Changes in immune function and prognostic risk factors for severe pneumonia in children

doi:10.3969/j.issn.1004-583X.2023.06.007

Abstract

Abstract:

Objective To investigate the prognostic factors of severe pneumonia in children. Methods It was a retrospective analysis involving 152 children with severe pneumonia in the pediatric intensive care unit (PICU), Quanzhou First Hospital affiliated to Fujian Medical University from December 2019 to December 2021. According to the outcome after treatment, the patients were allocated to complete remission group and incomplete remission group (partial remission or death). Clinical data like gender, age, onset season, pediatric critical illness score (PCIS) with in 24 hours after admission, laboratory examination, length of stay, blood routine, C-reactive protein (CRP), treatment and outcome were compared between groups. Immune levels in children with different prognosis were analyzed, and influencing factors for the prognosis were identified by Logistic regression analysis.Resultss There were significant differences in age, onset season, length of stay, white blood cell count, CRP, and PCIS scores between the both groups ( P <0.05). The proportion of children with low levels of CD3⁺, CD4⁺, CD8⁺T lymphocytes, B lymphocytes, IgG, IgM and IgA in the incomplete remission group was significantly higher than that in the complete remission group ( P <0.05). Logistic regression analysis showed that age, onset season, PCIS score, CD4⁺ and IgG levels were important factors affecting the prognosis of severe pneumonia in children ( P <0.05). Conclusion Children with severe pneumonia who are young, with the onset season of autumn and winter, low PCIS score, and accompanied by low levels of CD4⁺ and IgG have a poor prognosis.

Key words: pneumonia, children, immunity, prognosis

CLC Number:

R563.1

Sun Xingxing, Lin Hai. Changes in immune function and prognostic risk factors for severe pneumonia in children[J]. Clinical Focus, 2023, 38(6): 521-525.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.06.007

https://huicui.hebmu.edu.cn/EN/Y2023/V38/I6/521

Figures/Tables 4

Tab.1 Comparison of general data between groups

组别	例数	性别[例(%)]		年龄 (月)	住院天数 (天)	发病季节[例(%)]				白细胞计数 (×10⁹/L)	CRP (mg/L)
组别	例数	男	女	年龄 (月)	住院天数 (天)	春季	夏季	秋季	冬季	白细胞计数 (×10⁹/L)	CRP (mg/L)
完全缓解组	104	56(53.8)	48(46.2)	10.00(3.25,63.00)	6.18±3.90	9(8.6)	9(8.6)	31(29.8)	55(52.9)	11.16±5.76	8.30(0.55,20.58)
未完全缓解组	48	24(50.0)	24(50.0)	12.00(6.25,32.50)	8.19±5.93	6(12.5)	11(22.9)	16(33.3)	15(31.2)	14.21±8.77	34.63(0.90,91.17)
$t$ / $Z$ /χ²值		0.193		1.414	-2.479	6.632				-2.556	2.553
$P$ 值		0.661		0.037	0.014	0.029				0.012	<0.01

Tab.1 Comparison of general data between groups

组别	例数	性别[例(%)]		年龄 (月)	住院天数 (天)	发病季节[例(%)]				白细胞计数 (×10⁹/L)	CRP (mg/L)
组别	例数	男	女	年龄 (月)	住院天数 (天)	春季	夏季	秋季	冬季	白细胞计数 (×10⁹/L)	CRP (mg/L)
完全缓解组	104	56(53.8)	48(46.2)	10.00(3.25,63.00)	6.18±3.90	9(8.6)	9(8.6)	31(29.8)	55(52.9)	11.16±5.76	8.30(0.55,20.58)
未完全缓解组	48	24(50.0)	24(50.0)	12.00(6.25,32.50)	8.19±5.93	6(12.5)	11(22.9)	16(33.3)	15(31.2)	14.21±8.77	34.63(0.90,91.17)
$t$ / $Z$ /χ²值		0.193		1.414	-2.479	6.632				-2.556	2.553
$P$ 值		0.661		0.037	0.014	0.029				0.012	<0.01

Tab.2 Comparison of PCIS scores between groups

组别	例数	PCIS评分 (分)	PCIS分级[例(%)]
组别	例数	PCIS评分 (分)	危重	极危重
完全缓解组	104	85.11±2.87	104(100.0)	0
未完全缓解组	48	76.71±7.35	44(91.7)	4(8.3)
$t$ 值		10.14	-
$P$ 值		<0.01	0.009

Tab.2 Comparison of PCIS scores between groups

组别	例数	PCIS评分 (分)	PCIS分级[例(%)]
组别	例数	PCIS评分 (分)	危重	极危重
完全缓解组	104	85.11±2.87	104(100.0)	0
未完全缓解组	48	76.71±7.35	44(91.7)	4(8.3)
$t$ 值		10.14	-
$P$ 值		<0.01	0.009

Tab.3 Comparison of lymphocyte and immunoglobulin levels between groups [cases (%)]

组别	例数		CD3⁺			CD4⁺				CD8⁺			B
组别	例数		低水平	正常		低水平		正常		低水平	正常		低水平		正常
完全缓解组	104		0	104(100.0)		0		104(100.0)		0	104(100.0)		3(2.9)		101(97.1)
未完全缓解组	48		3(6.3)	45(93.7)		5(6.3)		43(93.7)		6(12.5)	42(87.5)		8(16.7)		40(83.3)
χ²值			7.048			11.900				14.375			8.515
$P$ 值			0.008			0.001				<0.01			0.004
组别		IgG					IgM					IgA
组别		低水平			正常		低水平		正常			低水平		正常
完全缓解组		12(11.5)			92(88.5)		5(4.8)		99(95.2)			5(4.8)		99(95.2)
未完全缓解组		12(25.0)			36(75.0)		8(16.7)		40(83.3)			10(20.8)		38(79.2)
χ²值		4.223					5.428					8.711
$P$ 值		0.040					0.020					0.003

Tab.3 Comparison of lymphocyte and immunoglobulin levels between groups [cases (%)]

组别	例数		CD3⁺			CD4⁺				CD8⁺			B
组别	例数		低水平	正常		低水平		正常		低水平	正常		低水平		正常
完全缓解组	104		0	104(100.0)		0		104(100.0)		0	104(100.0)		3(2.9)		101(97.1)
未完全缓解组	48		3(6.3)	45(93.7)		5(6.3)		43(93.7)		6(12.5)	42(87.5)		8(16.7)		40(83.3)
χ²值			7.048			11.900				14.375			8.515
$P$ 值			0.008			0.001				<0.01			0.004
组别		IgG					IgM					IgA
组别		低水平			正常		低水平		正常			低水平		正常
完全缓解组		12(11.5)			92(88.5)		5(4.8)		99(95.2)			5(4.8)		99(95.2)
未完全缓解组		12(25.0)			36(75.0)		8(16.7)		40(83.3)			10(20.8)		38(79.2)
χ²值		4.223					5.428					8.711
$P$ 值		0.040					0.020					0.003

Tab.4 Analysis of prognostic risk factors

因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	-0.120	0.034	12.615	<0.01	0.888	0.830	0.948
发病季节	-0.844	0.421	4.029	0.045	0.430	0.189	0.980
PCIS评分	-0.749	0.168	19.854	<0.01	0.473	0.340	0.657
CD4⁺	-0.003	0.001	13.879	<0.01	0.997	0.996	0.999
IgG	0.639	0.244	6.856	0.009	1.894	1.174	3.055

Tab.4 Analysis of prognostic risk factors

因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	-0.120	0.034	12.615	<0.01	0.888	0.830	0.948
发病季节	-0.844	0.421	4.029	0.045	0.430	0.189	0.980
PCIS评分	-0.749	0.168	19.854	<0.01	0.473	0.340	0.657
CD4⁺	-0.003	0.001	13.879	<0.01	0.997	0.996	0.999
IgG	0.639	0.244	6.856	0.009	1.894	1.174	3.055

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