الفهرس 
Pediatric community acquired pneumoniaOnly 14 pages are availabe for public view
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Abstract
Community acquired pneumonia is pneumonia acquired outside hospital or which appears within 48h of admission to hospital , It is an important cause of pediatric mortality and morbidity. CAP usually presents with acute respiratory symptoms, but should always be considered in patients with unexplained sepsis or delirium, CAP accounted for 15% of deaths in children under 5 years old globally and 922000 deaths globally in children of all ages, Defining causative organisms is a challenge. Clinical and radiological features do not reliably distinguish between viral and bacterial aetiology, and obtaining cultures from the lower respiratory tract of young children is tricky More specific but invasive investigations such as pleural aspiration are infrequently indicated and reserved for severe cases. Blood cultures are rarely performed in patients managed in the community, and hospitalised patients demonstrate a poor yield, Healthy children, those less than 5 years old are at greatest risk. Boys have a higher incidence across all ages. Other risk factors include prematurity, immunodeficiency, chronic respiratory disease, and neurodisability, CAP aetiology varies with age . Respiratory viruses are common, particularly in infants, accounting for 30-67% of hospitalised cases. Respiratory syncytial virus accounts for 30% of viral aetiology. Other viruses include influenza, parainfluenza, and human metapneumovirus, Streptococcus pneumoniae is the commonest bacterial cause across all ages, accounting for 30-40% of cases, For assessment of pneumonia severity several scores can be used as British thoracic society guidelines , American Thoracic Society consensus guidelines, PRESS scoring system and PRIOM score. SuPAR, soluble urokinase-type plasminogen activator receptor, is the soluble form of uPAR. uPAR is a membrane bound receptor for uPA, otherwise known as urokinase as well as Vitronectin. suPAR results from the cleavage and release of membrane-bound suPAR. suPAR concentration positively correlates to the activation level of the immune system and is present in plasma, urine, blood, serum, and cerebrospinal fluid.
Elevated level of (suPAR) has been associated with activation of the immune system and it may be a novel biomarker for pneumonia severity.
The aim of the present study was to assess the ability of (suPAR) to predict the severity of pediatric community-acquired pneumonia.
A prospective observational study, conducted on a patient group consisting of 75 patients hospitalized for CAP in addition to 15 healthy children as a control group. The blood samples were collected within 24 hours of hospital admission of patients and to all children in the control group for measurement of suPAR. All patients were subjected to history taking, full clinical examination, as well as laboratory investigations. The data was collected and analyzed as follows.
Age and weight of patients with severe pneumonia was significantly lower than patients with non-severe pneumonia. No significant difference in gender distribution was found between patients with severe and those with non-severe CAP.
The suPAR level in the patient group was significantly higher than controls. Also suPAR level was significantly higher in children with severe pneumonia compared with those having non-severe pneumonia.
Mortality rate was significantly higher among patients with severe CAP compared with those with non-severe CAP.
suPAR was negatively correlated with age, weight, and SPO2 but positively correlated with respiratory rate and pulse. No significant correlation was found between suPAR and CRP, WBC, hemoglobin, platelet count, and temperature.
we explored the relation between suPAR and prediction of severe CAP. suPAR had a sensitivity of 42.1%, a specificity of 87.5%, p value=0.021 for prediction of severe pneumonia.
In conclusion, suPAR was found to be useful for diagnosis of pediatric CAP and prediction of its severity. suPAR in the patient group was significantly higher than controls also was significantly higher in children with severe pneumonia compared with those having non-severe pneumonia.