Meharry Medical College, Nashville, Tennessee, USA.
Department of Biostatistics, Vanderbilt University School of Medicine and Vanderbilt University Medical Center, Nashville, Tennessee, USA.
J Hosp Med. 2022 Jul;17(7):527-533. doi: 10.1002/jhm.12904. Epub 2022 Jun 27.
Underlying comorbidities are common in children with pneumonia.
To determine associations between comorbidity-related functional limitations and risk for severe pneumonia outcomes.
DESIGN, SETTING, AND PARTICIPANTS: We prospectively enrolled children <18 years with and without comorbidities presenting to the emergency department with clinical and radiographic pneumonia at two institutions. Comorbidities included chronic conditions requiring daily medications, frequent healthcare visits, or which limited age-appropriate activities. Among children with comorbidities, functional limitations were defined as none or mild, moderate, and severe.
Outcomes included an ordinal severity outcome, categorized as very severe (mechanical ventilation, shock, or death), severe (intensive care without very severe features), moderate (hospitalization without severe features), or mild (discharged home), and length of stay (LOS). Multivariable ordinal logistic regression was used to examine associations between comorbidity-related functional limitations and outcomes, while accounting for relevant covariates.
A cohort of 1116 children, including 452 (40.5%) with comorbidities; 200 (44.2%) had none or mild functional limitations, 93 (20.6%) moderate, and 159 (35.2%) had severe limitations. In multivariable analysis, comorbidity-related functional limitations were associated with the ordinal severity outcome and LOS (p < .001 for both). Children with severe functional limitations had tripling of the odds of a more severe ordinal (adjusted odds ratio [aOR]: 3.01, 95% confidence interval [2.05, 4.43]) and quadrupling of the odds for longer LOS (aOR: 4.72 [3.33, 6.70]) as compared to children without comorbidities.
Comorbidity-related functional limitations are important predictors of disease outcomes in children with pneumonia. Consideration of functional limitations, rather than the presence of comorbidity alone, is critical when assessing risk of severe outcomes.
患有肺炎的儿童常伴有潜在的合并症。
确定与合并症相关的功能障碍与严重肺炎结局之间的关联。
设计、地点和参与者：我们前瞻性地招募了 2 家机构急诊科就诊的 18 岁以下患有和不患有合并症的具有临床和影像学肺炎的儿童。合并症包括需要每日药物治疗、频繁就诊或限制适龄活动的慢性疾病。在患有合并症的儿童中，功能障碍定义为无或轻度、中度和重度。
结局包括一个有序严重程度结局，分为非常严重（机械通气、休克或死亡）、严重（无非常严重特征的重症监护）、中度（无严重特征的住院）和轻度（出院回家）和住院时间（LOS）。多变量有序逻辑回归用于检查与合并症相关的功能障碍与结局之间的关联，同时考虑了相关的协变量。
共纳入 1116 名儿童，其中 452 名（40.5%）患有合并症；200 名（44.2%）无或轻度功能障碍，93 名（20.6%）中度，159 名（35.2%）重度。在多变量分析中，与合并症相关的功能障碍与有序严重程度结局和 LOS 相关（均 < .001）。与无合并症的儿童相比，功能障碍严重的儿童发生更严重的有序结局的几率增加了两倍（校正比值比 [aOR]：3.01，95%置信区间 [2.05，4.43]），并且 LOS 延长的几率增加了四倍（aOR：4.72 [3.33，6.70]）。
与合并症相关的功能障碍是儿童肺炎疾病结局的重要预测因素。在评估严重结局的风险时，考虑功能障碍，而不仅仅是合并症的存在，至关重要。
