儿童腺病毒与肺炎支原体共感染重症肺炎早期预测因素的病例对照研究OA

Background Human adenovirus(HAdV)and Mycoplasma pneumoniae(MP)are common pathogens of community-acquired pneumonia(CAP)in children.HAdV-MP coinfection may substantially increase the risk of severe pneumonia,which is often associated with adverse clinical outcomes.Objective To characterize the clinical features of children with pneumonia and HAdV-MP coinfection,and identify early predictors of severe pneumonia.Design Case-control study.Methods Children aged 29 days to 18 years with CAP and HAdV-MP coinfection who were hospitalized at Tianjin Children's Hospital between September 1,2018,and May 1,2024,were enrolled.Patients with confirmed coinfection with other pathogens,chronic airway diseases or severe underlying conditions,or those who met the diagnostic criteria for severe pneumonia within 24 h of admission were excluded.Patients were classified into the severe group(diagnosed with severe pneumonia≥24 h after admission)and the non-severe group.Variables with P<0.05 in univariable analyses,including symptoms,signs,laboratory findings,and imaging findings obtained within 24 h of admission,were entered into a multivariable logistic regression model to identify independent early predictors of severe pneumonia.The predictive performance of the combined model was evaluated using receiver operating characteristic(ROC)curve analysis,calibration curves,and the Hosmer-Lemeshow goodness-of-fit test.Main Outcome Measures Early predictors of severe pneumonia in children with HAdV-MP coinfection.Results A total of 225 children with HAdV-MP coinfection were included,with a median age at disease onset of 7.0(5.0,9.0)years;121(53.8%)were boys.Eighty patients(35.6%)were classified into the non-severe group and 145(64.4%)into the severe group.Compared with the non-severe group,the severe group had a higher peak body temperature,a higher incidence of plastic bronchitis,higher proportions of patients with moist rales and decreased breath sounds,and a longer duration of fever.The severe group also had higher neutrophil-to-lymphocyte ratio(NLR),systemic immune-inflammation index(SII),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),interleukin-6(IL-6),lactate dehydrogenase(LDH),alanine aminotransferase(ALT),and D-dimer levels.On imaging,atelectasis and large-area pulmonary consolidation were more common in the severe group than in the non-severe group(all P<0.05).Multivariable logistic regression analysis identified atelectasis,large-area pulmonary consolidation,peak body temperature(continuous variable),ESR>40 mm·h-1,and LDH>400 U·L-1 as independent risk factors for severe pneumonia in children with HAdV-MP coinfection(all P<0.05).ROC curve analysis demonstrated good discrimination,with an area under the curve(AUC)of 0.801(95%CI:0.741-0.861).The calibration curve showed good agreement between predicted and observed risks,and the Hosmer-Lemeshow goodness-of-fit test indicated good model fit(χ²=10.19,P=0.252),suggesting good calibration.Conclusion Atelectasis,large-area pulmonary consolidation,higher peak body temperature,ESR>40 mm·h-1,and LDH>400 U·L-1 are independent early predictors of severe pneumonia in children with HAdV-MP coinfection.ROC analysis identified a peak temperature of 39.9℃ as the optimal cutoff value for predicting severe pneumonia.These variables can all be obtained within 24 hours of hospital admission,facilitating early identification of children at high risk for severe pneumonia and providing a basis for timely clinical intervention.