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Observational Study
. 2024 Oct 23:14:1398152.
doi: 10.3389/fcimb.2024.1398152. eCollection 2024.

Risk factors for identifying pneumocystis pneumonia in pediatric patients

Chunyan Zhang #  1   2 , Zheng Li #  1   2 , Xiao Chen  3 , Mengyuan Wang  1   2 , Enhui Yang  4 , Huan Xu  4 , Shifu Wang  1   2
Affiliations
Observational Study

Risk factors for identifying pneumocystis pneumonia in pediatric patients

Chunyan Zhang et al. Front Cell Infect Microbiol. .

Abstract

Objectives: This study aimed to identify the risk factors and construct the diagnostic model associated with pneumocystis pneumonia (PCP) in pediatric patients.

Methods: This retrospective observational study analyzed 34 cases of PCP and 51 cases of other types of pneumonia treated at Children's Hospital Affiliated to Shandong University between January 2021 and August 2023. Multivariate binary logistic regression was used to identify the risk factors associated with PCP. Receiver operating characteristic curves and calibration plots were constructed to evaluate the diagnostic model.

Results: Twenty clinical variables significantly differed between the PCP and non-PCP groups. Multivariate binary logistic regression analysis revealed that dyspnea, body temperature>36.5°C, and age<1.46 years old were risk factors for PCP. The area under the curve of the diagnostic model was 0.958, the P-value of Hosmer-Lemeshow calibration test was 0.346, the R2 of the calibration plot for the actual and predicted probability of PCP was 0.9555 (P<0.001), and the mean Brier score was 0.069. In addition, metagenomic next-generation sequencing revealed 79.41% (27/34) and 52.93% (28/53) mixed infections in the PCP and non-PCP groups, respectively. There was significantly more co-infection with cytomegalovirus and Streptococcus pneumoniae in the PCP group than that in the non-PCP group (p<0.05).

Conclusions: Dyspnea, body temperature>36.5°C, and age<1.46 years old were found to be independent risk factors for PCP in pediatric patients. The probability of co-infection with cytomegalovirus and S. pneumoniae in the PCP group was significantly higher than that in the non-PCP group.

Keywords: area under the curve; metagenomic next-generation sequencing; pediatric; pneumocystis pneumonia; receiver operating characteristic curve.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Forest map of 20 risk factors identified in the univariate logistic analysis for the PCP group. APTT, activated partial thromboplastin time; AST, aspartate aminotransferase.
Figure 2
Figure 2
Forest map of 3 risk factors identified by the multivariate logistic analysis for the PCP group.
Figure 3
Figure 3
Validation of the model for predicting PCP probability. (A) The area under the receiver operating characteristic curve was 0.958, 0.905, 0.813, and 0.702 for the model group, dyspnea group, and age and body temperature group, respectively. (B) The calibration plot indicated that the predicted probability of PCP had a moderate agreement with the actual observed outcome (R2 = 0.9555, P<0.001).
Figure 4
Figure 4
(A) The mixed infections were identified by mNGS in the PCP group. (B) The mixed infections were identified by mNGS in the non-PCP group. (C) Comparative analysis of major co-pathogenic in PCP group and non-PCP group (** Indicates p<0.01).
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