Hu Qian, Liang Wen, Yi Qiuwei, Zheng Yuejie, Wang Wenjian, Wu Yuhui
Department of Respiratory Diseases, Shenzhen Children's Hospital, Shantou University School of Medicine, Shenzhen, China.
Department of Pediatric Intensive Care, Shenzhen Children's Hospital, Shantou University Medical College, Shenzhen, China.
Front Pediatr. 2023 Sep 12;11:1249058. doi: 10.3389/fped.2023.1249058. eCollection 2023.
To summarize the clinical features of severe influenza in children and the high-risk factors for influenza-related deaths and to raise awareness among pediatricians.
A retrospective study of clinical manifestations, laboratory tests, and diagnosis and treatment of 243 children with severe influenza admitted to Shenzhen Children's Hospital from January 2009 to December 2022 was conducted. Univariate logistic regression analysis and Boruta analysis were also performed to identify potentially critical clinical characteristics associated with death, and clinically significant were used in further multivariate logistic regression analysis. Subject receiver operating characteristic (ROC) curves were applied to assess the efficacy of death-related independent risk factors to predict death from severe influenza.
There were 169 male and 74 female patients with severe influenza, with a median age of 3 years and 2 months and 77.4% of patients under six. There were 46 cases (18.9%) in the death group. The most common pathogen was Influenza A virus (IAV) (81.5%). The most common complication in the death group was influenza-associated acute necrotizing encephalopathy (ANE [52.2%]). Severe influenza in children decreased significantly during the COVID-19 pandemic, with a median age of 5 years, a high predominance of neurological symptoms such as ANE ( = 0.001), and the most common pathogen being H3N2 ( < 0.001). D-dimer, acute respiratory distress syndrome (ARDS), and acute necrotizing encephalopathy (ANE) were significant independent risk factors for severe influenza-associated death. Furthermore, the ROC curves showed that the combined diagnosis of independent risk factors had significant early diagnostic value for severe influenza-related deaths.
Neurological disorders such as ANE are more significant in children with severe influenza after the COVID-19 pandemic. Influenza virus infection can cause serious multisystem complications such as ARDS and ANE, and D-dimer has predictive value for early diagnosis and determination of the prognosis of children with severe influenza.
总结儿童重症流感的临床特征以及流感相关死亡的高危因素，提高儿科医生的认识。
对2009年1月至2022年12月期间收治于深圳市儿童医院的243例重症流感患儿的临床表现、实验室检查及诊治情况进行回顾性研究。还进行了单因素逻辑回归分析和博鲁塔分析，以确定与死亡相关的潜在关键临床特征，并将具有临床意义的特征用于进一步的多因素逻辑回归分析。应用受试者工作特征（ROC）曲线评估与死亡相关的独立危险因素预测重症流感死亡的效能。
重症流感患儿中男性169例，女性74例，中位年龄为3岁2个月，6岁以下患儿占77.4%。死亡组46例（18.9%）。最常见的病原体是甲型流感病毒（IAV，81.5%）。死亡组最常见的并发症是流感相关急性坏死性脑病（ANE，52.2%）。在新冠疫情期间，儿童重症流感显著减少，中位年龄为5岁，ANE等神经症状占比高（P = 0.001），最常见的病原体是H3N2（P < 0.001）。D - 二聚体、急性呼吸窘迫综合征（ARDS）和急性坏死性脑病（ANE）是重症流感相关死亡的重要独立危险因素。此外，ROC曲线显示，独立危险因素的联合诊断对重症流感相关死亡具有显著的早期诊断价值。
新冠疫情后，ANE等神经系统疾病在重症流感患儿中更为显著。流感病毒感染可导致ARDS和ANE等严重多系统并发症，D - 二聚体对重症流感患儿的早期诊断及预后判断具有预测价值。
