Tools for Predicting Prolonged Hospitalization in Pediatric CAP

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Higher levels of LDH and lower levels of glucose in pleural fluid were both significantly associated with prolonged hospitalizations.
Higher levels of LDH and lower levels of glucose in pleural fluid were both significantly associated with prolonged hospitalizations.

Pleural fluid lactic dehydrogenase (LDH) and glucose are useful parameters for determining severity of pediatric community-acquired complicated pneumonia (PCACP), according to a multicenter observational study published in Chest.

With the incidence of pediatric community-acquired complicated pneumonia (PCACP) on the rise worldwide, the need exists for a useful clinical tool that can help clinicians identify patients who are expected to have a prolonged disease course. The researchers of this study sought to develop and validate a clinical prediction tool for prolonged hospitalization in this patient population.

 

The derivation and validation cohorts comprised 144 and 169 patients with PCACP, respectively. Participants were hospitalized between 1997 and 2017 in 3 tertiary care hospitals in Israel. The investigators used logistic regression analyses to identify those parameters associated with prolonged hospitalization, and to develop and validate a prediction model that would be an appropriate clinical tool.

According to the findings, higher levels of LDH and lower levels of glucose in pleural fluid were both significantly associated with prolonged hospitalizations (P <.026 and P =.018, respectively). When a predictive stepwise logistic regression model was applied to the validation cohort, the area under the curve (AUC) constructed demonstrated that the model retained favorable predictive value (AUC for derivation vs validation data: 0.77 [95% CI, 0.66-0.87] vs 0.82 [95% CI, 0.72-0.91], respectively).

A clinical tool derived from these data uses a combination of the following: pleural LDH >1000 U/L and pleural glucose <1 mmol/L, pleural LDH >2000 U/L and pleural glucose <2 mmol/L, or pleural LDH >3000 U/L and pleural glucose <3 mmol/L is predictive of prolonged hospitalization, with positive and negative predictive values of 78% and 73% (95% CI, 0.71-0.85 and 0.59-0.85, respectively).

The researchers concluded that in pediatric patients, pleural fluid LDH and glucose are both useful parameters for the assessment of PCACP severity. The model developed in this study was able to accurately identify those children who endured prolonged hospitalizations.

Reference

Breuer O, Picard E, Benabu N, et al. Predictors of prolonged hospitalizations in pediatric complicated pneumonia [published online September 21, 2017]. Chest. doi:10.1016/j.chest.2017.09.021

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