Inflammatory biomarkers associated with surgical intervention in pediatric pneumococcal pneumonia: a five-year retrospective cohort study.

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.