OBJECTIVE To explore the changes of serum high mobility group protein 1 (HMGB1), receptor for advanced glycation end products(RAGE) and oncostatin-M (OSM) in the severe pneumonia (SP) children with secondary acute respiratory distress syndrome (ARDS) and analyze the clinical significance.

METHODS A total of 42 SP children with secondary ARDS and 48 SP children without secondary ARDS who were treated in the First Hospital of Jilin University from Jan. 2021 to Jul. 2023 were enrolled in the study and were respectively assigned as the study group and the control group. The distribution of pathogens isolated from the two groups was observed, the levels of serum HMGB1, RAGE and OSM were compared between the two groups. The association of HMGB1, RAGE and OSM with the secondary ARDS in SP children was observed. The values of the indexes in diagnosis of SP with secondary ARDS were analyzed.

RESULTS Totally 69 strains of pathogens were isolated from the two groups of children, 39 of which were gram-negative bacteria, and 30 were gram-positive bacteria. The expression levels of serum HMGB1, RAGE and OSM of the study group were higher than those of the control group(P < 0.05). The result of Spearman correlation analysis showed that the levels of serum HMGB1, RAGE and OSM were positively correlated with the SP with secondary ARDS(P < 0.05). The area under curve (AUC) of the joint detection of serum HMGB1, RAGE and OSM was higher than that of the single detection in diagnosis of the SP with secondary ARDS(P < 0.05), the sensitivity of the joint detection was 90.48%, with the specificity 85.42%.

CONCLUSIONS The gram-negative bacteria are dominant among the pathogens isolated from the children with SP. The SP children with secondary ARDS show high expressions of serum HMGB1, RAGE and OSM. The levels of serum HMGB1, RAGE and OSM are closely associated with the secondary ARDS in the SP children. The joint detection of the three indexes has high value in diagnosis of the secondary ARDS in the SP children.