Liu Chun-Yan, Li Cheng
Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Sichuan Clinical Research Center for Birth Defects, Luzhou, China.
Front Pediatr. 2022 May 6;10:813638. doi: 10.3389/fped.2022.813638. eCollection 2022.
This study aims to analyze the clinical characteristics of pediatric acute lymphoblastic leukemia (ALL) complicated by pneumonia and the risk factors of severe cases to preliminarily construct a prediction model for ALL complicated by severe pneumonia.
A retrospective analysis was carried out on the clinical data of children diagnosed with ALL complicated by pneumonia hospitalized at the Department of Pediatrics of the Affiliated Hospital of Southwest Medical University between January 2013 and December 2020. The risk factors of severe ALL complicated by pneumonia were investigated with logistic regression analysis, and the risk prediction model was constructed.
A total of 116 cases of pediatric ALL complicated by pneumonia were analyzed. There were 71 cases of mild pneumonia and 45 cases of severe pneumonia. The main clinical manifestations were cough in 112 cases and fever in 109. Pathogens were detected in 23 cases. Multiple regression factor analysis indicated that the use of hormones (OR 4.001, 95% CI: 1.505-10.632), neutropenia or agranulocytosis (OR 7.472, 95% CI: 2.710-20.602), hemoglobin (Hb) < 90 g/L (OR 3.270, 95% CI: 1.2568.516), and C-reactive protein (CRP) >15 mg/L (OR 3.253, 95% CI: 1.2098.751) were independent risk factors that were associated with severe pneumonia. Logistic regression was used to establish the risk prediction model of ALL with severe pneumonia. The -value was 0.659. The area under the receiver operating characteristic curve was 0.851, and the sensitivity and specificity were 84.4 and 71.8%, respectively.
The development of severe pneumonia may be affected by the use of hormones, neutropenia or agranulocytosis, Hb < 90 g/L, and CRP > 15 mg/L. The prediction model based on the risk factors is effective, which can provide a reference for the clinical evaluation of acute lymphoblastic leukemia with severe pneumonia.
本研究旨在分析小儿急性淋巴细胞白血病（ALL）合并肺炎的临床特征及重症病例的危险因素，初步构建ALL合并重症肺炎的预测模型。
回顾性分析2013年1月至2020年12月在西南医科大学附属医院儿科住院诊断为ALL合并肺炎的患儿临床资料。采用logistic回归分析ALL合并肺炎重症的危险因素，并构建风险预测模型。
共分析116例小儿ALL合并肺炎病例。其中轻症肺炎71例，重症肺炎45例。主要临床表现为咳嗽112例、发热109例。23例检测出病原体。多因素回归分析显示，使用激素（OR 4.001，95%CI：1.505 - 10.632）、中性粒细胞减少或缺乏（OR 7.472，95%CI：2.710 - 20.602）、血红蛋白（Hb）<90 g/L（OR 3.270，95%CI：1.2568.516）、C反应蛋白（CRP）>15 mg/L（OR 3.253，95%CI：1.2098.751）是与重症肺炎相关的独立危险因素。采用logistic回归建立ALL合并重症肺炎的风险预测模型，P值为0.659。受试者工作特征曲线下面积为0.851，灵敏度和特异度分别为84.4%和71.8%。
重症肺炎的发生可能受使用激素、中性粒细胞减少或缺乏、Hb<90 g/L及CRP>15 mg/L影响。基于危险因素的预测模型有效，可为临床评估急性淋巴细胞白血病合并重症肺炎提供参考。
