为SP患儿预后的影响因素,基于影响因素构建的列线图预测模型在预测SP患儿预后不良方面具有良好预测效能及临床效用。

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.