Pleural fluid LDH, glucose predict prolonged hospitalization in PCACP
Pleural fluid lactic dehydrogenase (LDH) and glucose are useful parameters for evaluating severity of paediatric community acquired complicated pneumonia (PCACP), according to a study. Measurements of both parameters strongly correlate with prolonged hospitalization as an indirect indicator of disease severity.
Researchers conducted a multicentre observational study to develop and validate a clinical prediction tool for prolonged hospitalizations in PCACP. Logistic regression and predictive stepwise logistic regression analyses were used to identify parameters associated with a prolonged hospitalization and validate their usefulness as independent predictors.
The derivation and validation cohorts included 144 and 169 PCACP patients, respectively. Prolonged hospitalization was significantly associated with higher levels of LDH (p<0.026) and lower levels of glucose (p=0.018) in pleural fluid. These two parameters retained good predictive value, as indicated in the area under the receiver operating characteristic curve (AUC for the derivation cohort, 0.77 vs 0.82 for the validation cohort).
Using the above data, a clinical prediction tool for prolonged hospitalization was then developed: the combination of pleural LDH >1,000 U/L and pleural glucose <1 mmol/L, or pleural LDH >2,000 U/L and pleural glucose <2 mmol/L, or pleural LDH >3,000 U/L and pleural glucose <3 mmol/L. This model showed positive and negative predictive values of 78 and 73 percent, respectively.
The current study offers a useful clinical tool that can identify PCACP patients expected to have a prolonged disease course, researchers said, adding that the tool stresses the importance of measuring pleural fluid characteristics in children.
Researchers also noted that the clinical tool particularly has major implications given that the incidence of PCACP has been increasing worldwide, despite treatment protocols and early immunization, and that the disease is associated with high morbidity and increased health expenditures.