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Early predictors of lung necrosis severity in children with community-acquired necrotizing pneumonia
  • +8
  • Qiaoling Li,
  • Xueya Zhang,
  • Bo Chen,
  • Yongan Ji,
  • Wei Chen,
  • Shujing Cai,
  • Ming Xu,
  • Mingwei Yu,
  • Qiyu Bao,
  • Changchong Li,
  • Hailin Zhang
Qiaoling Li
The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University

Corresponding Author:[email protected]

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Xueya Zhang
The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
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Bo Chen
The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
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Yongan Ji
The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
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Wei Chen
The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
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Shujing Cai
The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
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Ming Xu
The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
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Mingwei Yu
The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
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Qiyu Bao
The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
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Changchong Li
The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
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Hailin Zhang
Wenzhou Medical University Second Affiliated Hospital
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Abstract

Abstract Objective: To analyze baseline clinical and laboratory characteristics and explore the possible predictors of lung necrosis severity in children with community-acquired necrotizing pneumonia (NP). Methodology: This retrospective observational study was performed in a tertiary referral center. A total of 104 patients aged <15 years with community-acquired pneumonia and radiologically confirmed NP were included. Patients were classified into the mild, moderate, or massive necrosis groups. Results: Among them, 29, 41, and 34 patients had mild, moderate, and massive necrosis, respectively. Moreover, 34.6% of the patients were admitted to the pediatric intensive care unit. Massive necrosis was more likely to occur during winter (p<0.05) and was associated with more severe clinical outcomes, such as longer duration of fever, longer hospitalization, increased mortality, and a higher risk of subsequent surgical intervention (p<0.05). Multivariate analysis demonstrated that the following were independent risk factors for massive necrosis: C-reactive protein (CRP) ≥ 122 mg/L (adjusted odds ratio [aOR], 8.780; 95% confidence interval [CI], 3.320–21.089; p=0.003), serum albumin ≤ 30.8 g/L (aOR, 11.608; 95% CI, 5.147–27.058; p=0.001), and immunoglobulin M (IgM) ≤ 95.7 mg/dL (aOR, 7.152; 95% CI, 2.240–17.692; p=0.021). Receiver operating characteristic analysis demonstrated that these variables showed good diagnostic performance for differentiating patients with massive necrosis from all patients with NP. Conclusion: NP is a potentially severe complication of pediatric community-acquired pneumonia. Different severities of lung necrosis can lead to different clinical outcomes. CRP, serum albumin, and IgM levels are independent predictors of the degree of lung necrosis.
06 Oct 2021Submitted to Pediatric Pulmonology
07 Oct 2021Submission Checks Completed
07 Oct 2021Assigned to Editor
25 Oct 2021Reviewer(s) Assigned
16 Dec 2021Review(s) Completed, Editorial Evaluation Pending
10 Jan 2022Editorial Decision: Revise Major
02 Mar 20221st Revision Received
02 Mar 2022Assigned to Editor
02 Mar 2022Reviewer(s) Assigned
02 Mar 2022Submission Checks Completed
04 Mar 2022Review(s) Completed, Editorial Evaluation Pending
15 Apr 2022Editorial Decision: Revise Minor
17 May 20222nd Revision Received
17 May 2022Submission Checks Completed
17 May 2022Assigned to Editor
17 May 2022Reviewer(s) Assigned
26 May 2022Review(s) Completed, Editorial Evaluation Pending
29 May 2022Editorial Decision: Accept
20 Jun 2022Published in Pediatric Pulmonology. 10.1002/ppul.26020