Department of Pediatrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Information Center, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Minerva Pediatr (Torino). 2024 Jun;76(3):335-342. doi: 10.23736/S2724-5276.20.06065-X. Epub 2021 Jan 13.
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.
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.
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).
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.
喘息是儿童肺炎的常见临床表现。然而，喘息性肺炎发生的相关危险因素及其临床特征尚不完全明确，尤其是在重症肺炎患儿中。
我们回顾性纳入了 2012 年 4 月至 2019 年 9 月在福建省妇幼保健院诊断为重症肺炎的 1434 例儿科患者。收集了人口统计学信息、临床表现、影像学/实验室检查结果和并发症的病历。根据是否存在喘息症状和体征，将患者分为喘息组（n=684）和非喘息组（n=750），比较其临床数据。采用多变量 Cox 回归分析确定喘息的独立危险因素。
性别、体重、发病季节、出生体重、足月出生或否、肺炎史等人口统计学特征与重症 CAP 喘息的发生显著相关（P<0.05）。具体而言，男性、秋冬发病季节和无肺炎史是多变量分析中喘息的独立危险因素（P<0.05）。在临床特征方面，喘息组与非喘息组在临床表现（咳嗽和呼吸急促发生率较高，发热发生率较低）、实验室检查结果（红细胞、血红蛋白和白蛋白水平较高，总胆红素和间接胆红素及肌酸水平较低）、病原体检测（呼吸道合胞病毒感染发生率较高）和临床并发症（脓毒症和胸腔积液风险较低）方面存在差异（P<0.05）。
伴有喘息的重症 CAP 是儿童重症肺炎的一种特殊临床实体，具有特定的危险因素，且在临床特征和病原体方面与非喘息性肺炎不同。
