ABSTRACT
Background: Acute respiratory illness is responsible for 19% of all deaths in children in below five years of age and 8.2% of all disability as measured by DALY. Recent studies have added other risk factors to the list including large family size, poor socioeconomic status, family history of bronchitis, advanced birth order, crowding, young age, air pollution, and the use of non-allopathic treatment in early stages of illness. Also, indoor air pollution is one of the major risk factors for acute lower respiratory tract infection in children in developing countries. The objectives of this study were to identify and compare the risk factors associated with severe and very severe pneumonia.Methods: A prospective observational study. Children between 2 months to 5 years with clinical features of severe pneumonia were included in the study. Socioeconomic history like the type of house, family size, sanitary facilities and fuel-based cooking was recorded. Detailed history about immunization, feeding practice and degree of malnutrition was recorded. Chi Square test was used to determine significant differences between two groups.Results: Total 150 patients could be included in the study. Immunization status shows that 74% were completely immunized, 9% were unimmunized and 17% were partially immunized. Most of the children were breast fed 95.33% and only 4.67% were bottle fed. 30% of the cases were grade 3 and 4 PEM and anemic. The socioeconomic status showed 84% were belonged to grade 3,4 and 5 and 16% belonged to grade 1 and 2. 96.67% were living in ill ventilated kutcha house with poor sanitation facilities and nearly 94% were living in house with fuel other than LPG.Conclusions: Factors like previous history of similar illness, inappropriate immunization for age, anemia, PEM grade 3 and 4, poor housing condition, and indoor air pollution were significantly associated with severity of pneumonia. While severity of illness, PEM grade 3 and 4 and associated illness were the important risk factors for mortality.
ABSTRACT
Objective To study the application value of neutrophil elastase (NE), fibrinogen (Fib) combined with tumor necrosis factor-α (TNF-α) in the prognosis prediction of severe pneumonia in children. Methods Eighty-two children with severe pneumonia who were admitted into the Yuhang District Maternal and Child Health Hospital of Hangzhou in Zhejiang Province from July 2016 to September 2018 were treated as a severe group, and the children with severe pneumonia were subdivided into a survival group (70 cases) and a death group (12 cases) according to the prognosis; another 90 children with common pneumonia who were treated in our hospital at the same time were selected as a general group; and 85 normal children who received physical examinations at the same time as a healthy control group. The levels of serum NE, Fib and TNF-α in the three groups were measured by enzyme-linked immunosorbent assay (ELISA), and the pneumonia severity index (PSI) was calculated in the severe group and the general group; Spearman correlation analysis was used to analyze the correlation between NE, Fib, TNF-α and PSI;the NE, Fib and TNF-α levels were evaluated to predict the prognosis of children with severe pulmonary disease;the receive operating characteristic (ROC) curve was drawn to evaluate the prognostic value of NE, Fib, TNF-α in children with severe pulmonary disease. Results The expression levels of serum NE, Fib and TNF-α in the severe group were higher than those in the general group and the healthy control group [NE (μg/L): 127.5±12.3 vs. 75.1±6.6, 24.3±5.9, Fib (g/L): 6.9±1.2 vs. 5.1±0.7, 2.8±0.8, TNF-α (μg/L): 98.3±6.9 vs. 63.1±6.8, 30.2±2.1, all P <0.05]. Serum levels of NE, Fib and TNF-α in the death group were higher than those in the survival group [NE (μg/L):141.2±14.9 vs. 80.3±7.4, Fib (g/L): 7.6±1.5 vs. 5.7±1.0, TNF-α (μg/L): 105.4±7.8 vs. 68.2±4.6, all P < 0.05]. It was shown by ROC curve analysis that NE, Fib, TNF-α have some value in predicting the prognosis of children with severe pneumonia, the area under the ROC curve (AUC) were 0.889, 0.809, 0.803, 0.961, 95% confidence internal (95%CI) were 0.817-0.968、0.706-0.909、0.702-0.891、0.908-1.000, the sensitivity were 71.2%, 62.7%, 64.9%, 92.3%, the specificity were 73.5%, 68.3%, 74.5%, 90.9%, all P = 0.000. The PSI of severe pneumonia group was significantly higher than that of the general group (97.4±12.1 vs. 76.4±9.6), the PSI of the death group was obviously higher than that of the survival group (100.8±13.1 vs. 87.3±10.5), and the differences were statistically significant (both P < 0.01). Spearman correlation analyses showed that serum NE, Fib, TNF-α and PSI were significantly positively correlated in children with severe pneumonia respectively (r = 0.767, 0.734, 0.673, all P < 0.05), and there were positive correlations between NE and Fib (r = 0.655,P = 0.000), NE and TNF-α (r = 0.530,P = 0.000), Fib and TNF-α (r = 0.522,P = 0.000). Conclusion The combined detections of NE, Fib, and TNF-α levels can help clinicians determine the changes in the condition of children with severe pneumonia and evaluate their prognoses, combined detection has high sensitivity and specificity.