基于决策曲线分析血清CCL2、PDK4、YY1对急诊重症肺炎患儿并发心肌损害的预测价值OA

Objective To explore the predictive value of serum CC chemokine ligand 2(CCL2),pyruvate dehydro-genase kinase 4(PDK4),and Yin Yang 1 transcription factor(YY1)for myocardial injury in children with severe pneumonia in the emergency department.Methods A total of 215 children with severe pneumonia admitted to the Emergency Internal Medicine Department of Kunming Children's Hospital from January 2025 to December 2025 were selected as study subjects.According to whether they developed myocardial injury within 7 days after admission,they were divided into a myocardial in-jury group(n=62)and a non-myocardial injury group(n=153).Clinical data of the children were collected,and serum levels of CCL2,PDK4,and YY1 were measured within 24 hours of admission.Independent risk factors for the development of myo-cardial injury in children with severe pneumonia were analyzed.The predictive efficacy of serum CCL2,PDK4,and YY1 alone and in combination for myocardial injury was evaluated,and the clinical utility of the prediction model was assessed using decision curve analysis.Risk analysis was performed to examine the strength of the association between serum levels of CCL2,PDK4,YY1 and the development of myocardial injury in pediatric emergency patients with severe pneumonia.Results The incidence of myocardial injury among the 215 children with severe pneumonia was 28.84%(62/215).Serum levels of CCL2 and PDK4 in the myocardial injury group were significantly higher than those in the non-myocardial injury group,while YY1 level was significantly lower(t=9.123,8.700,8.555,respectively,all P<0.001).Respiratory failure,elevated C-re-active protein(CRP),elevated creatine kinase-MB(CK-MB),elevated CCL2,and elevated PDK4 were independent risk factors for myocardial injury in children with severe pneumonia,while elevated YY1 was an independent protective factor[OR(95%CI)=3.574(1.064-12.001),2.104(1.115-3.970),2.060(1.171-3.623),2.811(1.498-5.274),4.319(1.543-12.086),0.338(0.131-0.869)].The AUCs of CCL2,PDK4,YY1,and their combination for predicting myocardial injury were 0.806,0.783,0.826,and 0.895,respectively.The combined model had a significantly larger AUC(DeLong method:Z/P=2.677/0.007,3.375/0.001,2.116/0.034).Within the threshold probability range of 0.10-0.85,the combined prediction model showed higher clinical net benefit(P<0.05).Conclusion Elevated serum CCL2 and PDK4 levels,as well as decreased YY1 levels,are inde-pendent risk factors for the development of myocardial injury in pediatric emergency patients with severe pneumonia.Com-bined detection of these three markers demonstrates good predictive value and favorable potential for clinical application.