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Diagnostic accuracy of time to first positivity of blood cultures for predicting severe clinical outcomes in children with pneumonia-related bacteremia
  1. Yin Zhang,
  2. Jilei Lin,
  3. Qingxia Shi,
  4. Chulin Li,
  5. Jingyue Liu,
  6. Jihong Dai
  1. Department of Respiratory Disease, Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Children’s Hospital of Chongqing Medical University, Chongqing, China
  1. Correspondence to Professor Jihong Dai, Department of Respiratory Disease, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China; danieljh{at}163.com

Abstract

Early recognition of severe clinical outcomes in children with pneumonia-related bacteremia is vitally important because of the high mortality. This study aims to explore risk factors for severe clinical outcomes in children with pneumonia-related bacteremia and evaluate the value of time to first positive blood cultures (TTFP) in predicting prognosis. Children with pneumonia-related bacteremia in Children’s Hospital of Chongqing Medical University were included (January 2013–May 2019), respectively. TTFP and clinical parameters were collected and analyzed. The area under the curve (AUC)-receiver operating characteristic was used to evaluate the discrimination ability of TTFP. Multivariate logistic regression tests were performed to evaluate the association between TTFP and severe clinical outcomes. A total of 242 children with pneumonia-related bacteremia were included. The least absolute shrinkage and selection operator (LASSO) regression analysis identified TTFP, serum albumin (ALB) and lactic dehydrogenase (LDH) as predictors of in-hospital mortality. Multivariate logistic regression analysis showed that shorter TTFP (OR 0.94; 95% CI 0.89 to 0.97; p<0.01), lower ALB level (OR 0.93; 95% CI 0.89 to 0.98; p<0.01) and higher LDH level (OR 1.001; 95% CI 1.000 to 1.001; p<0.01) were risk factors for in-hospital mortality in children with pneumonia-related bacteremia. AUC of TTFP for predicting in-hospital mortality was 0.748 (95% CI 0.668 to 0.829). Shorter TTFP (≤16 hours) was associated with in-hospital mortality and septic shock. TTFP plays an important role in predicting severe clinical outcomes in children with pneumonia-related bacteremia.

  • bacterial infections
  • pneumonia
  • bacterial
  • serum albumin

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Footnotes

  • Contributors Conceptualization: YZ, JL and JD. Methodology: JL, JD. Validation: YZ and JD. Formal analysis: YZ and JL. Investigation: QS, JL and CL. Data curation: QS, JL and CL. Writing—original draft preparation: YZ and JL. Writing—review and editing: YZ and JD.

  • Funding Natural Science Foundation of Science and Technology Department in Guizhou Province (Grant No. 20152154).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study design was approved by the ethics committee of Children’s Hospital of Chongqing Medical University (No. 2019221) and conducted according to the Declaration of Helsinki guidelines.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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