Zhongguo quanke yixue (Mar 2022)
The Study of the Value of High Mobility Group Protein B1 Combined with Acute Physiological Score in the Diagnosis and Prognosis of Children with Severe Pneumonia
Abstract
BackgroundSevere pneumonia in children is a common respiratory critical illness, and accurate assessment of its prognosis is the key to reasonable clinical decision-making. High mobility group protein B1 (HMGB1) and acute physiology score (APS) have high prognostic significance for adult critically ill patients, but the value of diagnosis and prognosis in children with severe pneumonia is still unclear.ObjectiveTo investigate the value of HMGB1 combined with APS in the diagnosis and prognosis of children with severe pneumonia.MethodsThe data of 55 children with severe pneumonia (severe pneumonia group) treated in Children's Hospital affiliated to Zhengzhou University from May 2020 to February 2021 were collected and the childrenwere divided into the improvement subgroup (n=41) and the poor outcome subgroup (n=14) according to the prognosis. Data of 60 children with common pneumonia (common pneumonia group) and 40 children with healthy physical examination (control group) who were treated in this hospital during the same period. The APS score and HMGB1 level at admission of each groupwere compared. The correlation between APS and HMGB1 was analyzed. The risk factors affecting the prognosis of severe pneumonia were analyzed by multivariate Logistic regression. The value of HMGB1, APS and combined variables in the diagnosis and prognosis of children with severe pneumonia was analyzed by ROC curve.ResultsThe HMGB1 level and APS score of the severe pneumonia group were significantly higher than those of the normal pneumonia group (P<0.05) ; the HMGB1 level and APS score of the poor prognosis subgroup were significantly higher than those of the prognosis subgroup (P<0.05) . The results of correlation analysis showed that there was a positive correlation between HMGB1 and APS in severe pneumonia group (r=0.542, P<0.001) . Multivariate Logistic regression analysis showed that HMGB1 level〔OR=8.411, 95%CI (1.411, 50.137) , P<0.05〕, APS score〔OR=5.724, 95%CI (1.108, 29.572) , P<0.05〕 were the influence factors for poor prognosis in children with severe pneumonia. The area under ROC curve for the combined diagnosis of HMGB1 and APS for the diagnostic value was 0.975〔95%CI (0.918, 0.996) 〕, and the optimal cut-off value was -0.203, and the sensitivity was 98.18%, and the specificity was 96.67%. The area under ROC curve for the combined diagnosis of HMGB1 and APS for the prognosis of pneumonia was 0.923〔95%CI (0.819, 0.978) 〕, and the optimal cut-off value was -0.030, and the sensitivity was 97.56%, and the specificity was 92.86%.ConclusionBoth HMGB1 level and APS score at admission are influence factors for the poor prognosis of severe pneumonia, and the combination of the two can further improve the diagnostic performance and prognosis of pneumonia.
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