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Published on: June 28, 2018
The Clinical Risk Factors of Adenovirus Pneumonia in Children Based on the Logistic Regression Model: Correlation
Yuqiao Liu1, Yang Shen1, Botao Wei1
1Department of Infectious Diseases, Tianjin Children's Hospital, 238 Longyan Road, Beichen District, Tianjin, China.
Insights
Lactate dehydrogenase (LDH) levels, age, and hospital stay effectively differentiate bacterial from adenovirus pneumonia in children. This predictive model aids in personalized treatment strategies for pediatric pneumonia.
Area of Science:
- Pediatric Infectious Diseases
- Respiratory Medicine
- Clinical Diagnostics
Background:
- Distinguishing between bacterial and viral pneumonia in children is crucial for appropriate treatment.
- Adenovirus pneumonia and bacterial pneumonia present overlapping symptoms, complicating diagnosis.
- Identifying reliable clinical markers can improve diagnostic accuracy and patient management.
Purpose of the Study:
- To compare clinical characteristics of bacterial and adenovirus pneumonia in hospitalized children.
- To develop and validate a predictive model for differentiating these two pneumonia types.
- To identify key factors associated with each pneumonia type for guiding clinical decisions.
Main Methods:
- Retrospective analysis of 220 children (41 bacterial, 179 adenovirus pneumonia) hospitalized between January-October 2020.
- Comparison of baseline and clinical characteristics using chi-square and Wilcox tests.
- Application of a Least Absolute Shrinkage and Selection Operator (LASSO) model for feature selection, followed by logistic regression model construction and validation using Receiver Operating Characteristic (ROC) curves and Area Under Curve (AUC).
Main Results:
- Significant differences observed in age, hospital stay duration, tonsil condition, Interleukin-6 (IL-6), and Lactate Dehydrogenase (LDH) levels between the two groups.
- Factors associated with pneumonia type included sex, tonsil condition, age, hospital stay, r-glutamyltransferase (r-GT), and LDH.
- Adenovirus pneumonia cases were characterized by younger age, longer hospital stays, and higher LDH levels compared to bacterial pneumonia. The predictive model achieved 92.4% accuracy with an AUC of 0.981.
Conclusions:
- Lactate dehydrogenase (LDH) level is a key associated factor for predicting pneumonia type in children.
- Adenovirus pneumonia is associated with younger age and longer hospital stays compared to bacterial pneumonia.
- The developed predictive model demonstrates high efficacy in differentiating pediatric pneumonia types, supporting individualized treatment approaches.
Methods:
Children with bacterial pneumonia (41 cases) and adenovirus pneumonia (179 cases) hospitalized in Tianjin Children's Hospital from January to October 2020 were selected. The differences in baseline and clinical characteristics between children with two pneumonias, respectively, were compared via the chi-square test and Wilcox test. The Least Absolute Shrinkage and Selection Operator (LASSO) model was applied to screen the pneumonia type-related characteristics. Patients were randomly divided into the training set (n = 154) and test set (n = 66). The logistic model was constructed using the screened characteristics in the training set to predict whether the cases are bacterial pneumonia or adenovirus pneumonia. Finally, the model was validated by receiver operating characteristic (ROC) curve and area under curve (AUC) in the test set.
Results:
The age (p < 0.001), hospital stay (p < 0.001), tonsil condition (p < 0.001), interleukin-6 (IL-6; p=0.033), and lactate dehydrogenase (LDH; p < 0.001) between children with bacterial pneumonia and adenovirus pneumonia were significantly different. Sex, tonsil condition, age, hospital stay, r-glutamyltransferase (r-GT), and LDH levels were the factors associated with the types of pneumonia. Compared with bacterial pneumonia, children with adenovirus pneumonia were younger (OR = 0.207, 95% CI: 0.041-0.475), with longer hospital stay (OR = 7.974, 95% CI: 2.626-74.354) and higher LDH expression level (OR = 1.025, 95% CI: 1.006-1.060). 92.4% types of pneumonia were correctly predicted, and the AUC value of the model was 0.981.
Conclusion:
The LDH level was the associated factor to predict the types of pneumonia. Adenovirus pneumonia was associated with earlier age and longer hospital stay than bacterial pneumonia. The established model can well predict the types of pneumonia in children and provide clinical basis for guiding the individualized treatment of children.
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