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. 2023 Oct 27;10(11):1744.
doi: 10.3390/children10111744.

The Role of Mannose-Binding Lectin and Inflammatory Markers in Establishing the Course and Prognosis of Community-Acquired Pneumonia in Children

Roxana Taraș  1   2 , Beatrice Mahler  3   4 , Mihaela Bălgrădean  1   2 , Diana Derewicz  1   2 , Miruna Ioana Lazăr  2 , Ruxandra Vidlescu  1   2 , Florian Berghea  5   6
Affiliations

The Role of Mannose-Binding Lectin and Inflammatory Markers in Establishing the Course and Prognosis of Community-Acquired Pneumonia in Children

Roxana Taraș et al. Children (Basel). .

Abstract

Background: Community-acquired pneumonia (CAP) is one of the most significant childhood diseases worldwide and a leading infectious cause of death in children. This study aimed to evaluate the prognostic value of the inflammatory markers-C-reactive protein (CRP) and procalcitonin (PCT)-and the polymorphic glycoprotein mannose-binding lectin (MBL), deficiency of which is associated with severe infections, in the determination of the optimal type and timing of therapeutic intervention for CAP in childhood.

Methods: Retrospective evaluation was conducted on a cohort of 204 children aged 4 months-17 years hospitalized with CAP. Their levels of CRP, PCT, and MBL were assessed for their association with a variety of outcomes, including the incidence of local and systemic complications, admission to the ICU, duration of antibiotic treatment and hospital stay, and death.

Results: CRP and PCT proved to be better predictors of complications of CAP than MBL. The area under the curve (AUC) value was highest for PCT as a predictor of systemic complications (AUC = 0.931, 95%CI 0.895-0.967), while CRP (AUC = 0.674, 95%CI 0.586-0.761) performed best as a predictor of local complications (AUC = 0.674, 95%CI 0.586-0.761). Regarding admission to the ICU, CRP was the weakest predictor (AUC = 0.741), while PCT performed the best (AUC = 0.833), followed by MBL (AUC = 0.797). Sensitivity and specificity were calculated for the optimal threshold generated by receiver operating characteristic (ROC) curves, rendering sensitivity of 90% and specificity of 87% for PCT in assessing the risk of systemic complications, compared to sensitivity of 83% and specificity of 90% for CRP. MBL showed relatively high sensitivity (96%) but low specificity (25%) for predicting the need for ICU admission.

Conclusions: Early measurement of CRP, PCT, and MBL provides clinicians with important information regarding the course and prognosis of children diagnosed with CAP, thus ensuring prompt, optimal therapeutic management.

Keywords: C-reactive protein; community-acquired pneumonia; mannose-binding lectin; procalcitonin.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study of children hospitalized with community-acquired pneumonia (CAP) between 2018 and 2020. MBL: mannose-binding lectin, CRP: C-reactive protein, PCT: procalcitonin.
Figure 2
Figure 2
Box plot of the distribution of levels of C-reactive protein (CRP) in children hospitalized with community-acquired pneumonia (N = 204). The “×” sign indicates the mean value.
Figure 3
Figure 3
Receiver operating characteristic (ROC) curves for C-reactive protein (CRP) as a predictor of local (A) and systemic (B) complications of pneumonia and admission to ICU (C) in children hospitalized for community-acquired pneumonia (N = 204).
Figure 4
Figure 4
Box plot of the distribution of levels of procalcitonin (PCT) in children hospitalized with community-acquired pneumonia (N = 204). The “×” sign indicates the mean value.
Figure 5
Figure 5
Receiver operating characteristic (ROC) curves for procalcitonin (PCT) as a predictor of local (A) and systemic (B) complications of pneumonia and admission to ICU (C) in children hospitalized for community-acquired pneumonia (N = 204).
Figure 6
Figure 6
Box plot of the distribution of levels of mannose-binding lectin (MBL) in children hospitalized with community-acquired pneumonia (N = 204). The “×” sign indicates the mean value.
Figure 7
Figure 7
Receiver operating characteristic (ROC) curves for mannose-binding lectin (MBL) as a predictor of local (A) and systemic (B) complications of pneumonia and admission to ICU (C) in children hospitalized for community-acquired pneumonia (N = 204).
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