Risk Factors for Poor Outcomes in Children Hospitalized With Virus-associated Acute Lower Respiratory Infections: A Systematic Review and Meta-analysis

Daira Trusinska; Si Thu Zin; Emmanuel Sandoval; Nusrat Homaira; Ting Shi

doi:10.1097/INF.0000000000004258

Risk Factors for Poor Outcomes in Children Hospitalized With Virus-associated Acute Lower Respiratory Infections: A Systematic Review and Meta-analysis

Pediatr Infect Dis J. 2024 May 1;43(5):467-476. doi: 10.1097/INF.0000000000004258. Epub 2024 Jan 26.

Authors

Daira Trusinska¹, Si Thu Zin², Emmanuel Sandoval^{1

3}, Nusrat Homaira^{4

5

6}, Ting Shi¹

Affiliations

¹ From the Usher Institute, Old Medical School, Teviot Place, University of Edinburgh, Edinburgh, United Kingdom.
² Randwick Clinical Campus, School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia.
³ Department of Acute and General Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
⁴ Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia.
⁵ Respiratory Department, Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia.
⁶ James P. Grant School of Public Health, BRAC University, Bangladesh.

Abstract

Background: Acute lower respiratory infection (ALRI) caused by respiratory viruses is among the most common causes of hospitalization and mortality in children. We aimed to identify risk factors for poor outcomes in children <5 years old hospitalized with ALRI caused by respiratory syncytial virus (RSV), influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Methods: We searched Embase, Medline and Global Health databases and included observational studies reporting risk factors for poor outcomes (defined as use of supplemental oxygen, mechanical ventilation, intensive care unit admission, prolonged hospital stay and mortality) published between January 2011 and January 2023. Two authors independently extracted data on study characteristics, outcomes and risk factors. Due to limited data, meta-analyses were only conducted for RSV-ALRI poor outcome risk factors using random effects model when there were at least 3 studies.

Results: We included 30 studies. For RSV-related ALRI, significant risk factors based on meta-analysis were: neurological disease [odds ratio (OR): 6.14; 95% confidence intervals (CIs): 2.39-15.77], Down's syndrome (5.43; 3.02-9.76), chronic lung disease (3.64; 1.31-10.09), immunocompromised status (3.41; 1.85-6.29), prematurity (2.98; 1.93-4.59), congenital heart disease (2.80; 1.84-4.24), underlying disease (2.45; 1.94-3.09), age <2 months (2.29; 1.78-2.94), age <6 months (2.08; 1.81-2.39), viral coinfection (2.01; 1.27-3.19), low birth weight (1.88; 1.19-2.95) and being underweight (1.80; 1.38-2.35). For influenza-related ALRI, chronic conditions and age 6-24 months were identified as risk factors for poor outcomes. Cardiovascular disease, immunosuppression, chronic kidney disease, diabetes and high blood pressure were reported as risk factors for mortality due to SARS-CoV-2 associated ALRI.

Conclusions: These findings might contribute to the development of guidelines for prophylaxis and management of ALRI caused by RSV, influenza and SARS-CoV-2.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Child
Child, Preschool
Hospitalization
Humans
Infant
Infant, Newborn
Infant, Premature
Influenza, Human* / complications
Influenza, Human* / epidemiology
Respiratory Syncytial Virus Infections* / epidemiology
Respiratory Syncytial Virus Infections* / therapy
Respiratory Syncytial Virus, Human*
Respiratory Tract Infections* / epidemiology
Risk Factors