儿童社区获得性肺炎住院时间的影响因素分析

Influencing factors for length of hospital stay in children with community-acquired pneumonia

摘要:

目的 通过对社区获得性肺炎(community acquired pneumonia, CAP)患儿的临床资料进行回顾性分析，探讨CAP患儿住院时间的影响因素。方法 本研究对象为2018年8月—2019年7月在上海交通大学医学院附属儿童医院呼吸科收治住院的942例CAP患儿，根据本研究对象住院时间的中位数，将其分为两组: ≤7 d组（441例），>7 d组（501例），将两组患儿一般资料、入院后首次实验室检查指标、发热天数、影像学病变部位及病原学感染情况等因素与住院时间的关系进行分析，首先进行单因素分析，将符合条件的自变量(P<0.05)再纳入多因素Logistic回归分析，通过受试者工作特征曲线(ROC)分析其对CAP患儿住院时间>7 d的预测价值。结果 两组患儿一般资料(年龄)、影像学病变部位、病原学感染情况、发热天数及入院后首次实验室检查指标: 白细胞计数(white blood cell count, WBC)、中性粒细胞百分比(neutrophil percentage, NEUT)、嗜酸性粒细胞绝对值(absolute eosinophil counts, EOS)、C反应蛋白(C-reactive protein, CRP)、降钙素原(procalcitonin, PCT)、血沉(erythrocyte sedimentation rate, ESR)、肌酸激酶同工酶(creatine kinase-isoenzyme MB, CK-MB)、乳酸脱氢酶(lactate dehydrogenase, LDH)、血尿素氮(blood urea nitrogen, BUN)及肌酐(serum creatinine, Scr)比较，差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示影像学病变部位、病原学感染情况、发热天数、NEUT、CRP、ESR是CAP患儿住院时间>7 d独立危险因素。发热天数、NEUT、CRP、ESR预测CAP患儿住院时间>7 d的ROC面积分别为0.69(95%CI: 0.650.72, P<0.01)、0.63(95%CI: 0.590.66, P<0.01)、0.63(95%CI: 0.590.66, P<0.01)、0.60(95%CI: 0.560.63, P<0.01)。结论 CAP患儿住院时间受多种因素影响，发热天数、入院后首次实验室检查指标(NEUT、CRP、PCT、ESR、LDH、Scr)与住院时间具有正相关性(P<0.05)，但发热天数、NEUT、CRP、ESR对CAP患儿住院时间>7 d预测效能不高，尚不能作为预测指标。

Abstract:

Objective To investigate the factors influencing the length of hospital stay in children with community-acquired pneumonia(CAP). Methods The clinical data of 942 children with CAP admitted to the Shanghai Children’s Hospital from August 2018 to July 2019 were retrospectively analyzed. The length of stay was ≤7 d in 441 cases and >7 d in 501 cases. The associations of demographic characteristics, laboratory and radiographic findings at admission, days of fever, and pathogens of infection with the length of hospital stay were examined by univariate and multivariate logistic regression analysis. Results There were significant differences in age, infection sites by radiograph, pathogens of infection, days of fever, and white blood cell count(WBC), neutrophil percentage(NEUT), eosinophils(EOS), C-reactive protein(CRP), procalcitonin(PCT), erythrocyte sedimentation rate(ESR), creatine kinase-isoenzyme MB(CK-MB), lactate dehydrogenase(LDH), blood urea nitrogen(BUN) and serum creatinine(Scr) between the two groups(all P<0.05). Multivariate logistic regression analysis showed that multiple infection sites, co-pathogenic infections, more days of fever, and elevated NEUT, CRP, and ESR were independent risk factors for the length of hospital stay >7 d in children with CAP. The areas under the ROC curve(AUC) of fever days, NEUT, CRP, and ESR for predicting length of stay >7 days was 0.69(95%CI: 0.65-0.72, P<0.01), 0.63(95%CI: 0.59-0.66, P<0.01), 0.63(95%CI: 0.59-0.66, P<0.01), 0.60(95%CI: 0.56-0.63, P<0.01), and 0.60(95%CI: 0.56-0.63, P<0.01), respectively. Conclusion The number of fever days, and the NEUT, CRP, PCT, ESR, LDH, Scr levels at admission are positively correlated with the length of hospital stay in children with CAP. However, fever days, NEUT, CRP, and ESR are not effective indicators for predicting the length of stay.