The predictive value of endothelial activation and stress index for respiratory failure in the children with severe pneumonia

Wang Xiuqin; Xu Weihua

doi:10.3969/j.issn.1002-1949.2025.10.014

Abstract：Objective To investigate the predictive value of endothelial activation and stress index(EASIX)for respiratory failure(RF)in the children with severe pneumonia.Methods 151 children with severe pneumonia admitted to our hospital from August 2023 to February 2025 were retrospectively selected and divided into RF group(n=52)and non-RF group(n=99)according to whether they were complicated with RF.The basic information,disease data,treatment status,blood biochemistry and blood routine of the first admission were collected,and EASIX was calculated according to the levels of lactate dehydrogenase(LDH),platelet count(PLT)and creatinine in peripheral blood of the first admission.Multivariate Logistic regression analysis was used to analyze the risk factors of RF in the children,and the receiver operating characteristic(ROC)curve was drawn to analyze the predictive performance of different indicators for RF.Results There were significant differences in chest infection,hemoglobin(Hb),procalcitonin(PCT),C-reactive protein(CRP),confusion,uremia,respiratory,BP,age 65 years(CURB-65),acute physiology and chronic health evaluationⅡ(APACHEⅡ)and EASIX between the RF group and the non-RF group(P<0.05).Multivariate Logistic regression analysis showed that CRP,CURB-65 score,APACHEⅡ score and EASIX were independent risk factors for RF in the children with severe pneumonia(P<0.05).The results of ROC curve analysis showed that the AUC of CRP,CURB-65 score,APACHEⅡ score and EASIX in predicting RF in the children with severe pneumonia were 0.749,0.714,0.661 and 0.812,respectively.The AUC predicted by EASIX was the highest,the optimal cut-off value was 0.81,the sensitivity was 89.23%,and the specificity was 66.15%.Compared with the low EASIX group,the hospitalization time of the high EASIX group was significantly longer and the incidence of poor prognosis was higher(P<0.05).Multivariate Logistic regression analysis showed that EASIX>0.81 was an independent risk factor for poor prognosis after adjusting for age,gender,CRP and APACHEⅡ score(P<0.001).Conclusions CRP,CURB-65 score,APACHEⅡ score and EASIX have important value in the prediction of respiratory failure in the children with severe pneumonia.In particular,EASIX shows good predictive accuracy and is closely related to the prognosis of children.Clinicians can comprehensively use these indicators to identify RF high-risk children at an early stage,and take effective intervention measures to improve the prognosis of children.