Analysis of Ifluencing Factors on the Outcome of Community-acquired Severe Pneumonia in Children And the Predictive Value of Serum HMGB1,PCT,And TLR4
Objective To detect the serum levels of high mobility group protein-1(HMGB1),procalcitonin(PCT),and Toll-like receptor 4(TLR4)in children with community-acquired severe pneumonia(SCAP),and to analyze their predictive value for adverse outcomes.Methods A total of 151 children with SCAP who were admitted to Zhengzhou Jinshui District General Hospital from June 2019 to June 2023 were selected,and they were divided into an adverse group and an outcomes group according to their outcomes of 28 days after admission.The general data and the serum levels of HMGB1,PCT,and TLR4 at admission and 48 h after admission were compared between the two groups.Logistic regression analysis was used to analyze the influencing factors of adverse outcomess in children with SCAP,and receiver operating characteristic curves(ROC)were drawn to analyze the predictive value of serum HMGB1,PCT,and TLR4 at admission and 48 hours after admission alone and in combination for adverse outcomes.Results The adverse outcomes rate of children with SCAP was 24.31%.The proportion of pathogenic bacteria species≥2,acute physiology and chronic health evaluation system(APACHE Ⅱ)score,the proportion mechanical ventilation,and serum HMGB1,PCT,TLR4 levels at admission and 48 h after admission in the adverse group were higher than those in the outcomes group,while the age and oxygenation index were lower than those in the outcomes group,and the differences were statistically significant(P＜0.05).Logistic regression analysis showed that age,pathogenic bacteria≥2 kinds,APACHE Ⅱ score,mechanical ventilation,HMGB1,PCT,and TLR4 at admission and 48 hours after admission were influencing factors of adverse outcomess in children with SCAP,and the differences were statistically significant(P＜0.05).ROC curves showed that the sensitivity of HMGB1,PCT,and TLR4 at admission and 48 hours after admission combined test was higher than that of single test,,and the difference was statistically significant(P＜0.05).The specificity of single test and combined test of the three factors was compared,and there was no significant difference(P＞0.05).Pairwise algorithm test showed that compared with single test of HMGB1,PCT,and TLR4,the area under the curve(AUC)of combined test increased,and the difference was statistically significant(P＜0.05).Conclusion Serum HMGB1,PCT,TLR4 levels at admission and 48 hours after admission,age,pathogenic bacteria≥2 kinds,APACHE Ⅱ score,and mechanical ventilation are influencing factors of adverse outcomess in children with SCAP,among which the combination of serum HMGB1,PCT and TLR4 levels has a high predictive value for adverse outcomes.
community-acquired severe pneumoniahigh mobility group protein-1procalcitonintoll-like receptor 4adverse outcomes
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