Clinical features and prediction of risk factors for severe adenovirus pneumonia in children

Ning Wang; Yulian Fang; Hanquan Dong; Lu Wang; Mengzhu Hou; Wei Wang; Jing Ning

doi:10.21037/tp-23-312

Clinical features and prediction of risk factors for severe adenovirus pneumonia in children

Transl Pediatr. 2024 Jan 29;13(1):63-71. doi: 10.21037/tp-23-312. Epub 2024 Jan 19.

Authors

Ning Wang^#^{1

2}, Yulian Fang^#^{1

2}, Hanquan Dong^#³, Lu Wang^#^{1

2}, Mengzhu Hou^{1

2}, Wei Wang^{1

2}, Jing Ning³

Affiliations

¹ Department of Pediatric Research Institute, Tianjin Children's Hospital/Children's Hospital of Tianjin University, Tianjin, China.
² Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, China.
³ Department of Respiratory, Tianjin Children's Hospital/Children's Hospital of Tianjin University, Tianjin, China.

^# Contributed equally.

Abstract

Background: Adenoviral infections are most likely to invade the respiratory tract, and the clinical manifestations of the infections are varied; in severe cases, they may cause systemic multi-system damages and so on. At present, early clinical differential diagnosis is difficult under the existing testing methods, so it is important to analyze its clinical characteristics and risk factors for early identification of critical status and early and rational treatment.

Methods: The clinical data of 202 children with adenovirus pneumonia admitted to Tianjin Children's Hospital from January 2019 to December 2021 were retrospectively analyzed. According to the evaluation criteria for severe pneumonia, they were divided into a severe group (77 cases) and a non-severe group (125 cases). The clinical characteristics, complications, and laboratory data of the 2 groups were collected for statistical analysis, and then significant factors were analyzed by receiver operating characteristic curve (ROC) and binary logistic regression.

Results: Among the 202 children with adenovirus pneumonia, there were 108 males and 94 females. The children ranged in age from 2 months to 13 years. The duration of fever, incidence of wheezing, neutrophil ratio (NEUT%), and serum ferritin (SF) levels were significantly higher in the severe group than in the non-severe group (χ²/Z/P=-9.173/<0.001, 5.469/0.019, 5.831/<0.001, -3.845/<0.001). The incidences of liver injury, electrolyte disturbance, and coagulation dysfunction in the severe group were significantly higher than those in the non-severe group (χ²/Z/P=0.001/0.001, 28.208/0.001, 32.079/0.001). Logistic regression combined with ROC curve analysis suggested that fever duration >4.50 days, with wheezing, NEUT% ≥47.60, and SF ≥139.60 ng/mL were risk factors for developing severe adenovirus pneumonia in children [odds ratio (OR) (95% CI): 1.394 (1.230-1.581), 3.673 (1.246-10.828), 1.034 (1.001-1.067), 1.004 (1.001-1.008)].

Conclusions: Studies have shown that the fever associated with severe adenovirus pneumonia has a long duration, and that severe clinical manifestations and multiple complications, fever duration >4.50 days, wheezing, NEUT% ≥47.60, and SF ≥139.60 ng/mL are risk factors for severe adenovirus pneumonia.

Keywords: Adenoviral pneumonia; children; risk factor; severe pneumonia.