Community-acquired pneumonia (CAP) remains a leading cause of mortality among children under 5 years of age in China, underscoring the critical need for early identification of severe cases and timely intervention; however, ideal predictive indicators for severe pediatric pneumonia are currently lacking. This study aimed to investigate the risk factors and predictive value of severe pneumonia in children, thereby providing a theoretical basis for early clinical diagnosis and prompt therapeutic intervention. A retrospective analysis was performed on clinical data from pediatric patients with CAP who were hospitalized in the Department of Pediatrics, Guangzhou Red Cross Hospital, between December 2023 and June 2024. Clinical characteristics were compared between study groups, risk factors for severe pneumonia were analyzed using multivariate logistic regression, and the predictive value of each indicator was evaluated via receiver operating characteristic (ROC) curve analysis. A total of 237 children with CAP were included, comprising 123 cases in the mild group (58 males and 65 females) with a median age of 5.0 years (interquartile range [IQR], 2.0–7.0 years) and 114 cases in the severe group (54 males and 60 females) with a median age of 6.0 years (IQR, 4.0–8.25 years). Compared with the mild group, the severe group exhibited significantly higher values for age, neutrophil percentage (NEUT%), absolute neutrophil count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), interleukin-6 (IL-6), procalcitonin (PCT), C-reactive protein (CRP), and the rate of pulmonary consolidation, while platelet count (PLT), absolute lymphocyte count, absolute monocyte count, albumin (ALB), creatine kinase (CK), and creatine kinase-MB (CK-MB) were significantly lower (all P<0.05). Multivariate logistic regression analysis, after adjustment for confounding factors, identified absolute lymphocyte count, NLR, lactate dehydrogenase (LDH), and pulmonary consolidation as independent risk factors for severe pneumonia (all P<0.05). ROC curve analysis demonstrated that the individual diagnostic value of absolute lymphocyte count, NLR, LDH, or pulmonary consolidation for predicting severe pneumonia was limited, whereas their combined detection yielded good predictive performance (area under the curve [AUC] >0.8, P<0.05). All enrolled children achieved clinical cure and were discharged following treatment; notably, the severe group had significantly higher rates of oxygen therapy utilization, corticosteroid administration, immunoglobulin use, and fiberoptic bronchoscopic alveolar lavage, as well as a longer hospital stay, compared with the mild group (all P<0.01). Collectively, these findings indicate that absolute lymphocyte count, NLR, LDH, and pulmonary consolidation are independent risk factors for the development of severe pneumonia in children, capable of assessing the risk of severe disease in affected patients, with the highest predictive value observed when these indicators are detected in combination.

Lin Mingcan, Luo Lirong. Multifactorial Model-Based Risk Assessment and Predictive Biomarker Analysis in Pediatric Severe Pneumonia. Academic Journal of Medicine & Health Sciences (2025), Vol. 6, Issue 8: 18-23. https://doi.org/10.25236/AJMHS.2025.060803.

[1] Smith D K, Kuckel D P. Community-Acquired Pneumonia in Children: Rapid Evidence Review[J]. American family physician. 2021, 104(6):618-25.

[2] Leung A K C, Wong A H C, Hon K L. Community-Acquired Pneumonia in Children[J]. Recent Patents on Inflammation & Allergy Drug Discovery, 2018, 12(2): 136-144.

[3] Liang Y, Wu J, Chen G, et al. Risk factor analysis and prediction model construction for severe adenovirus pneumonia in children[J]. Italian Journal of Pediatrics, 2024, 50(1).

[4] Dean P, Florin T A. Factors Associated With Pneumonia Severity in Children: A Systematic Review [J]. Journal of the Pediatric Infectious Diseases Society, 2018, 7(4): 323-334.

[5] Florin T A, Ambroggio L, Brokamp C, et al. Biomarkers and Disease Severity in Children With Community-Acquired Pneumonia[J]. Pediatrics, 2020, 145(6): e20193728.

[6] Méndez R, Aldás I, Menéndez R. Biomarkers in Community-Acquired Pneumonia (Cardiac and Non-Cardiac)[J]. Journal of Clinical Medicine, 2020, 9(2): 549.

[7] Zhu Z, Zhang T, Guo W, et al. Clinical characteristics of refractory mycoplasma pneumoniae pneumonia in children treated with glucocorticoid pulse therapy[J]. BMC infectious diseases, 2021, 21(1): 126.

[8] Lee H, Kim I, Kang B H, et al. Prognostic value of serial neutrophil-to-lymphocyte ratio measurements in hospitalized community-acquired pneumonia[J]. PLOS ONE, 2021, 16(4): e0250067.

[9] Fan F, Lv J, Yang Q, et al. Clinical characteristics and serum inflammatory markers of community‐acquired mycoplasma pneumonia in children[J]. The Clinical Respiratory Journal, 2023, 17(7): 607-617.

[10] Zhang Y xiang, Li Y, Wang Y, et al. Prospective cohort study on the clinical significance of interferon-γ, D-dimer, LDH, and CRP tests in children with severe mycoplasma pneumonia[J]. Medicine, 2024, 103(41): e39665.

[11] Gong W, Gao K, Shan Z, et al. Research progress of biomarkers in evaluating the severity and prognostic value of severe pneumonia in children[J]. Frontiers in Pediatrics, 2024, 12: 1417644.

[12] Lin J, Chen J, Yuan S, et al. Local and systemic cytokine profiles in children with pneumonia- associated lung consolidation[J]. Frontiers in Immunology, 2025, 16: 1546730.