Relationship between serum ferritin level and the severity of community acquired pneumonia in children / 中华实用儿科临床杂志

ABSTRACT

Objective To analyze the relationship between the level of serum ferritin (SF)and the severity of community acquired pneumonia (CAP)in children,and to explore the timing of glucocorticoid therapy for children with CAP.Methods Retrospective analysis was performed on the clinical data of 738 children with CAP who were hospitalized at the Department of Respiratory,Beijing Children's Hospital,Capital Medical University from January 2014 to December 2015.All patients were divided into a mild group and a severe group based on the severity of CAP,and the levels of SF,C-reactive protein (CRP),erythrocyte sedimentation rate (ESR),white blood cell (WBC) and D-dimer were compared between the 2 groups.In addition,the analysis of receiver operating characteristic (ROC) curve was performed to study the usefulness of SF as severity indicators for CAP,and to learn the relationship between the level of SF and the glucocorticoid therapy in children with CAP.Simultaneous analysis of SF and CRP,WBC,ESR,D-dimer was made at the same time.Results (1) There were all 738 children enrolled into this study.There were 442 children in the mild group and 296 children in the severe group.There was no significant difference in age and sex between the mild group and the severe group(all P ＞ 0.05).(2)Comparisons between the mild group and the severe group were as followsdays of hospitalization [10.0 (9.0,13.0) days],duration of fever [10.0 (7.0,10.0) days] and heat peak [39.9 ℃ (39.1 ℃,40.1 ℃)] in the severe group,which had significant differences than those in the mild group [days of hospitalization 7.0 (6.0,9.0) days,duration of fever 7.0 (5.0,10.0) days and heat peak 39.3 ℃ (39.0 ℃,39.8 ℃)] (all P ＜ 0.05).The levels of SF [229.0 (150.0,436.2) μg/L],CRP [30.00 (9.84,78.20) mg/L],WBC [8.44 (5.91,12.6) × 109/L],ESR [30.5 (16.0,49.0) mm/1 h] and D-dimer [0.871 (0.317,2.532) μg/L] in the severe group were significantly higher than those in the mild group [SF98.0 (68.2,136.1)μg/L,CRP11.50 (5.77,11.50) mg/L,WBC7.59 (5.87,10.1) × 109/L,ESR23.0 (13.0,36.3) mm/1 h and D-dimer 0.232 (0.159,0.407) μg/L],and the differences were statistically significant (all P ＜ 0.05).(3) The levels of SF [258.5 (177.8,404.9) μg/L] and CRP [8.0 (8.0,16.5) mg/L] in CAP children in the recovery phase were significantly lower than those in the acute phase [SF912.1 (418.7,1 380.3) μg/L,CRP47.4 (18.8,105.8)mg/L].(4)The level of SF had significantly positive correlations with CRP,ESR,D-dimer (r =0.485,0.286,0.611,all P ＜ 0.05).(5) The cutoff value for SF,D-dimer for diagnosing severe pneumonia was 168.0 μg/L (sensitivity 70.6％,specificity 86.2％),and 0.616 μg/L (sensitivity 58.1％,specificity 87.1％).(6) There were 17.2％ cases (76/442 cases) in the mild group and 52.7％ cases (159/296 cases) in the severe group who received systemic glucocorticoid therapy.Conclusion The level of SF was correlated with the severity of CAP in children,and the level of SF in patients in recovery phase was significantly lower than that in the acute phase.When SF ≥ 168.0 μg/L,D-dimer ≥0.616 μg/L,attention should be paid to the possibility of severe CAP,regarding the indication for systemic steroid therapy for CAP in children.