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 by computed tomography (CT) 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 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 in this study: C‐reactive protein (CRP) (p = 0.036), serum albumin (p = 0.009), and immunoglobulin M (IgM) (p = 0.022). Receiver operating characteristic analysis showed that when the cut‐off value for CRP, serum albumin, and IgM were set at 122 mg/L, 30.8 g/L, and 95.7 mg/dl, respectively, they 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.

Development of a Nomogram for Predicting Massive Necrotizing Pneumonia in Children

“…Therefore, LDH is also often used as a predictor of severe pneumonia. 18 , 19 A retrospective analysis of NP by Li et al 11 found that CRP is an independent predictor of the degree of lung necrosis. CRP > 48.35 mg/L had a high predictive value for the diagnosis of NP, according to Qian et al 7 Zhou et al 20 found that WBC and CRP in the NP group caused by Mycoplasma pneumoniae were significantly higher than those in non-NP group.…”

“…More than 30% necrosis was included in the MNP group, and no more than 30% necrosis was included in the non-MNP group. 11 …”

“… 9 , 10 Mild pulmonary necrosis can be cured by anti-infection and anti-inflammatory treatment, while massive necrotizing pneumonia (MNP) requires surgical intervention, and more severe cases can eventually die. 11–15 As a result, Li et al 11 investigated the early warning indicators of massive lung necrosis in children with CAP in order to detect it early. However, this study’s sample size was small, and it is not clinically useful to predict the severity of NP using just one predictor.…”

Necrotizing Pneumonia in Children: Early Recognition and Management

“…The common clinical manifestations of NP have no difference from those of uncomplicated pneumonia, including fever, cough, sometimes with chest pain, emesis, abdominal pain, dyspnea, anemia and fatigue [ 2 ]. But patients with NP have a more serious clinical course, longer duration of fever and length of stay, higher mortality, higher incidence of extra-pulmonary complications such as septic shock, respiratory failure and HUS and pulmonary complications such as parapneumonic effusion, pleural empyema, pyothorax, pneumothorax, pyopneumothorax and BPF [ 8 , 85 ]. PVL-positive Staphylococcus aureus is associated with high fever and an enhanced risk of purulent expectoration and hemoptysis [ 10 ].…”

“…Age and gender have no significant influence on the incidence of NP. The majority of reported cases are previously healthy and immunocompetent children [ 85 ]. When patients have flu-like symptoms, we should consider the possibility of viruses, especially during influenza season.…”