Chen Huabao, Zhang Lidan, Nie Xing, Wang Li, Kang Liangliang, Zhang Yucong, Chen Zhuanggui, Li Yating, Wu Yuhui
Department of Pediatric Intensive Care Unit, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518038, China.
Department of Pediatric Intensive Care Unit, The First Hospital Affiliated to Lanzhou University, Lanzhou, 730000, China.
J Epidemiol Glob Health. 2025 Apr 3;15(1):53. doi: 10.1007/s44197-025-00398-7.
This study aims to investigate the spectrum of viruses leading to severe viral pneumonia (SVP) and the associated risk factors for mortality among pediatric patients in the pediatric intensive care unit (PICU).
Taking the outbreak and end of the COVID-19 pandemic as a aboundary, The pre-pandemic period of COVID-19 spans from 01/2017 to 12/2019, the pandemic period from 01/2020 to 12/2021, and the post-pandemic period from 01/2022 to 12/2023. Patients were subsequently stratified into survivor and non-survivor groups based on clinical outcomes.
A total of 1007 patients (median age 1.42 years, range 0.58-4.00; male: female ratio 1.7:1) diagnosed with SVP. Cases were stratified into pre-pandemic (n = 419, 41.6%), pandemic (n = 272, 27.0%), and post-pandemic (n = 316, 31.4%) periods. Viral predominance varied across phases: Pre-pandemic: Influenza A (IVA, 37.0% [155/419]), respiratory syncytial virus (RSV, 29.8%), adenovirus (19.8%), and influenza B (15.5%). Pandemic phase: Human rhinovirus (HRV, 40.1% [109/272]), RSV (33.1%), parainfluenza viruses (11.4%), and bocavirus (HBoV, 10.7%). Post-pandemic: HRV (24.4% [77/316]), RSV (22.8%), HBoV (14.2%), and IVA (13.6%). Comparative analysis revealed significant intergroup differences in the proportion of patients aged < 3 years, primary immunodeficiency disorders (PIDs), and sepsis between pure viral infection deaths and coinfection-associated fatalities among SVP cases. Logistic regression identified eight independent mortality predictors: acute leukemia, other malignant tumors, PIDs, moderate-to-severe underweight, rhabdomyolysis, acute respiratory distress syndrome (ARDS), infection-related encephalopathy, and multiorgan dysfunction syndrome (MODS). The prediction model demonstrated robust discriminative capacity for SVP mortality: sensitivity 73.8%, specificity 90.2%, and AUC 0.888 (95%CI 0.838-0.938) via ROC curve analysis.
The COVID-19 pandemic has altered the landscape of respiratory viruses causing SVP in children. The presence of underlying health conditions, particularly acute leukemia, other malignancies, and immunodeficiency, significantly increases the risk of death in children with viral pneumonia. The risk prediction model offers a reliable tool for clinical practice to predict mortality in these patients.
本研究旨在调查导致小儿重症监护病房（PICU）中儿童严重病毒性肺炎（SVP）的病毒谱以及相关的死亡风险因素。
以新型冠状病毒肺炎（COVID-19）大流行的爆发和结束为界限，COVID-19大流行前时期为2017年1月至2019年12月，大流行时期为2020年1月至2021年12月，大流行后时期为2022年1月至2023年12月。随后根据临床结局将患者分为存活组和非存活组。
共有1007例患者（中位年龄1.42岁，范围0.58 - 4.00岁；男女比例1.7:1）被诊断为SVP。病例被分为大流行前（n = 419，41.6%）、大流行（n = 272，27.0%）和大流行后（n = 316，31.4%）时期。不同阶段病毒优势不同：大流行前：甲型流感病毒（IVA，37.0% [155/419]）、呼吸道合胞病毒（RSV，29.8%）、腺病毒（19.8%）和乙型流感病毒（15.5%）。大流行阶段：人鼻病毒（HRV，40.1% [109/272]）、RSV（33.1%）、副流感病毒（11.4%）和博卡病毒（HBoV，10.7%）。大流行后：HRV（24.4% [77/316]）、RSV（22.8%）、HBoV（14.2%）和IVA（13.6%）。比较分析显示，SVP病例中，年龄＜3岁患者的比例、原发性免疫缺陷病（PIDs）以及单纯病毒感染死亡与合并感染相关死亡患者之间的败血症在组间存在显著差异。逻辑回归确定了八个独立的死亡预测因素：急性白血病、其他恶性肿瘤、PIDs、中度至重度体重不足、横纹肌溶解、急性呼吸窘迫综合征（ARDS）、感染相关性脑病和多器官功能障碍综合征（MODS）。通过受试者工作特征（ROC）曲线分析，该预测模型对SVP死亡率显示出强大的判别能力：敏感性73.8%，特异性90.2%，曲线下面积（AUC）为0.888（95%置信区间0.838 - 0.938）。
COVID-19大流行改变了导致儿童SVP的呼吸道病毒格局。潜在健康状况的存在，尤其是急性白血病、其他恶性肿瘤和免疫缺陷，显著增加了病毒性肺炎儿童的死亡风险。该风险预测模型为临床实践预测这些患者的死亡率提供了一个可靠工具。
