An Analysis of the Evaluation Index of the Poor Prognosis of Severe Community-acquired Pneumonia
Objective To investigate the clinical pulmonary infection score(CPIS),sputum bacterial clearance,High Mobility Group Protein 1(HMGB1),interleukin 17(IL-17),interleukin 23(IL-23)levels in Severe,community-acquired pneumonia,and to evaluate clinical value of therapeutic effect of SCAP in children.Methods A controlled experiment was conducted in 80 children with community acquired pneumonia(CAP)admitted to our hospital from June,2022 to June,2023.Subjects were divided into mild(0-1 points),moderate(2 points)and severe(≥3 points-SCAP group)according to the severity of their disease(CURB-65 score scale),with 26,27 and 27 cases in each group.All three groups were given cefotaxime sodium alone,intravenous infusion:Mild group,100mg/kg;Moderate group,150mg/kg;Severe group,150mg/kg,with 2 to 4 times during the course of 1 week treatment.Sputum bacterial clearance rate and CPIS score of each group were counted before and after 1 week of treatment.Enzyme-linked immunosorbent assay(ELISA)was used to detect expression levels of HMGB1,IL-17 and IL-23 in each group before and after treatment.The obtained dataset were incorporated into SPSS 23.0 software for processing,and the differences of sputum bacterial clearance,CPIS score,HMGB1,IL-17 and IL-23 in different groups were analyzed.Their correlations with the prognosis of children were evaluated and the value of these indicators in predicting severe pneumonia independently and jointly was analyzed.Results ①The more severe the SCAP disease,the lower the sputum bacterial clearance,and the higher the CPIS score(P＜0.05).②The higher the expression of HMGB1,IL-17,and IL-23 before treatment,the more severe the SCAP children were(P＜0.001),and the less severe the SCAP children after treatment,the lower the expression of HMGB1,IL-17,and IL-23(P＜0.05).③Sputum bacterial clearance showed a significant negative correlation with CPIS score(P＜0.001),while HMGB1,IL-17 and IL-23 showed significant positive correlations with CPIS score(P＜0.005).④AUC values of sputum bacterial clearance,CPIS score,HMGB1,IL-17,IL-23(maximum:0.982,95％CI 0.851-0.995)were successively higher than HMGB1,IL-23,IL-17,sputum bacterial clearance and CPIS score.Conclusion The innovative point of this paper is to identify the role of reduced sputum bacterial clearance,CPIS score,HMGB 1,IL-17 and IL-23 in comprehensively evaluating the prognosis of children with SCAP:Sputum bacteria clearance in children with SCAP decreases,CPIS score increases,and HMGB1,IL-17 and IL-23 show abnormal expression,which can be used as the reference basis for evaluating the disease condition and poor prognosis of children with SCAP.
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