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Association of complete blood count parameters with adverse outcomes in acute pediatric pneumonia
Lin Han1,2, Ying Yang1, Yanhao Huang1
1Department of Respiratory Medicine Children's Hospital of Chongqing Medical University, National Clinical Research Center for Children and Adolescents' Health and Diseases, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing, China.
Insights
Complete blood count parameters like neutrophil-to-lymphocyte ratio (NLR) and hemoglobin (Hb) can predict adverse outcomes in pediatric pneumonia. These accessible biomarkers aid in rapid risk assessment, especially in resource-limited settings.
Area of Science:
- Pediatric Medicine
- Hematology
- Clinical Diagnostics
Background:
- Pediatric pneumonia is a major global cause of mortality in children under five.
- Complete blood count (CBC) parameters show potential as early indicators of clinical deterioration.
- Identifying cost-effective biomarkers for adverse outcome prediction in pediatric pneumonia is crucial for primary care settings.
Purpose of the Study:
- To identify reliable and accessible biomarkers for predicting adverse outcomes in pediatric pneumonia.
- To evaluate the predictive performance of seven CBC parameters in pediatric pneumonia cases.
- To assess the utility of CBC parameters for risk stratification in resource-limited settings.
Main Methods:
- Retrospective case-control study of 15,359 pediatric pneumonia admissions (2015-2022).
- Analysis of seven CBC parameters: hemoglobin (Hb), platelet (PLT), neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), absolute neutrophil count (ANC), lymphocyte absolute value (LYM), and white blood cell count (WBC).
- Utilized restricted cubic splines, multivariable logistic regression, and ROC curve analysis to correlate CBC parameters with adverse outcomes.
Main Results:
- Severe pediatric pneumonia cases showed reduced Hb, PLT, and LYM, with elevated RDW, ANC, and NLR.
- Multivariable analysis identified Hb and PLT as negative predictors, and NLR and RDW as positive predictors of adverse outcomes.
- Neutrophil-to-lymphocyte ratio (NLR) exhibited the strongest predictive performance, followed by Hb; their combination further improved prediction.
Conclusions:
- Complete blood count parameters, particularly NLR and Hb, are robust predictors of adverse outcomes in pediatric pneumonia.
- These readily available and low-cost indices can be integrated into risk stratification protocols.
- The findings offer a practical tool for rapid triage and clinical decision-making in primary and resource-limited care settings.
Background:
Pediatric pneumonia remains a leading cause of under-5 mortality worldwide. Emerging evidence suggests that complete blood count (CBC) parameters may serve as predictive indicators for acute clinical deterioration. This study aimed to identify a cost-effective, rapid, and reliable biomarker for predicting adverse outcomes in pediatric pneumonia within outpatient and primary care settings.
Methods:
This retrospective case-control study analyzed 15,359 pediatric pneumonia admissions at a tertiary hospital between 2015 and 2022. Using restricted cubic splines (RCS), multivariable logistic regression, and receiver operating characteristic (ROC) curve, this study evaluated the correlation between seven CBC parameters - hemoglobin (Hb), platelet (PLT), neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), absolute neutrophil count (ANC), lymphocyte absolute value (LYM), and white blood cell count (WBC) - and adverse outcomes in pediatric pneumonia.
Results:
Severe cases exhibited reduced Hb, PLT, and LYM (all P < 0.001) and elevated RDW, ANC, and NLR (all P < 0.001). Multivariable logistic analysis identified Hb and PLT as independent negative predictors, while NLR and RDW as independent positive predictors for adverse outcomes (P < 0.001). NLR demonstrated superior predictive performance, followed by Hb. Combining NLR and Hb significantly enhanced predictive capacity.
Conclusions:
We found that CBC parameters, particularly NLR and Hb, were robust, accessible predictors of adverse outcomes in pediatric pneumonia. Their integration into risk stratification protocols could optimize clinical decision-making, especially in resource-limited settings.
Impact:
This study identified Hb, PLT, NLR, and RDW as independent predictors of adverse outcomes in pediatric pneumonia. NLR demonstrated the strongest predictive performance, and its combination with Hb significantly enhanced risk stratification These low-cost, readily available indices offered a practical tool for rapid triage in primary care and resource-constrained settings.
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