Zhang Hu, Li Huajun, Wang Lijun, Huang Lisu, Ma Qibo, Wu Hanwen, Pang Huanchun, Chen Yiping, Ruan Zhengshang
Pediatric Infectious Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Pediatric Infectious Disease, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
Transl Pediatr. 2022 Nov;11(11):1766-1775. doi: 10.21037/tp-22-6.
Adenovirus pneumonia (AVP) and pneumonia (MPP) have similar clinical manifestations such as a high prevalence of lung consolidation, making the differential diagnosis difficult before the etiology is reported. This study aimed to compare AVP and MPP, and to build a predictive model to differentiate them early.
We selected 198 cases of AVP and 876 cases of MPP. Clinical manifestations, computed tomography (CT) features, and biomarkers were compared. A logistic regression model was built to predict AVP. The area under the curve (AUC) of the receiver-operating characteristic was calculated to evaluate the discriminant ability of the prediction model.
Patients in the AVP group were mainly infants and toddlers, while the MPP group had more pre-school age children. The rate of hypoxemia and severe pneumonia was 3- and 11-times higher, respectively, in the AVP group than in the MPP group (5.6% 1.8%, 27.8% 2.5%, P<0.01). The proportion of patients with a Pediatric Logistic Organ Dysfunction-2 score ≥2 was 10 times higher in the AVP group than in the MPP group (17.4% 1.7%, P<0.01). Bilateral pneumonia was present in 90.2% of the AVP group. Biomarkers, such as interleukin (IL)-2 receptor, IL-10 and lactic dehydrogenase (LDH), were considerably higher in the AVP group than in the MPP group (P<0.01). The predictive model included eight variables, namely: age, severe pneumonia, bilateral pneumonia, ground-glass attenuation, consolidation, atelectasis, C-reactive protein, and LDH. The AUC was 86.6%.
Compared with MPP, AVP affects younger children, presents a more severe respiratory tract involvement, results in a larger range of lung lesions, and is associated with higher inflammatory biomarkers. Our predictive model includes a combination of clinical features, imaging findings, and biomarkers. It may help pediatricians in the early differentiation of AVP from MPP.
腺病毒肺炎（AVP）和支原体肺炎（MPP）具有相似的临床表现，如肺部实变的高发生率，这使得在病因报告之前进行鉴别诊断变得困难。本研究旨在比较AVP和MPP，并建立一个早期鉴别它们的预测模型。
我们选取了198例AVP患者和876例MPP患者。比较了临床表现、计算机断层扫描（CT）特征和生物标志物。建立了一个逻辑回归模型来预测AVP。计算受试者工作特征曲线下面积（AUC）以评估预测模型的判别能力。
AVP组患者主要为婴幼儿，而MPP组学龄前儿童更多。AVP组低氧血症和重症肺炎的发生率分别比MPP组高3倍和11倍（5.6%对1.8%，27.8%对2.5%，P<0.01）。儿科逻辑器官功能障碍-2评分≥2的患者比例在AVP组比MPP组高10倍（17.4%对1.7%，P<0.01）。AVP组90.2%存在双侧肺炎。白细胞介素（IL）-2受体、IL-10和乳酸脱氢酶（LDH）等生物标志物在AVP组显著高于MPP组（P<0.01）。预测模型包括八个变量，即：年龄、重症肺炎、双侧肺炎、磨玻璃影、实变、肺不张、C反应蛋白和LDH。AUC为86.6%。
与MPP相比，AVP影响年龄更小的儿童，呼吸道受累更严重，导致肺部病变范围更大，且与更高的炎症生物标志物相关。我们的预测模型结合了临床特征、影像学表现和生物标志物。它可能有助于儿科医生早期区分AVP和MPP。
