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Predictors of Prolonged Hospitalizations in Pediatric Complicated Pneumonia
Oded Breuer1, Elie Picard2, Naama Benabu3
1Department of Pediatrics and Pediatric Pulmonology, Hadassah-Hebrew University Medical Center, The Hebrew University, Jerusalem, Israel.
Insights
In pediatric community-acquired complicated pneumonia (PCACP), pleural fluid lactate dehydrogenase (LDH) and glucose levels can predict prolonged hospital stays. This study developed a clinical tool to identify children at risk for extended hospitalization.
Area of Science:
- Pediatric Pulmonology
- Clinical Prediction Modeling
- Infectious Diseases
Background:
- Pediatric community-acquired complicated pneumonia (PCACP) often presents with a variable and prolonged clinical course.
- Accurate prediction of hospitalization duration is crucial for resource allocation and patient management.
Purpose of the Study:
- To develop and validate a clinical prediction tool for prolonged hospitalizations in pediatric community-acquired complicated pneumonia (PCACP).
Main Methods:
- A multicenter observational study involving 144 (derivation) and 169 (validation) pediatric patients with PCACP.
- Logistic regression analyses were employed to identify predictors of prolonged hospitalization and construct a predictive model.
- The model's performance was assessed using the area under the receiver operating characteristic curve (AUROC).
Main Results:
- Elevated pleural fluid lactate dehydrogenase (LDH) and decreased glucose levels were significantly associated with prolonged hospitalizations.
- The developed prediction model demonstrated good predictive value in both derivation (AUROC 0.77) and validation (AUROC 0.82) cohorts.
- A clinical tool combining specific pleural fluid LDH and glucose thresholds accurately predicted prolonged hospitalizations (positive predictive value 78%).
Conclusions:
- Pleural fluid LDH and glucose levels are valuable biomarkers for assessing PCACP severity in children.
- The developed clinical prediction tool effectively identifies pediatric patients likely to experience prolonged hospitalizations.
Background:
Pediatric community-acquired complicated pneumonia (PCACP) is characterized by a prolonged clinical course, but this may be highly variable.
Methods:
A multicenter observational study was conducted to develop and validate a clinical prediction tool for prolonged hospitalizations in PCACP. The derivation and validation cohorts consisted of 144 and 169 patients with PCACP, respectively, hospitalized between the years 1997 and 2017 in three tertiary care hospitals. Logistic regression analyses were used to identify parameters associated with a prolonged hospitalization and to develop and validate a prediction model for constructing a useful clinical tool.
Results:
Higher levels of lactate dehydrogenase (LDH) (P < .026) and lower levels of glucose (P = .018) in pleural fluid were significantly associated with prolonged hospitalization. A predictive stepwise logistic regression model was developed and applied to the validation cohort. The area under the receiver operating characteristic curve (AUROC) constructed indicated that the model retained good predictive value (AUROC for the derivation vs validation data, [0.77 (95% CI, 0.66-0.87) vs 0.82 (95% CI, 0.72-0.91)], respectively). From these data, a clinical tool was derived; the combination of pleural LDH >1,000 units/L and pleural glucose levels < 1 mmol/L or pleural LDH levels > 2,000 units/L and pleural glucose levels < 2 mmol/L or pleural LDH levels > 3,000 units/L and pleural glucose < 3 mmol/L predict prolonged hospitalization with positive and negative predictive values of 78% (95% CI, 0.71-0.85) and 73% (95% CI, 0.59-0.85), respectively.
Conclusions:
In children, pleural fluid LDH and glucose levels are useful parameters for assessing the severity of PCACP. The model developed in this study accurately predicts patients who will have prolonged hospitalization.
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