PDF(Pubmed)
Abstract：
UNASSIGNED: Current prognostic tools do not reliably and objectively identify children with pneumonia at risk of a severe or life-threatening episode. Heparin-binding protein (HBP) is a host immune protein that is released in response to infection. We hypothesized that measuring HBP concentrations at hospital admission could help risk-stratify children with pneumonia and identify those at higher risk of an adverse prognosis.
UNASSIGNED: We evaluated the prognostic accuracy of HBP for predicting in-hospital mortality among children with respiratory distress, and whether HBP could improve the accuracy of validated composite clinical severity scores.
UNASSIGNED: Of 778 Ugandan children under 5 years of age and presenting with clinically defined pneumonia, 60 (7.7%) died during hospital admission. HBP concentrations at presentation were significantly higher in children with fatal outcomes (median, 76 ng/mL [interquartile range {IQR}, 41-150]) compared to children who survived (median, 31 ng/mL [IQR, 18-57]) (P < .001). Children with HBP >41 ng/mL on admission had an elevated risk of death (hazard ratio, 5.3 [95% confidence interval {CI}, 2.9-9.5]; P < .0001). In receiver operating characteristic (ROC) curve analysis, HBP concentrations distinguished between fatal and nonfatal outcomes (area under the ROC curve, 0.75 [95% CI, .66-.84]) and significantly improved the prediction provided by the Respiratory Index of Severity in Children, a composite clinical severity score (P = .0026).
UNASSIGNED: Measuring HBP at presentation could help identify children at risk of severe and fatal pneumonia. Adding HBP to clinical scores could improve the recognition and triage of children with pneumonia at risk of death.
UNASSIGNED: We evaluated the prognostic accuracy of HBP for predicting in-hospital mortality among children with respiratory distress, and whether HBP could improve the accuracy of validated composite clinical severity scores.
UNASSIGNED: Of 778 Ugandan children under 5 years of age and presenting with clinically defined pneumonia, 60 (7.7%) died during hospital admission. HBP concentrations at presentation were significantly higher in children with fatal outcomes (median, 76 ng/mL [interquartile range {IQR}, 41-150]) compared to children who survived (median, 31 ng/mL [IQR, 18-57]) (P < .001). Children with HBP >41 ng/mL on admission had an elevated risk of death (hazard ratio, 5.3 [95% confidence interval {CI}, 2.9-9.5]; P < .0001). In receiver operating characteristic (ROC) curve analysis, HBP concentrations distinguished between fatal and nonfatal outcomes (area under the ROC curve, 0.75 [95% CI, .66-.84]) and significantly improved the prediction provided by the Respiratory Index of Severity in Children, a composite clinical severity score (P = .0026).
UNASSIGNED: Measuring HBP at presentation could help identify children at risk of severe and fatal pneumonia. Adding HBP to clinical scores could improve the recognition and triage of children with pneumonia at risk of death.
摘要：
■目前的预后工具不能可靠和客观地确定肺炎患儿有严重或危及生命的风险。肝素结合蛋白(HBP)是响应于感染而释放的宿主免疫蛋白。我们假设，在入院时测量HBP浓度可以帮助肺炎患儿进行风险分层，并确定不良预后风险较高的患儿。
我们评估了HBP预测呼吸窘迫患儿住院死亡率的准确性，以及HBP是否可以提高经过验证的复合临床严重程度评分的准确性。
■在778名5岁以下的乌干达儿童中，60人（7.7％）在住院期间死亡。在出现致命结局的儿童中，HBP浓度显着升高（中位数，76ng/mL[四分位距{IQR}，41-150])与幸存的儿童(中位数，31ng/mL[IQR，18-57]）（P<.001）。入院时HBP>41ng/mL的儿童死亡风险升高(风险比，5.3[95%置信区间{CI}，2.9-9.5]；P<.0001）。在接收器工作特性(ROC)曲线分析中，HBP浓度在致命和非致命结局之间有区别（ROC曲线下面积，0.75[95%CI，.66-.84])，并显著提高了儿童严重程度呼吸指数提供的预测，复合临床严重程度评分（P=.0026）。
■在就诊时测量HBP可以帮助识别有严重和致命肺炎风险的儿童。在临床评分中加入HBP可以提高对有死亡风险的肺炎患儿的认识和分诊。
我们评估了HBP预测呼吸窘迫患儿住院死亡率的准确性，以及HBP是否可以提高经过验证的复合临床严重程度评分的准确性。
■在778名5岁以下的乌干达儿童中，60人（7.7％）在住院期间死亡。在出现致命结局的儿童中，HBP浓度显着升高（中位数，76ng/mL[四分位距{IQR}，41-150])与幸存的儿童(中位数，31ng/mL[IQR，18-57]）（P<.001）。入院时HBP>41ng/mL的儿童死亡风险升高(风险比，5.3[95%置信区间{CI}，2.9-9.5]；P<.0001）。在接收器工作特性(ROC)曲线分析中，HBP浓度在致命和非致命结局之间有区别（ROC曲线下面积，0.75[95%CI，.66-.84])，并显著提高了儿童严重程度呼吸指数提供的预测，复合临床严重程度评分（P=.0026）。
■在就诊时测量HBP可以帮助识别有严重和致命肺炎风险的儿童。在临床评分中加入HBP可以提高对有死亡风险的肺炎患儿的认识和分诊。
