Critical pertussis: A multi-centric analysis of risk factors and outcomes in Oman
Florence Birru1, Zaid Al-Hinai2, Saif Awlad Thani3
1Paediatric Critical Care Medicine, Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman.
Insights
Critical pertussis in children is predicted by elevated white blood cell count (WBCC), absolute lymphocyte count (ALC), and absolute neutrophil count (ANC). A WBCC exceeding 31.5 × 10^9/L indicates critical pertussis.
Area of Science:
- Pediatric Infectious Diseases
- Hematology
- Epidemiology
Background:
- Pertussis, or whooping cough, remains a significant global health concern, particularly for infants and young children.
- Identifying predictors of severe disease is crucial for timely intervention and improved patient outcomes.
Purpose of the Study:
- To determine the risk factors and clinical outcomes associated with critical pertussis in pediatric patients.
- To evaluate the predictive value of specific laboratory parameters in identifying severe pertussis cases.
Main Methods:
- A retrospective observational cohort study was conducted involving children under 13 years old diagnosed with pertussis.
- Data were collected from January 2013 to December 2018 at two hospitals in Muscat, Oman.
- Laboratory-confirmed pertussis cases were identified using polymerase chain reaction (PCR).
Main Results:
- Out of 157 pertussis patients, 12% (n=19) experienced critical illness.
- Higher white blood cell count (WBCC), absolute lymphocyte count (ALC), and absolute neutrophil count (ANC) were significantly associated with critical pertussis.
- Multivariate analysis confirmed these findings, with adjusted odds ratios indicating increased risk with higher counts.
Conclusions:
- Elevated WBCC, ALC, and ANC are significant predictors of critical pertussis in children.
- A WBCC threshold of 31.5 × 10^9/L demonstrated a strong association with critical pertussis, suggesting its utility as a diagnostic marker.
Objectives:
To identify risk factors and outcomes of patients with critical pertussis.
Design:
Retrospective observational cohort study.
Setting:
Sultan Qaboos University Hospital and The Royal Hospital, Muscat, Oman.
Subjects:
Children aged <13 years presenting to the emergency departments and diagnosed with laboratory-confirmed pertussis by polymerase chain reaction between January 2013 and December 2018.
Measurements And Main Results:
In total, 157 patients were diagnosed with pertussis, of which 12% (n = 19) had critical pertussis. Patients with critical pertussis had a higher white blood cell count (WBCC) [adjusted odds ratio (aOR) 1.05; 95% confidence interval (CI) 1.02-1.08; P = 0.003], absolute lymphocyte count (ALC) (aOR 1.08; 95% CI 1.03-1.15; P = 0.004) and absolute neutrophil count (ANC) (aOR 1.05; 95% CI 1.01-1.10; P = 0.032) than patients with non-critical pertussis, even after multi-variate adjustment. The area under the curve for discriminatory accuracy of laboratory variables was 0.75 (95% CI 0.65-0.85), 0.74 (95% CI 0.64-0.84) and 0.72 (95% CI 0.60-0.83) for maximum WBCC, ALC and ANC, respectively, with Youden's cut-off values of 31.5 × 109/L, 19.9 × 109/L and 5.0 × 109/L, respectively.
Conclusions:
In children, higher WBCC, ALC and ANC were significant predictors of critical pertussis. A cut-off level of 31.5 × 109/L for WBCC was associated with critical pertussis.
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