Diagnostic value of serum KL-6 and IL-6 levels in critically ill patients with COVID-19-associated pneumonia

KL-6 as a predictor of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) and mortality in critically ill COVID-19 patients: A single-center retrospective cohort study

This study evaluated the predictive value of Krebs von den Lungen-6 (KL-6) for the development of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) and its association with mortality in critically ill COVID-19 patients. A retrospective single-center cohort study was conducted on critically ill COVID-19 patients who required high-flow oxygen or mechanical ventilation between January 2021 and June 2023. Serial serum KL-6 levels were measured at admission and weekly thereafter. The predictive performance of initial KL-6 was assessed using ROC curve analysis, and risk factors for CAPA and 30-day mortality were analyzed using multivariable models. Among 238 patients, 25 (10.5%) developed CAPA. Initial KL-6 demonstrated good discriminative ability for CAPA prediction (AUC 0.745; 95% CI: 0.685-0.799), with an optimal cutoff of 270.9 U/ml (sensitivity: 88.0%, specificity: 55.4%). KL-6 ≥ 270.9 U/ml remained independently associated with CAPA (aHR: 9.66; 95% CI: 2.28-40.89) after multivariable analysis. Serial measurements showed a trend toward a greater increase in KL-6 levels among CAPA patients than non-CAPA patients (median difference: 259.9 vs. 73.0 U/ml, P = .053). Additional independent predictors of CAPA included inotropic/vasopressor support, diabetes mellitus, and tocilizumab use. CAPA patients had higher all-cause 30-day mortality (60.8% vs. 45.2%; P = .020), which remained significant after adjustment (aHR: 2.19; 95% CI: 1.08-4.15). Furthermore, KL-6 was independently associated with 30-day mortality (aHR: 1.03 per 100 U/ml; 95% CI: 1.00-1.07). These findings suggest that KL-6 is a promising biomarker for predicting CAPA and mortality in critically ill COVID-19 patients.

Efficacy of the PDCA cyclic care model in improving lung function and speed of recovery in children with mycoplasma pneumonia

OBJECTIVE

To explore the effect of Plan-Do-Check-Act (PDCA) cycle nursing on the prognosis of children with mycoplasma pneumonia (MMP).

METHODS

Clinical data of 112 children with MMP who were admitted to Hangzhou Ninth People's Hospital from September 2020 to December 2022 were retrospectively analyzed. The children were divided into a control group (56 cases, receiving routine care) and a PDCA group (56 cases, receiving PDCA care) according to nursing interventions. Blood gas analysis, pulmonary function, inflammation levels, clinical treatment, complications, and satisfaction were compared between the two group pre- and post-care.

RESULTS

The results showed that the children in PDCA group experienced a more significant improvement in blood oxygen levels, evidenced by increased PaO2 and SaO2 levels and decreased PaCO2 levels, as well as enhanced lung function. Meanwhile, PDCA care was more effective in reducing interleukin-6, C-reactive protein, and tumor necrosis factor-alpha levels in children. In addition, children in the PDCA group recovered more quickly, with shorter times to temperature normalization, cough improvement, asthma resolution, lung rales disappearance, and hospital stay. Moreover, PDCA nursing effectively reduced the incidence of intrapulmonary and extrapulmonary complications, and improved care quality and patient satisfaction.

CONCLUSIONS

The PDCA cycle nursing model significantly improves the prognosis of children with MMP by promoting faster recovery, reducing adverse reactions, and enhancing overall nursing satisfaction. This approach fosters a more harmonious doctor-patient relationship, contributing to better patient outcomes and a more effective care environment.