Agimas Muluken Chanie, Tesfie Tigabu Kidie, Derseh Nebiyu Mekonnen, Kassaw Amare
Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
Department of Pediatrics and Child Health Nursing, College of Health sciences, Debre Tabor University, Debre Tabor, Ethiopia.
PLoS One. 2025 Mar 26;20(3):e0320448. doi: 10.1371/journal.pone.0320448. eCollection 2025.
Severe community-acquired pneumonia related treatment failure is persistence of features of severe pneumonia after initiation of antimicrobial therapy or a worsening clinical condition within 48-72 hours of the commencement of the antibiotics. Even though it is the most devastating public health problem in Ethiopia, there is no study to derivate and validate a model to predict treatment failure. To do this, nomogram was used to estimate the probability of treatment failure for each individual child and to classify their risk of treatment failure.
to develop and validate the model to predict treatment failure among under five children with severe community-acquired pneumonia in Debre Tabor comprehensive specialized hospital.
A secondary analysis of the previously collected prospective follow-up study was used for further analysis among 590 under-5 children hospitalized with severe community-acquired pneumonia. The STATA version 17 software was used for analysis. Descriptive analysis was summarized by frequency and percentage. A multivariable binary logistic regression was also conducted, and the model performance was evaluated using the receiver operating characteristics curve with its area under the curve and calibration curve. Internal validation of the model was assessed using the bootstrap technique. The decision curve analysis was also used to evaluate the usefulness of the nomogram.
The incidence of treatment failure among severe community-acquired pneumonia children was 28.1% (95% CI: 24.7%-30.8%). The previous history of severe community-acquired pneumonia, abnormal pulse rate, chest indrowing, anemia, HIV status, and plural effusion remained for the final model. The area under the curve for the original model and validated model was 0.7719 (95%CI: 0.729, 0.815) and 0.7714 (95% CI: 0.728-0.82), respectively. The decision curve analysis showed that the nomogram had a better net benefit across the threshold probability.
The incidence of treatment failure among children with severe community-acquired pneumonia was high in Debre Tabor comprehensive hospital. The previous history of severe community-acquired pneumonia, abnormal pulse rate, chest indrowing, anemia, HIV status, and plural effusion were the significant factors to develop the predictive model. The model had good discriminatory performance and internally valid. Similarly, the model has a good calibration ability with an insignificant loss of accuracy from the original. The models can have the potential to improve treatment outcomes in the clinical settings. But needs external validation before use.
严重社区获得性肺炎相关治疗失败是指在开始抗菌治疗后严重肺炎特征持续存在，或在抗生素开始使用后48 - 72小时内临床状况恶化。尽管这是埃塞俄比亚最具破坏性的公共卫生问题，但尚无研究推导和验证预测治疗失败的模型。为此，使用列线图来估计每个儿童治疗失败的概率，并对他们治疗失败的风险进行分类。
在德布雷塔博尔综合专科医院开发并验证预测5岁以下患有严重社区获得性肺炎儿童治疗失败的模型。
对之前收集的前瞻性随访研究进行二次分析，用于对590名因严重社区获得性肺炎住院的5岁以下儿童进行进一步分析。使用STATA 17版软件进行分析。描述性分析通过频率和百分比进行总结。还进行了多变量二元逻辑回归，并使用受试者工作特征曲线及其曲线下面积和校准曲线评估模型性能。使用自助法技术对模型进行内部验证。决策曲线分析也用于评估列线图的有用性。
严重社区获得性肺炎儿童的治疗失败发生率为28.1%（95%置信区间：24.7% - 30.8%）。严重社区获得性肺炎的既往史、脉搏异常、胸廓凹陷、贫血、艾滋病毒感染状况和胸腔积液被纳入最终模型。原始模型和验证模型的曲线下面积分别为0.7719（95%置信区间：0.729，0.815）和0.7714（95%置信区间：0.728 - 0.82）。决策曲线分析表明，列线图在整个阈值概率范围内具有更好的净效益。
在德布雷塔博尔综合医院，严重社区获得性肺炎儿童的治疗失败发生率较高。严重社区获得性肺炎的既往史、脉搏异常、胸廓凹陷、贫血、艾滋病毒感染状况和胸腔积液是建立预测模型的重要因素。该模型具有良好的区分性能和内部有效性。同样，该模型具有良好的校准能力，与原始模型相比准确性损失不显著。这些模型有可能改善临床环境中的治疗结果。但在使用前需要外部验证。
