Predictive value of CCL26 and CCR3 levels for prognosis assessment in children with pneumonia treated with azithromycin.

BACKGROUND

pneumonia (MPP), a prevalent form of community-acquired pneumonia (CAP) in schoolchildren, frequently results in persistent fever or complications in 15-25% of cases despite azithromycin treatment. This highlights the urgent need for novel biomarkers to identify high-risk cases. This study aims to investigate the predictive value of serum C-C motif chemokine ligand 26 (CCL26) and C-C chemokine receptor 3 (CCR3) levels for treatment prognosis in children with MPP receiving azithromycin therapy.

METHODS

Clinical data of 205 pediatric MPP patients treated in our hospital from February 2023 to February 2025 were collected. Serum levels of CCL26, CCR3, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and D-dimer (DD) were measured by enzyme-linked immunosorbent assay (ELISA), while (MP) antibody titers were determined using passive agglutination. Pearson correlation analysis evaluated relationships between CCL26 and CCR3 and inflammatory cytokines (IL-6, TNF-α). Logistic regression identified risk factors for poor prognosis, with receiver operating characteristic (ROC) curve analysis assessing the predictive value of CCL26 and CCR3.

RESULTS

Compared with healthy controls, MPP patients showed elevated serum CCL26, CCR3 and inflammatory cytokines (TNF-α, IL-6) both pre- and post-treatment (all P<0.05). These markers significantly decreased after therapy (all P<0.05). Pretreatment CCL26 and CCR3 levels positively correlated with inflammatory cytokines (P<0.05). Poor prognosis cases exhibited higher levels of CCL26, CCR3, TNF-α, IL-6, C-reactive protein (CRP), DD, MP antibody titers (≥1:160), fever duration (≥5 d), and peak temperature (≥38.5 °C) (P<0.05). Multivariate analysis identified MP antibody titer ≥1:160, elevated CCL26, CCR3, TNF-α, and IL-6 levels, fever ≥5 days, and temperature ≥38.5 °C as independent risk factors. The area under the curve (AUC) for CCL26 and CCR3 in predicting poor prognosis was 0.709 and 0.751, respectively, increasing to 0.798 when combined.

CONCLUSIONS

Serum CCL26 and CCR3 levels decrease following azithromycin treatment and demonstrate significant associations with inflammatory markers and clinical outcomes, serving as reliable predictors for poor prognosis in MPP patients.