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Risk factors associated with wheezing in severe pediatric community-acquired pneumonia: a retrospective study
Lumin Chen1, Chong Miao2, Yanling Chen1
1Department of Pediatrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Insights
Wheezing in severe pediatric pneumonia is linked to male gender, autumn/winter onset, and no prior pneumonia history. These children present with distinct clinical features and pathogens compared to non-wheezing cases.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Clinical Epidemiology
Background:
- Wheezing is a common symptom in pediatric pneumonia, but its specific risk factors and clinical characteristics in severe cases remain unclear.
- Understanding these factors is crucial for accurate diagnosis and management of severe pneumonia in children.
Purpose of the Study:
- To identify the independent risk factors associated with wheezing in children diagnosed with severe community-acquired pneumonia (CAP).
- To compare the clinical features, laboratory findings, and complications between children with severe CAP who wheeze and those who do not.
Main Methods:
- A retrospective study involving 1434 pediatric patients with severe pneumonia.
- Patients were categorized into wheezing (N.=684) and non-wheezing (N.=750) cohorts based on clinical signs.
- Multivariate Cox regression analysis was employed to determine independent risk factors for wheezing.
Main Results:
- Independent risk factors for wheezing included male gender, onset during autumn/winter, and no prior history of pneumonia.
- The wheezing group exhibited higher rates of cough and breathlessness, but lower fever incidence.
- Laboratory findings showed higher red blood cells, hemoglobin, and albumin, with lower bilirubin and creatine levels in the wheezing cohort. Respiratory syncytial virus was a more frequent pathogen, and sepsis/hydrothorax risks were lower.
Conclusions:
- Severe CAP with wheezing represents a distinct clinical entity in children.
- It is characterized by specific demographic and etiological risk factors.
- Wheezing pneumonia differs significantly from non-wheezing pneumonia in clinical presentation, laboratory results, and common pathogens.
Background:
Wheezing is a common clinical manifestation in children with pneumonia. However, the risk factors associated with the development of wheezing pneumonia and its clinical features are not fully characterized, especially in children with severe pneumonia.
Methods:
We retrospectively recruited 1434 pediatric patients diagnosed with severe pneumonia between April 2012 and September 2019 in Fujian Maternity and Child Health Hospital. The medical records regarding demographic information, clinical manifestations, radiographic/laboratory findings, and complications were collected. Based on the presence or absence of wheezing symptoms and signs, subjects were divided into wheezing cohort (N.=684) and non-wheezing cohort (N.=750), and their clinical data were compared. Multivariate cox regression analysis was performed to identify independent risk factors of wheezing.
Results:
Demographic features including gender, weigh, onset season, birth weight, full-term birth or not, history of pneumonia were significantly associated with the occurrence of wheezing in severe CAP (P<0.05). Specifically, male gender, onset seasons in autumn/winter, and absence of a history of pneumonia were identified as independent risk factors of wheezing in multivariate analysis (P<0.05). As for clinical features, wheezing cohort differed from the non-wheezing one in terms of clinical manifestation (higher incidence of cough and breathless, but lower incidence of fever), laboratory finding (higher levels of red blood cells, hemoglobin, and albumin and lower levels of total or indirect bilirubin and creatine), pathogen detection (higher incidence of respiratory syncytial viral infection), and clinical complications (lesser risk of sepsis and hydrothorax) (P<0.05).
Conclusions:
Severe CAP with wheezing is a special clinical entity of severe pneumonia in children, which has specific risk factors and differ from non-wheezing pneumonia in terms of clinical features and etiologic pathogens.
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