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Retrospective analysis of 104 cases of pediatric severe pertussis in Southern China
Xueqian Li1, Feng Ye1, Jianhui Zhang2
1Department of PICU, National Children's Medical Center for South Central Region, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510620, China.
Insights
Severe pertussis in children is linked to higher white blood cell counts and conditions like pulmonary hypertension, which decrease survival rates. Hypotension and pulmonary hypertension are key independent risk factors requiring aggressive treatment and monitoring for exchange blood transfusion (EBT).
Area of Science:
- Pediatric Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- Pertussis (whooping cough) incidence has risen, posing significant risks of severe illness and mortality in infants.
- Understanding risk factors for severe pediatric pertussis is crucial for timely intervention and improved outcomes.
Purpose of the Study:
- To retrospectively analyze clinical characteristics and outcomes of severe pertussis in pediatric patients in southern China.
- To identify risk factors associated with mortality and the need for exchange blood transfusion (EBT) in severe pertussis.
Main Methods:
- Retrospective analysis of 104 children hospitalized with severe pertussis in a pediatric intensive care unit (PICU) from August 2023 to May 2024.
- Comparison of clinical characteristics and identification of risk factors for prognosis and EBT indications using Cox and ROC curve analyses.
Main Results:
- Deceased patients exhibited higher white blood cell (WBC) counts and increased rates of oliguria, pulmonary hypertension (PAH), and tricuspid regurgitation.
- Hypotension and PAH were identified as independent risk factors for mortality (HR=6.44 and HR=10.33, respectively).
- WBC count (cut-off=30.2×10^9/L) and lymphocyte count (cut-off=13.5×10^9/L) predicted the need for EBT.
Conclusions:
- Pediatric severe pertussis with complications like oliguria, hypotension, shock, elevated WBC counts, or PAH is associated with significantly decreased survival rates.
- Hypotension and pulmonary hypertension are critical independent prognostic risk factors.
- Close monitoring for EBT and clear indications for its use are recommended in severe pertussis cases.
Objectives:
The incidence of pertussis has increased significantly in the past year, with infants at high risk of severe disease and death. We aimed to retrospectively analyze pediatric severe pertussis in southern China.
Methods:
Children diagnosed with severe pertussis who were hospitalized in the pediatric intensive care unit (PICU) of Guangzhou Women and Children's Medical Center from August 2023 to May 2024 were included. We compared clinical characteristics among different groups and identified risk factors for outcomes and indications for exchange blood transfusion (EBT) in severe pertussis.
Results:
A total of 104 children with severe pertussis were included. The deceased patients had higher white blood cell counts (WBC) and higher rates of oliguria, pulmonary hypertension (PAH), and tricuspid regurgitation. Kaplan-Meier survival curves showed a lower survival rate in patients with oliguria, hypotension, WBC ≥ 36.0 × 109/L, neutrophil count ≥ 11.9 × 109/L, PAH, and tricuspid regurgitation. Univariate Cox analysis identified risk factors for prognosis: hypotension (HR = 9.36, 95% CI: 1.89-46.41, P = 0.006), WBC (HR = 1.04, 95% CI: 1.01-1.06, P = 0.002), neutrophil count (HR = 1.04, 95% CI: 1.01-1.08, P = 0.019), and PAH (HR = 12.50, 95% CI: 2.29-68.31, P = 0.004). Multivariate Cox analysis revealed that hypotension (HR = 6.44, 95% CI: 1.28-32.35, P = 0.024) and PAH (HR = 10.33, 95% CI: 1.87-57.18, P = 0.007) were independent risk factors. Receiver operating characteristic (ROC) curve analysis indicated that WBC (AUC = 0.836, cut-off = 30.2 × 109/L, P < 0.001) and lymphocyte count (AUC = 0.765, cut-off = 13.5 × 109/L, P < 0.001) could predict the need for EBT.
Conclusions:
In pediatric severe pertussis with oliguria, hypotension or shock, WBC ≥ 36.0 × 109/L, neutrophil count ≥ 11.9 × 109/L, or PAH, the survival rate decreases significantly, necessitating more aggressive treatments. Both hypotension and PAH have been identified as independent prognostic risk factors. We recommend monitoring for EBT and defining its indications.
