{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T06:13:55Z","timestamp":1779257635371,"version":"3.51.4"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify clinical risk factors and characterize associated features of necrotizing pneumonia (NP) in children with severe pneumonia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective case\u2013control study included children with severe pneumonia hospitalized at the Children's Hospital of Soochow University between July 2022 and June 2025. Children who met the diagnostic criteria for NP were classified into the NP group, while a 1:2 control group (NNP) was randomly selected from eligible patients without NP during the same period. Clinical characteristics were compared between the two groups, followed by risk factor analysis and construction of ROC curves.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 33 children with NP were included. Compared with the NNP group, significant differences were observed in duration of fever, hemoptysis, wheezing, chest pain, duration of corticosteroid use after admission, alanine aminotransferase, lactate dehydrogenase, albumin, white blood cell count (WBC), neutrophil percentage, platelet count, C-reactive protein, fibrin degradation products (FDPs), fibrinogen, D-dimer, anticoagulant therapy, pulmonary consolidation, pleural effusion, mucus plugs, and the number of bronchoscopic procedures (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05). After variable selection using LASSO regression under the\n                      <jats:italic>\u03bb<\/jats:italic>\n                      1se criterion, duration of fever, wheezing, chest pain, WBC, FDPs, and the number of bronchoscopic procedures remained associated with NP. Further multivariable logistic regression and ROC curve analyses demonstrated that chest pain, elevated WBC and FDPs were independent factors associated with NP. The combined model of these three variables showed good predictive performance for NP, with an AUC of 0.941 (95% CI: 0.891\u20130.990), and both sensitivity and specificity of 87.88%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Chest pain, elevated WBC, and increased FDPs were independently associated with NP, suggesting that these factors may help identify children at higher risk and inform clinical assessment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1837505","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T05:47:09Z","timestamp":1779256029000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical characteristics and risk factors of necrotizing pneumonia secondary to severe pneumonia in children"],"prefix":"10.3389","volume":"14","author":[{"given":"Lin","family":"Che","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Children\u2019s Hospital of Soochow University","place":["Suzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weifang","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Children\u2019s Hospital of Soochow University","place":["Suzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qinghui","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Children\u2019s Hospital of Soochow University","place":["Suzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fangfang","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Children\u2019s Hospital of Soochow University","place":["Suzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianmei","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Children\u2019s Hospital of Soochow University","place":["Suzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1016\/j.prrv.2024.02.003","article-title":"Necrotizing pneumonia in children: a review","volume":"52","author":"Teresinha Mocelin","year":"2024","journal-title":"Paediatr Respir Rev"},{"key":"B2","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1016\/j.anpede.2020.10.002","article-title":"Long-term outcomes of necrotizing pneumonia","volume":"95","author":"Bover-Bauza","year":"2021","journal-title":"An Pediatr (Barc)"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e71241","DOI":"10.1002\/ppul.71241","article-title":"Long-Term outcomes of necrotizing pneumonia and parapneumonic effusion in children","volume":"60","author":"Oksay","year":"2025","journal-title":"Pediatr Pulmonol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"364","DOI":"10.3390\/diseases13110364","article-title":"Clinical profiles, management, and outcomes of complicated pneumonia in children: a retrospective study from tertiary centers in Jordan","volume":"13","author":"Alshadfan","year":"2025","journal-title":"Diseases (Basel, Switzerland)"},{"key":"B5","doi-asserted-by":"publisher","first-page":"786","DOI":"10.1016\/S0140-6736(20)31550-6","article-title":"Complicated pneumonia in children","volume":"396","author":"de Benedictis","year":"2020","journal-title":"Lancet (London, England)"},{"key":"B6","doi-asserted-by":"publisher","first-page":"3777","DOI":"10.2147\/IDR.S419294","article-title":"Clinical characteristics of necrotizing pneumonia caused by different pathogens","volume":"16","author":"Luo","year":"2023","journal-title":"Infect Drug Resist"},{"key":"B7","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1007\/5584_2014_99","article-title":"Necrotizing pneumonia and its complications in children","volume":"857","author":"Krenke","year":"2015","journal-title":"Adv Exp Med Biol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"978","DOI":"10.3390\/jcm15030978","article-title":"Retrospective study of complicated pneumonia at the pediatric department of the university hospital of Padua: experience from 2022 to 2024","volume":"15","author":"Ferraro","year":"2026","journal-title":"J Clin Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"920","DOI":"10.3760\/cma.j.cn112140-20240728-00523","article-title":"Guidelines for the management of community-acquired pneumonia in children (2024 revision)","volume":"62","year":"2024","journal-title":"Zhonghua er ke za zhi=Chinese Journal of Pediatrics"},{"key":"B10","doi-asserted-by":"publisher","first-page":"984","DOI":"10.3390\/pathogens13110984","article-title":"Necrotizing pneumonia: a practical guide for the clinician","volume":"13","author":"Kapania","year":"2024","journal-title":"Pathogens (Basel, Switzerland)"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2256","DOI":"10.3390\/jcm12062256","article-title":"Necrotizing pneumonia in children: early recognition and management","volume":"12","author":"Chen","year":"2023","journal-title":"J Clin Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e640","DOI":"10.1097\/PCC.0000000000002793","article-title":"Characteristics and outcomes of children with necrotizing pneumonia","volume":"22","author":"Ness-Cochinwala","year":"2021","journal-title":"Pediatr Crit Care Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1093\/cid\/ciy872","article-title":"Impact of the 13-valent pneumococcal conjugate vaccine among adults: a systematic review and meta-analysis","volume":"69","author":"Vadlamudi","year":"2019","journal-title":"Clin Infect Dis"},{"key":"B14","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1097\/QCO.0000000000001126","article-title":"Resurgence of Mycoplasma pneumoniae infections in children: emerging challenges and opportunities","volume":"38","author":"de Groot","year":"2025","journal-title":"Curr Opin Infect Dis"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s12519-023-00783-x","article-title":"Current status of Mycoplasma pneumoniae infection in China","volume":"20","author":"Yan","year":"2024","journal-title":"World J Pediatr"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e515","DOI":"10.1016\/S2666-5247(23)00405-6","article-title":"Resurgence of Mycoplasma pneumonia by macrolide-resistant epidemic clones in China","volume":"5","author":"Li","year":"2024","journal-title":"The Lancet. Microbe"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1449511","DOI":"10.3389\/fmicb.2024.1449511","article-title":"Increased macrolide resistance rate of Mycoplasma pneumoniae correlated with epidemic in Beijing, China in 2023","volume":"15","author":"Chen","year":"2024","journal-title":"Front Microbiol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e2220949","DOI":"10.1001\/jamanetworkopen.2022.20949","article-title":"Global trends in the proportion of macrolide-resistant Mycoplasma pneumoniae infections: a systematic review and meta-analysis","volume":"5","author":"Kim","year":"2022","journal-title":"JAMA Netw Open"},{"key":"B19","doi-asserted-by":"publisher","first-page":"S34","DOI":"10.1016\/S0049-3848(10)70153-5","article-title":"Inflammation and coagulation","volume":"127","author":"Pet\u00e4j\u00e4","year":"2011","journal-title":"An Overview. Thromb Res"},{"key":"B20","doi-asserted-by":"publisher","first-page":"4659","DOI":"10.2147\/IJGM.S478443","article-title":"Clinical value of coagulation function indicators in children with severe pneumonia","volume":"17","author":"Song","year":"2024","journal-title":"Int J Gen Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1186\/s13052-023-01545-1","article-title":"Changes in coagulation markers in children with Mycoplasma pneumoniae pneumonia and their predictive value for Mycoplasma severity","volume":"49","author":"Li","year":"2023","journal-title":"Ital J Pediatr"},{"key":"B22","doi-asserted-by":"publisher","first-page":"844","DOI":"10.1111\/jth.14768","article-title":"Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia","volume":"18","author":"Tang","year":"2020","journal-title":"J Thromb Haemost"},{"key":"B23","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1111\/resp.12943","article-title":"Clinical relevance of necrotizing change in patients with community-acquired pneumonia","volume":"22","author":"Seo","year":"2017","journal-title":"Respirology (Carlton, Vic.)"},{"key":"B24","doi-asserted-by":"publisher","first-page":"19061","DOI":"10.1038\/s41598-020-76083-5","article-title":"Early prediction of necrotizing pneumonia from mycoplasma pneumoniae pneumonia with large pulmonary lesions in children","volume":"10","author":"Zhou","year":"2020","journal-title":"Sci Rep"},{"key":"B25","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1186\/s12879-025-12495-w","article-title":"Clinical analysis of Mycoplasma pneumoniae necrotizing pneumonia in children","volume":"26","author":"Zhang","year":"2026","journal-title":"BMC Infect Dis"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1829","DOI":"10.2147\/IDR.S408198","article-title":"Development of a nomogram for predicting massive necrotizing pneumonia in children","volume":"16","author":"Luo","year":"2023","journal-title":"Infect Drug Resist"},{"key":"B27","doi-asserted-by":"publisher","first-page":"658","DOI":"10.3760\/cma.j.cn112140-20210126-00072","article-title":"A multicenter retrospective study on the etiology of necrotizing pneumonia in children","volume":"59","author":"Zhou","year":"2021","journal-title":"Zhonghua er ke za zhi=Chin J Pediatr"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1961","DOI":"10.2147\/IDR.S459626","article-title":"Characteristics and outcomes of Mycoplasma Pneumoniae pneumonia associated with pulmonary embolism and necrotizing pneumonia in children","volume":"17","author":"Wang","year":"2024","journal-title":"Infect Drug Resist"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1837505\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T05:47:12Z","timestamp":1779256032000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1837505\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,20]]},"references-count":28,"alternative-id":["10.3389\/fped.2026.1837505"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1837505","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,20]]},"article-number":"1837505"}}