Early predictors of lung necrosis severity in children with community-acquired necrotizing pneumonia

Abstract

Objective: To analyze baseline clinical and laboratory characteristics and explore the possible predictors of lung necrosis severity in children with community-acquired necrotizing pneumonia (NP). Methodology: This retrospective observational study was performed in a tertiary referral center. A total of 104 patients aged <15 years with community-acquired pneumonia and radiologically confirmed NP were included. Patients were classified into the mild, moderate, or massive necrosis groups. Results: Among them, 29, 41, and 34 patients had mild, moderate, and massive necrosis, respectively. Moreover, 34.6% of the patients were admitted to the pediatric intensive care unit. Massive necrosis was more likely to occur during winter (p<0.05) and was associated with more severe clinical outcomes, such as longer duration of fever, longer hospitalization, increased mortality, and a higher risk of subsequent surgical intervention (p<0.05). Multivariate analysis demonstrated that the following were independent risk factors for massive necrosis: C-reactive protein (CRP) ≥ 122 mg/L (adjusted odds ratio [aOR], 8.780; 95% confidence interval [CI], 3.320–21.089; p=0.003), serum albumin ≤ 30.8 g/L (aOR, 11.608; 95% CI, 5.147–27.058; p=0.001), and immunoglobulin M (IgM) ≤ 95.7 mg/dL (aOR, 7.152; 95% CI, 2.240–17.692; p=0.021). Receiver operating characteristic analysis demonstrated that these variables showed good diagnostic performance for differentiating patients with massive necrosis from all patients with NP. Conclusion: NP is a potentially severe complication of pediatric community-acquired pneumonia. Different severities of lung necrosis can lead to different clinical outcomes. CRP, serum albumin, and IgM levels are independent predictors of the degree of lung necrosis.