Comparative analysis of infection-associated and non-infection-associated pulmonary embolism in children: a...

Pediatric pulmonary embolism (PE) exhibits distinct risk factors, with respiratory infections playing a predominant yet understudied role in children.

This multicenter, retrospective study analyzed pediatric patients with PE from 8 Chinese tertiary hospitals between 2003 and 2023. Patients were stratified into infection-associated PE (I-PE) and non-infection-associated PE (NI-PE) groups based on systemic infection status for comparative analysis.

Among 196 pediatric patients diagnosed with PE, I-PE was predominant at 75.5%, vs. 24.5% for NI-PE. The vast majority of I-PE group (77.0%) were associated with respiratory infections, among which 20.3% were attributable to Mycoplasma pneumoniae. Clinically, the I-PE group had higher inflammatory markers (CRP: 45.1 mg/L, ESR: 41 mm/h; P < 0.05) and more frequent chest pain (31.8% vs. 16.7%) and hemoptysis (19.6% vs. 0%; P < 0.05 for both). Low-risk stratification predominated in both groups (91.2% vs. 89.6%). Anticoagulation safety profiles were comparable (bleeding events: 5.4% vs. 4.2%), while the I-PE group without comorbidities demonstrated faster resolution of emboli (44 vs. 345 days). The PE-related mortality rate was 2.6% (below expected), with 10 (5.1%) cases developing late cardiopulmonary dysfunction.

This study revealed a predominance of school-age children within the identified PE cohort, whose actual prevalence exceeding prior estimates. The association between infection, particularly acute respiratory infection, and PE in this cohort supports consideration of PE in children with respiratory infection and concerning features. I-PE presents with marked inflammation, a higher proportion of markedly elevated D-dimer (≥5 μg/mL), and typical symptoms (chest pain/hemoptysis), yet demonstrates better short-term outcomes. NI-PE correlates with underlying diseases and warrants long-term complication monitoring. Recognizing these differences is vital for enhancing outcomes in children with respiratory diseases. PE should be considered in children with severe pneumonia who present with disproportionate inflammation or chest pain.