Sepsis in children with community-acquired pneumonia: clinical and laboratory features

Abstract

Sepsis is a life-threatening organ dysfunction caused by a dysregulated immune response to infection. Despite a decline in mortality among children under the age of five, the fatality rate in older children continues to rise. Sepsis associated with community-acquired pneumonia remains one of the leading causes of hospitalization in pediatric practice.

Aim - to identify the clinical and laboratory features of sepsis in children with community-acquired pneumonia.

Materials and methods. The study included 389 children aged 5-18 years, divided into retrospective (n=214), prospective (n=135), and control (n=40) groups. Disease severity was assessed using the Phoenix scale, which evaluates the function of four organ systems. Statistical analysis was performed using Student’s t-test and Fisher’s exact test (p<0.05).

Results. Children with pneumonia showed significant organ dysfunction: reduced PaO₂/FiO₂, elevated lactate, coagulation activation, and hypotension (p<0.001). In the retrospective group, metabolic disturbances were also reflected by higher lactate and altered hemodynamics. Among patients with ≥4 Phoenix points, severe pneumonia was observed in 80-100% of cases. Increases in C-reactive protein (CRP), leukocytes, erythrocyte sedimentation rate (ESR), nterleukin-1 (IL-1), and interleukin-6 (IL-6) levels correlated directly with illness severity. Тhe incidence of complications-including pleuritis, atelectasis, and need for mechanical ventilation-rose with higher Phoenix scores. In severe cases, hospital stays were 1.4 times longer, while the proportion discharged without complications was 2.5 times lower compared to mild cases.

Conclusions. In children with community-acquired pneumonia, sepsis is accompanied by pronounced organ dysfunction and a systemic inflammatory response. The Phoenix scale is an effective tool for early identification of severe forms of disease, assessment of complication risk, and selection of appropriate treatment strategies.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee for all participants. Informed consent was obtained from patients (parents of children or their guardians).

The authors declare no conflict of interest.