Risk factors for secondary heart failure in children with severe pneumonia and establishment of prediction model

OBJECTIVE To explore the influencing factors for secondary heart failure in the children with severe pneumonia and establish the nomogram prediction model.

METHODS A total of 767 children with severe pneumonia who were treated in Children′s Hospital of Nanjing Medical University from Mar. 2018 to Mar. 2024 were enrolled in the study and were divided into the modeling group with 537 cases and the validation group with 230 cases in a 7∶3 ratio. Meanwhile, 127 children with severe pneumonia who were treated from Apr. 2024 to Dec. 2024 were chosen as the external validation group. The children of the modeling group were divided into the heart failure group with 56 cases and the non-heart failure group with 481 cases according to the status of secondary heart failure. The clinical data were collected from the children. Multivariate logistic regression analysis was performed for the influencing factors for the secondary heart failure in the children with severe pneumonia, the prediction model for secondary heart failure in the severe pneumonia children was established with the use of R software. The efficacy of the model in prediction of secondary heart failure in the children with severe pneumonia was analyzed by means of receiver operating characteristic (ROC) curves and Hosmer-Lemeshow (H-L) fitting test.

RESULTS The critically ill case score(OR=8.847, 95%CI: 3.806 to 20.566), persistent pulmonary arterial hypertension (OR=5.557, 95% CI: 2.450 to 12.604), respiratory failure (OR=2.646, 95% CI: 1.066 to 6.567), coagulation dysfunction (OR=13.444, 95% CI: 5.790 to 31.219) and procalcitonin (PCT) (OR=8.103, 95% CI: 3.466 to 18.943) were the influencing factors for the secondary heart failure in the children with severe pneumonia(P < 0.05). The area under the ROC curve of the validation group was 0.962, the external validation group 0.973; the H-L test showed that the prediction model had high consistency and discrimination for the secondary heart failure in the children with severe pneumonia.

CONCLUSIONS The critically ill case score, persistent pulmonary arterial hypertension, respiratory failure, coagulation dysfunction and PCT level are the influencing factors for the secondary heart failure in the children with severe pneumonia. The prediction model that is established based on the influencing factors shows high efficiency.