Shi Tingting, Wu Shuning, Fan Huifeng, Xu Xuehua, Yang Diyuan, Chen Qingshan, Lu Gen
Department of Pediatrics, The First School of Clinical Medicine of Jinan University, The First Affiliated Hospital, Jinan University, Guangzhou, China.
Department of Pediatric Respiratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Transl Pediatr. 2025 Jul 31;14(7):1530-1540. doi: 10.21037/tp-2025-184. Epub 2025 Jul 28.
Severe adenovirus pneumonia (SAP) in immunocompetent children can progress rapidly despite conventional treatment, posing significant clinical challenges. The objective of this study to assess the factors influencing mortality in immunocompetent children with SAP undergoing conventional therapies. Early identification of risk factors for mortality is essential to guide timely intervention and optimize management strategies.
In this study, we conducted a retrospective study of 156 immunocompetent pediatric patients diagnosed with SAP, who were divided into the conventional treatments survivor group and death group, without receiving extracorporeal membrane oxygenation (ECMO). Baseline clinical features, laboratory data, imaging findings, treatments and complications were collected. Patients were followed until discharge or death, with mortality confirmed from medical records.
There were 156 children included, with 142 patients in the survivor group and 14 patients in the death group. The mean age was 30.12±28.78 months, with no significant differences in age or sex between the survivor group and the death group (P>0.05). In univariate analysis, significant differences were observed in shortness of breath, tachycardia, low oxygen saturation (SpO), partial pressure of oxygen (PO), partial pressure of carbon dioxide (PCO), and pulmonary consolidation involving two or more lobes and so on (all P<0.05). Respiratory failure, septic shock, and acute respiratory distress syndrome (ARDS) were significantly more common in the death group (P<0.05). In the multivariate analysis, the independent risk factors for death included decreased SpO [odds ratio (OR): 32.336, 95% confidence interval (CI): 2.385-619.473, P=0.02], increased pressure of carbon dioxide in arterial blood (PaCO) (OR: 2.187, 95% CI: 1.079-4.434, P=0.03), and pulmonary consolidation affecting two or more lobes (OR: 9.071, 95% CI: 1.123-73.248, P=0.04).
These findings emphasize the importance of close monitoring of SpO, PaCO levels, and extent of lung consolidation in children with SAP undergoing conventional treatment. Recognizing these risk factors early may prompt consideration of advanced supportive therapies beyond conventional measures to improve survival outcomes.
免疫功能正常儿童的重症腺病毒肺炎（SAP）尽管接受了常规治疗，仍可能迅速进展，带来重大临床挑战。本研究的目的是评估接受常规治疗的免疫功能正常的SAP儿童的死亡影响因素。早期识别死亡危险因素对于指导及时干预和优化管理策略至关重要。
在本研究中，我们对156例诊断为SAP的免疫功能正常的儿科患者进行了回顾性研究，这些患者被分为常规治疗存活组和死亡组，均未接受体外膜肺氧合（ECMO）治疗。收集了基线临床特征、实验室数据、影像学检查结果、治疗方法及并发症。对患者进行随访直至出院或死亡，通过病历确认死亡率。
共纳入156例儿童，其中存活组142例，死亡组14例。平均年龄为30.12±28.78个月，存活组和死亡组在年龄或性别上无显著差异（P>0.05）。单因素分析显示，在呼吸急促、心动过速、低氧饱和度（SpO）、氧分压（PO）、二氧化碳分压（PCO）以及累及两个或更多肺叶的肺部实变等方面存在显著差异（均P<0.05）。呼吸衰竭、感染性休克和急性呼吸窘迫综合征（ARDS）在死亡组中更为常见（P<0.05）。多因素分析显示，死亡的独立危险因素包括SpO降低[比值比（OR）：32.336，95%置信区间（CI）：2.385 - 619.473，P = 0.02]、动脉血二氧化碳分压（PaCO）升高（OR：2.187，95% CI：1.079 - 4.434，P = 0.03）以及累及两个或更多肺叶的肺部实变（OR：9.071，95% CI：1.123 - 73.248，P = 0.04）。
这些发现强调了在接受常规治疗的SAP儿童中密切监测SpO、PaCO水平及肺部实变程度的重要性。早期识别这些危险因素可能促使考虑采用超越常规措施的高级支持治疗，以改善生存结局。
