Non-linear Association between High-sensitivity C-reactive Protein and Mortality Risk in Children with Severe Pneumonia and the Mediating Role of Neutrophils
Year: 2025
Type: preprint
Study design: Observational Study
Abstract: Objective To investigate the non-linear association between high-sensitivity C-reactive protein (hs-CRP) and mortality risk in children with severe pneumonia and to evaluate the mediating role of absolute neutrophil count (ANC). Methods This retrospective cohort study used the Pediatric Intensive Care (PIC) database from Zhejiang University Children’s Hospital (2010–2018). A total of 789 pediatric patients with severe pneumonia were included. Patients were stratified by hs-CRP levels into low (0.25–0.50 mg/L), medium (0.51–5.00 mg/L), and high (5.29–200.00 mg/L) groups. Logistic regression, two-piecewise linear models, and mediation analysis were applied. Results Elevated hs-CRP was significantly associated with increased mortality risk (adjusted OR = 1.016, 95% CI: 1.010–1.021, P < 0.001). Mortality was 2.7%, 9.1%, and 25.0% in the low, medium, and high groups, respectively ( P < 0.001). A threshold effect was identified at 5.31 mg/L, below which mortality risk increased sharply (OR = 1.435, 95% CI: 1.230–1.674, P < 0.0001). ANC mediated 14.91% of the association ( P < 0.0001). Conclusions hs-CRP demonstrated a non-linear relationship with mortality in pediatric severe pneumonia, and ANC partially mediated this association. hs-CRP and ANC may serve as useful markers for risk stratification and clinical management in critically ill children with pneumonia.
Authors: He Wen, Xinli Fang, Chenming He, Yueyin Lin, Jiaoyan Zheng
Institution: Fujian Provincial Hospital
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Funder: Zhejiang University
OpenAlex ID: W4414313266
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