HSP-70 and TNF-α as predictors of acute respiratory distress syndrome in children with pneumonia

Community acquired pneumonia is a leading cause of pediatric hospitalization worldwide. Identifying predictor for pneumonia severity and complications is critical to improve the diagnosis and outcome. This study aimed to evaluate the role Heat shock protein-70 (HSP-70) and Tumor necrosis factor alpha (TNF-α) as predictors of acute respiratory distress syndrome (ARDS) in children with pneumonia. The current cross sectional study included 60 child with pneumonia who were referred for admission in pediatric intensive care during the period from February 2024 to July 2024. Clinical data, HSP-70, TNF-α serum levels, isolated bacteria and bacterial biofilm formation were assessed in all children. We found that 15 out of 60 included children developed ARDS (25%). Heat shock protein-70 and TNF-α were statistically significant higher in those who developed ARDS than those without ARDS. Isolated bacteria and a higher rate of biofilm formation were substantially higher in patients who developed ARDS. HSP-70 had 93.3% sensitivity and 91.1% specificity at cutoff point of 5.5 ng/ml and TNF-α had 93.3% sensitivity and 86.7% specificity at a cutoff point of 442 pg/ml to predict ARDS in children with pneumonia. Elevated HSP-70 (OR:10.5) elevated TNF- α (OR: 6), bacterial biofilm formation (OR:7.3), respiratory acidosis (OR:6), and low PaO2/FiO2 < 300 (OR:1.667) were independent predictors for development of ARDS. In conclusion, several confounders contribute to the development of ARDS in children with pneumonia included inflammatory biomarkers, bacterial biofilm formation, respiratory acidosis, and reduced PaO₂/FiO₂ ratios. HSP-70 and TNF-α showed good predictive performance, indicating their potential utility as early biomarkers for identifying high-risk patients.