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Risk factors for mortality in children with pertussis and hyperleukocytosis undergoing exchange transfusion: a
Xiaoying Wu1, Ruling Yang1, Hongmei Xu1
1Department of Infectious Diseases, National Clinical Research Center for Children and Adolescent's Health and Diseases, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, The First batch of key Disciplines On Public Health in Chongqing, Children's Hospital of Chongqing Medical University, No. 136 Zhongshaner Road, Yuzhong District, Chongqing, 400014, China.
Insights
Exchange transfusion (ET) can improve survival in children with pertussis-related hyperleukocytosis. Key mortality predictors include younger age, higher white blood cell counts, and cardiovascular failure before ET.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Hematology
Background:
- Pertussis (whooping cough) can cause hyperleukocytosis, a condition with dangerously high white blood cell counts, leading to significant pediatric mortality.
- Exchange transfusion (ET) is a life-saving treatment, but identifying children most at risk of death despite ET is crucial for optimizing care.
Purpose of the Study:
- To identify independent predictors of mortality in children with pertussis-related hyperleukocytosis who received exchange transfusion.
- To refine treatment strategies by understanding risk factors for adverse outcomes.
Main Methods:
- A retrospective cohort study analyzed 44 children with pertussis-related hyperleukocytosis treated with ET.
- Patients were divided into survival and mortality groups for comparison.
- Multivariate logistic regression identified independent predictors of death.
Main Results:
- The mortality group had a younger median age at onset (55 vs. 103 days) and higher peak white blood cell (WBC) counts (82.19 vs. 68.10 × 10⁹/L).
- Pre-ET cardiovascular failure was significantly more common in the mortality group (94.1% vs. 22.2%).
- Independent predictors of mortality included pre-ET cardiovascular failure (OR 53.69), higher peak WBC count (OR 1.09), and younger age at onset (OR 0.97).
Conclusions:
- Younger age at onset, severe leukocytosis, and pre-ET cardiovascular failure are associated with increased mortality in pertussis-related hyperleukocytosis.
- These findings aid in identifying high-risk patients, emphasizing early recognition and prompt supportive management.
- Further prospective studies are needed to validate these predictors and optimize treatment strategies.
Background:
Pertussis-related hyperleukocytosis is a major driver of pediatric mortality. While exchange transfusion (ET) improves survival, predictors of death in ET-treated children remain poorly defined. We sought to identify independent predictors of death to refine treatment strategies.
Methods:
A single-center retrospective cohort study analysis of 44 children with pertussis-related hyperleukocytosis treated with ET was conducted. Patients were stratified into survival (n = 27) and mortality (n = 17) groups. Univariate comparisons of clinical, laboratory, and ET-related parameters were performed. Multivariate logistic regression identified independent mortality risk factors.
Results:
The mortality group exhibited a younger median age at onset (55 vs. 103 days, p = 0.006), higher peak white blood cell (WBC) count (82.19 ± 21.95 vs. 68.10 ± 18.78 × 10⁹/L, p = 0.023), and greater incidence of pre-ET cardiovascular failure (94.1% vs. 22.2%, p < 0.001). In multivariable analysis using Firth's penalized logistic regression, pre-ET cardiovascular failure (OR 53.69, 95% CI 3.63-795.10), higher peak WBC count (OR 1.09 per 1 × 10⁹/L increase, 95% CI 1.02-1.17), and younger age at onset (OR 0.97 per day increase, 95% CI 0.95-0.99) showed significant associations with mortality.
Conclusion:
Younger age at onset, marked leukocytosis, and pre-ET cardiovascular failure were associated with increased mortality in children with pertussis complicated by hyperleukocytosis. These factors may help identify patients at higher risk and highlight the importance of early recognition, close monitoring, and timely supportive management. Further prospective studies with larger sample sizes are warranted to validate these findings and to inform optimized management strategies in this vulnerable population.
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