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Research Article: Combination of serum AIM2 and caspase-5 as a predictor of unfavorable prognosis in children with lobar pneumonia: a prospective cohort study

Date Published: 2026-10-14

Abstract:
To validate whether serum levels of absent in melanoma 2 (AIM2) and caspase-5 can serve as early combined biomarkers of unfavorable prognosis in children with lobar pneumonia. From February 2022 to June 2025, 475 children aged 1–14 years with first-episode lobar pneumonia were prospectively enrolled at Hebei Children's Hospital. Patients were divided into a favorable-prognosis group ( n =?395) and an unfavorable-prognosis group ( n =?80) based on treatment outcomes assessed during outpatient follow-up visits conducted 4–6 weeks after discharge. Fasting venous blood was drawn within 24?h of admission, and levels of AIM2 and caspase-5 were measured by enzyme-linked immunosorbent assay (ELISA). Co-infection, symptom duration, antibiotic duration, hospital stay, C-reactive protein (CRP), procalcitonin (PCT), and lactate dehydrogenase (LDH) were recorded. Prognostic associations were examined using Pearson correlation, multivariable logistic regression, and receiver operating characteristic (ROC) analysis. Multicollinearity was assessed; a tolerance > 0.1 and a variance inflation factor (VIF)?<?10 were considered acceptable. Serum AIM2 and caspase-5 levels were significantly higher in the unfavorable-prognosis group than in the favorable-prognosis group (both P <?0.001), and the two markers were positively correlated ( r =?0.241, P <?0.001). Multivariable analysis identified co-infection and elevated levels of CRP, PCT, AIM2, and caspase-5 as independent risk factors for unfavorable prognosis. The VIF ranged from 1.047 to 1.131, indicating no multicollinearity. The combination of AIM2 and caspase-5 yielded an AUC of 0.839 (95% CI 0.798–0.879) for predicting unfavorable prognosis, with a sensitivity of 75.70% and a specificity of 78.75%, which was significantly superior to either biomarker alone (DeLong test: Z?=??4.248, P <?0.001; Z?=??2.998, P =?0.003). Nested model analysis demonstrated that adding AIM2 and caspase-5 to conventional variables (co-infection, CRP, PCT, and LDH) improved the AUC from 0.855 to 0.893 (DeLong test P =?0.047), indicating significant incremental predictive value. Elevated serum AIM2 and caspase-5 are independent risk factors for unfavorable prognosis in children with lobar pneumonia. Their combination shows favorable predictive performance and may help identify high-risk children early.

Introduction:
Lobar pneumonia is an acute respiratory infection frequently encountered in children, pathologically characterized by consolidative changes involving one or more pulmonary lobes or segments ( 1 , 2 ). The incidence of this disease in the pediatric population has increased in recent years ( 3 ). Although most patients respond favorably to timely antibiotic therapy, some cases progress rapidly and, without prompt intervention, may develop severe complications including pleural effusion, lung abscess, and even…

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