{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T08:53:16Z","timestamp":1791449596375,"version":"4.3.3"},"reference-count":23,"publisher":"PAGEPress Publications","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Monaldi Arch Chest Dis"],"abstract":"<jats:p>Streptococcus pneumoniae remains an important cause of community-acquired pneumonia (CAP) in children, with complicated cases sometimes requiring surgical intervention. This 5-year retrospective cohort study included 104 children aged 1 month to 18 years hospitalized with microbiologically confirmed pneumococcal pneumonia at a tertiary referral center. We evaluated clinical and laboratory factors associated with surgical intervention, with particular emphasis on the C-reactive protein-to-albumin ratio (CAR) and fibrinogen-to-albumin ratio (FAR). Complications occurred in 72.1% of patients, and 45.2% required surgical intervention. Children requiring surgery were younger, had a longer duration of symptoms before hospitalization, and showed greater alterations in inflammatory biomarkers. In multivariable analysis, CAR [adjusted odds ratio (aOR) 1.29 per unit increase; 95% confidence interval (CI) 1.12-1.52; p=0.001] and FAR (aOR 1.14 per unit increase; 95% CI 1.03-1.28; p=0.021) remained independently associated with surgical intervention in separate adjusted models. Receiver operating characteristic curve analysis showed moderate discriminatory ability for CAR [area under the curve (AUC) 0.714; 95% CI 0.615-0.813] and FAR (AUC 0.701; 95% CI 0.580-0.822), while serum albumin showed the highest overall AUC (0.783; 95% CI 0.695-0.871). FAR demonstrated significantly greater discrimination than fibrinogen alone (p=0.005), whereas CAR did not significantly outperform CRP or albumin. These findings suggest that CAR and FAR may provide complementary information for identifying children at increased risk of surgical intervention. However, their clinical utility should be interpreted alongside clinical and radiological findings and requires prospective multicenter validation.<\/jats:p>","DOI":"10.4081\/monaldi.2026.3885","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T08:24:09Z","timestamp":1791447849000},"source":"Crossref","is-referenced-by-count":0,"title":["Inflammatory biomarkers associated with surgical intervention in pediatric pneumococcal pneumonia: a five-year retrospective cohort study"],"prefix":"10.4081","author":[{"given":"Kostadin","family":"Ketev","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Medical University of Plovdiv; Department of Pediatrics, University Hospital \u201cSt. George\u201d, Plovdiv"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6762-3494","authenticated-orcid":false,"given":"Daniela","family":"Milanova-Ilieva","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospital \u201cSt. George\u201d, Plovdiv"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivanka","family":"Karavelikova","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Medical University of Plovdiv; Department of Pediatrics, University Hospital \u201cSt. George\u201d, Plovdiv"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zdravko","family":"Ivanov","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospital \u201cSt. George\u201d, Plovdiv"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosen","family":"Iliev","sequence":"additional","affiliation":[{"name":"Dialysis Centre \u201cVia Dial\u201d, Stara Zagora"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Penka","family":"Stefanova","sequence":"additional","affiliation":[{"name":"Department of Propedeutics of Surgical Diseases, Pediatric Surgery, Medical University of Plovdiv; Department of Pediatric Surgery, University Hospital \u201cSt. George\u201d, Plovdiv"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miroslava","family":"Bosheva","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospital \u201cSt. George\u201d, Plovdiv"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2549","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"88278","doi-asserted-by":"crossref","unstructured":"Chen L, Miao C, Chen Y, et al. Age-specific risk factors of severe pneumonia among pediatric patients hospitalized with community-acquired pneumonia. Ital J Pediatr 2021;47:100.","DOI":"10.1186\/s13052-021-01042-3"},{"key":"88279","doi-asserted-by":"crossref","unstructured":"Alcoba G, Keitel K, Maspoli V, et al. A three-step diagnosis of pediatric pneumonia at the emergency department using clinical predictors, C-reactive protein, and pneumococcal PCR. Eur J Pediatr 2017;176:815-24.","DOI":"10.1007\/s00431-017-2913-0"},{"key":"88280","doi-asserted-by":"crossref","unstructured":"Djelantik IGG, Bradford DG, Augustinus S, et al. Case fatality proportions and predictive factors for mortality among children hospitalized with severe pneumonia in a rural developing country setting. J Trop Pediatr 2003;49:327-32.","DOI":"10.1093\/tropej\/49.6.327"},{"key":"88281","doi-asserted-by":"crossref","unstructured":"Tingting S, Chen C, Li H, et al. Risk factors for mortality from severe community-acquired pneumonia in hospitalized children transferred to the pediatric intensive care unit. Pediatr Neonatol 2020;61:577-83.","DOI":"10.1016\/j.pedneo.2020.06.005"},{"key":"88282","doi-asserted-by":"crossref","unstructured":"Krenke K, Krawiec M, Kraj G, et al. Risk factors for local complications in children with community-acquired pneumonia. Clin Respir J 2018;12:253-61.","DOI":"10.1111\/crj.12524"},{"key":"88283","unstructured":"Krishna Y, Shally A. Care-seeking behavior of families of north Indian children suffering from WHO-defined severe community-acquired pneumonia: a hospital-based prospective study. Cureus 2023;15:e41953."},{"key":"88284","doi-asserted-by":"crossref","unstructured":"Heinige P, Slov\u00e1kov\u00e1 L, Vo\u010dkov\u00e1 J, et al. Impact of the COVID-19 pandemic on pediatric pneumonia outcomes: a five-year retrospective cohort study. 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Utility of serum procalcitonin and C-reactive protein in severity assessment of community-acquired pneumonia in children. Clin Biochem 2016;49:47-50.","DOI":"10.1016\/j.clinbiochem.2015.09.008"},{"key":"88289","unstructured":"Okay ZU, Okay B, Hatipoglu HU, et al. The association of fibrinogen-albumin ratio and neutrophil-lymphocyte ratio with the severity of respiratory syncytial virus infection in children. Rev Inst Med Trop Sao Paulo 2024;66:e26."},{"key":"88290","doi-asserted-by":"crossref","unstructured":"Prais D, Kuzmenko E, Amir J, Harel L. Association of hypoalbuminemia with the presence and size of pleural effusion in children with pneumonia. Pediatrics 2008;121:e533-8.","DOI":"10.1542\/peds.2007-0317"},{"key":"88291","doi-asserted-by":"crossref","unstructured":"Quinton LJ, Jones MR, Robson ME, Mizgerd JP. Mechanisms of the hepatic acute-phase response during bacterial pneumonia. 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Children 2023;10:1731.","DOI":"10.3390\/children10111731"},{"key":"88295","doi-asserted-by":"crossref","unstructured":"Luo B, Sun M, Huo X, Wang Y. Two new inflammatory markers related to the CURB-65 score for disease severity in patients with community-acquired pneumonia: the hypersensitive C-reactive protein to albumin ratio and fibrinogen to albumin ratio. Open Life Scie 2021;16:84-91.","DOI":"10.1515\/biol-2021-0011"},{"key":"88296","doi-asserted-by":"crossref","unstructured":"Cetin EU, Kurtkulagi O, Kamis F, et al. Advancing ICU mortality prediction in community-acquired pneumonia: combining fibrinogen-to-albumin ratio, CT severity score, PSI, and CURB-65. Biomol Biomed 2025;25:2083-91.","DOI":"10.17305\/bb.2025.12127"},{"key":"88297","doi-asserted-by":"crossref","unstructured":"Yavuz S, Sherif A, Amirrad M, et al. A retrospective chart review of pediatric complicated community-acquired pneumonia: an experience in the Al Qassimi women and children hospital. 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Pediatr Surg Int 2025;41:111.","DOI":"10.1007\/s00383-025-06006-w"}],"container-title":["Monaldi Archives for Chest Disease"],"original-title":[],"link":[{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/download\/3885\/2289","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/download\/3885\/2289","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T08:25:12Z","timestamp":1791447912000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/view\/3885"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,8]]},"references-count":23,"URL":"https:\/\/doi.org\/10.4081\/monaldi.2026.3885","relation":{},"ISSN":["2532-5264","1122-0643"],"issn-type":[{"value":"2532-5264","type":"electronic"},{"value":"1122-0643","type":"print"}],"subject":[],"published":{"date-parts":[[2026,10,8]]}}}