Stephens Sara B, Tsang Rocky, Li Ruosha, Cazaban-Ganduglia Cecilia, Agopian A J, Morris Shaine A
Department of Epidemiology, Human Genetics & Environmental Sciences, UTHealth School of Public Health, Houston, TX, USA.
Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, 6651 Main Street E1920, Houston, TX, 77030, USA.
Pediatr Cardiol. 2024 Aug 5. doi: 10.1007/s00246-024-03613-7.
Influenza is associated with adverse outcomes in children, although modification by additional medical conditions is not well-documented. We aimed to compare outcomes in children with versus without congenital heart defects (CHDs) who were hospitalized for influenza. We retrospectively evaluated patients 1-18y hospitalized for influenza in the Pediatric Health Information (PHIS) database from 2004 to 2019. Outcomes were compared by CHD presence and then by CHD severity (minor biventricular, major biventricular, and single ventricle disease) using log-binomial regression adjusted for propensity scores accounting for age at admission, sex, and history of asthma. Outcomes included inpatient mortality, intensive care unit (ICU) admission, mechanical ventilation, and length of stay (LOS) > 12 days. To evaluate for effect modification by genetic diagnoses, analyses were repeated stratified by CHD and genetic diagnosis. Among 55,161 children hospitalized for influenza, 2369 (4.3%) had CHDs, including 963 with minor biventricular, 938 with major biventricular, and 468 with single ventricle CHDs. Adjusting for propensity scores, children with CHDs had higher mortality (4.1% versus 0.9%) compared to those without CHDs (risk ratio [RR] 2.5, 95% confidence interval [CI] 1.9-3.4). Children with CHDs were at higher risk of mechanical ventilation (RR 1.6, 95% CI 1.6-1.7), ICU admission (RR 1.9, 95% CI 1.8-2.1), and LOS > 12 days (RR 2.2, 95% CI 2.0-2.3). Compared to those with neither CHD nor genetic condition, children with both had significantly higher risk of all outcomes, with the largest difference for LOS > 12 days (RR 2.3, 95% CI 2.0-2.7). Children with CHDs hospitalized for influenza are particularly susceptible to adverse outcomes compared to those without CHDs. Future studies are needed to corroborate findings in light of influenza vaccination.
流感与儿童的不良结局相关，尽管其他疾病对其影响尚无充分记录。我们旨在比较因流感住院的先天性心脏病（CHD）患儿与非CHD患儿的结局。我们对2004年至2019年儿科健康信息（PHIS）数据库中因流感住院的1至18岁患者进行了回顾性评估。通过是否存在CHD比较结局，然后根据CHD严重程度（轻度双心室、重度双心室和单心室疾病），使用对数二项回归并根据入院年龄、性别和哮喘病史的倾向得分进行调整。结局包括住院死亡率、重症监护病房（ICU）入院、机械通气和住院时间（LOS）> 12天。为了评估基因诊断的效应修饰，按CHD和基因诊断分层重复分析。在55161名因流感住院的儿童中，2369名（4.3%）患有CHD，包括963名轻度双心室、938名重度双心室和468名单心室CHD。调整倾向得分后，与非CHD患儿相比，CHD患儿死亡率更高（4.1%对0.9%）（风险比[RR] 2.5，95%置信区间[CI] 1.9 - 3.4）。CHD患儿机械通气风险更高（RR 1.6，95% CI 1.6 - 1.7）、ICU入院风险更高（RR 1.9，95% CI 1.8 - 2.1）以及住院时间> 12天的风险更高（RR 2.2，95% CI 2.0 - 2.3）。与既无CHD也无基因疾病的患儿相比，同时患有两者的患儿所有结局风险均显著更高，住院时间> 12天的差异最大（RR 2.3，95% CI 2.0 - 2.7）。与非CHD患儿相比，因流感住院的CHD患儿尤其易发生不良结局。鉴于流感疫苗接种，未来需要开展研究以证实这些发现。
