Department of Pediatrics and Pediatric Pulmonology, Hadassah-Hebrew University Medical Center, The Hebrew University, Jerusalem, Israel.
Pediatric Pulmonology Unit, Shaare Zedek Medical Center, The Hebrew University, Jerusalem, Israel.
Chest. 2018 Jan;153(1):172-180. doi: 10.1016/j.chest.2017.09.021. Epub 2017 Sep 21.
Pediatric community-acquired complicated pneumonia (PCACP) is characterized by a prolonged clinical course, but this may be highly variable.
A multicenter observational study was conducted to develop and validate a clinical prediction tool for prolonged hospitalizations in PCACP. The derivation and validation cohorts consisted of 144 and 169 patients with PCACP, respectively, hospitalized between the years 1997 and 2017 in three tertiary care hospitals. Logistic regression analyses were used to identify parameters associated with a prolonged hospitalization and to develop and validate a prediction model for constructing a useful clinical tool.
Higher levels of lactate dehydrogenase (LDH) (P < .026) and lower levels of glucose (P = .018) in pleural fluid were significantly associated with prolonged hospitalization. A predictive stepwise logistic regression model was developed and applied to the validation cohort. The area under the receiver operating characteristic curve (AUROC) constructed indicated that the model retained good predictive value (AUROC for the derivation vs validation data, [0.77 (95% CI, 0.66-0.87) vs 0.82 (95% CI, 0.72-0.91)], respectively). From these data, a clinical tool was derived; the combination of pleural LDH >1,000 units/L and pleural glucose levels < 1 mmol/L or pleural LDH levels > 2,000 units/L and pleural glucose levels < 2 mmol/L or pleural LDH levels > 3,000 units/L and pleural glucose < 3 mmol/L predict prolonged hospitalization with positive and negative predictive values of 78% (95% CI, 0.71-0.85) and 73% (95% CI, 0.59-0.85), respectively.
In children, pleural fluid LDH and glucose levels are useful parameters for assessing the severity of PCACP. The model developed in this study accurately predicts patients who will have prolonged hospitalization.
小儿社区获得性复杂性肺炎（PCACP）的临床病程较长，但这可能高度可变。
进行了一项多中心观察性研究，以开发和验证用于 PCACP 患者住院时间延长的临床预测工具。推导和验证队列分别由 1997 年至 2017 年在 3 家三级保健医院住院的 144 名和 169 名 PCACP 患者组成。使用逻辑回归分析来确定与住院时间延长相关的参数，并开发和验证用于构建有用临床工具的预测模型。
胸腔积液中乳酸脱氢酶（LDH）水平较高（P<.026）和葡萄糖水平较低（P=.018）与住院时间延长显著相关。开发了一个预测性逐步逻辑回归模型，并将其应用于验证队列。构建的接受者操作特征曲线（ROC）下面积（AUROC）表明，该模型保留了良好的预测价值（推导与验证数据的 AUROC，[0.77（95%CI，0.66-0.87）与 0.82（95%CI，0.72-0.91）]）。根据这些数据，得出了一个临床工具；胸腔积液 LDH>1000 单位/L 和胸腔葡萄糖水平<1mmol/L 或胸腔 LDH 水平>2000 单位/L 和胸腔葡萄糖水平<2mmol/L 或胸腔 LDH 水平>3000 单位/L 和胸腔葡萄糖<3mmol/L 的组合可预测住院时间延长，其阳性预测值和阴性预测值分别为 78%（95%CI，0.71-0.85）和 73%（95%CI，0.59-0.85）。
在儿童中，胸腔积液 LDH 和葡萄糖水平是评估 PCACP 严重程度的有用参数。本研究中开发的模型可准确预测住院时间延长的患者。
