Early predictors of lung necrosis severity in children with
community-acquired necrotizing pneumonia
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.