Study on clinical characteristics and predictive indicators of necrotizing pneumonia caused by Streptococcus pneumoniae in children / 中华实用儿科临床杂志

ABSTRACT

Objective:To analyze the clinical features, inflammatory markers and imaging characteristics of necrotizing pneumonia(NP) caused by Streptococcus pneumoniae(SPNP) in children. Methods:The clinical manifestations, laboratory data, imaging performances of both SPNP patients and children with NP caused by Mycoplasma pneumoniae (MPNP) admitted at the Department of Pediatrics, Shengjing Hospital of China Medical University from October 2010 to September 2018 were retrospectively analyzed.Their data were compared, and the indicators showing significant differences between the two groups were plotted into ROC curves in order to identify the indicators of SPNP. Results:There were 20 cases in the SPNP group, 40 cases in the MPNP group.Compared with the MPNP group, the patients in the SPNP group were younger[2.69(1.30-7.00) years vs.5.00(1.00-11.00) years], more likely to develop hypoxemia[45.0%(9/20 cases) vs.2.5%(1/40 cases)], and easier to combine with the extra-pulmonary complications[60.0%(12/20 cases) vs.17.5%(7/40 cases)], and they had longer hospital stay [28.00(16.00-58.00) days vs.15.50 (7.00 -27.00) days], and the differences were statistically significant (all P<0.05). Besides the number of white blood cell(WBC) [34.40(22.48, 44.17)×10 9/L vs.14.26 (10.04, 19.48)×10 9/L], neutrophils [0.88(0.78, 0.91) vs.0.76(0.62, 0.81)], C-reactive protein(CRP)[195.5(166.50, 237.75) mg/L vs.77.9 (45.33, 123.50) mg/L], procalcitonin (PCT) [2.82(0.67, 5.61) μg/L vs.0.18 (0.12, 0.50) μg/L]in the SPNP group were significantly higher than those in the MPNP group, and the differences were statistically significant (all P<0.05); but levels of albumin [(27.93±2.53) g/L vs.(32.99±3.54) g/L] and pro-albumin [(0.09±0.05) g/L vs.(0.19±0.05) g/L] in the SPNP group were significantly lower than those in the MPNP group, and the differences were statistically significant (all P<0.05). The necrotic changes occurred earlier in the CT scan of the SPNP group than that in the MPNP group[(9.10±2.69) d vs.(20.12±4.35) d], and the difference was statistically significant ( P<0.05). In the SPNP group, 19 cases had pleural effusion, of which 14 cases(70%) performed closed thoracic drainage and 1 case(5%) underwent pleural puncture.In the MPNP group, there were 24 cases (57.5%) of patients with pleural effusion and 10 cases (25%)with pleural puncture.The values of WBC [41 319.0(13 974.25, 125 991.75)×10 6/L vs.867.5(779.75, 976.25)×10 6/L] and lactate dehydrogenase [19 332.50(15 454.25, 24 307.50)U/L vs.2 711.50(2 012.00, 2 968.25) U/L] in the pleural effusion in the SPNP group were significantly higher than those in the MPNP group, while the pH values (7.07± 0.11 vs. 7.43±0.56)and glucose [0.28(0.25, 0.36) mmol/L vs.6.90(6.48, 6.99) mmol/L] in the pleural effusion decreased significantly, and the differences were statistically significant (all P<0.05). The ROC curves analysis showed that the cut-off values of the 4 predictors including WBC, neutrophil ratio, CRP and PCT were 17.66×10 9/L, 0.847, 157.50 mg/L, and 1.54 μg/L, respectively. Conclusions:NP in children is severe, however after active anti-infection and symptomatic support treatment, most patients have a good progress.When WBC >17.66×10 9/L, neutrophils ratio>0.847, CRP>157.50 mg/L or PCT 1.54 μg/L, are highly possibly SPNP.