Analysis Of The Clinical Features And Prognosis Of Severe Adenovirus Pneumonia In Children Of Different Ages

Objective:(1).This study aimed to analysis the clinical features and prognosis of severe adenovirus pneumonia(SAP)in children of different ages,and to investigate the risk factors for poor prognosis of SAP.(2).To follow up children with a diagnosis of post-infectious bronchiolitis obliterans(PIBO),and evaluate the effect of current treatment on the long-term prognosis of PIBO.Methods: A retrospective observational study was performed to describe the clinical features and analyze the risk factors for mortality and PIBO in 303 children hospitalized with SAP in the Children’s Hospital of Chongqing Medical University from January 2015 through to January 2020.Children were divided into four age groups: < 6months,6-12 months,1-3years,> 3 years.Logistic regression was used to determine significant risk factors associated with mortality and PIBO.Children with PIBO were followed-up via telephone or clinics on the main treatment,remission of clinical symptoms,changes of lung function and chest computed tomography(CT).Results:(1).The median age of the SAP patients was 15.0(9.5,30.0)months.The ratio of males to females was 2.1:1.The recovery rate was85.5%(259/303),mortality rate was 3.3%(10/303),and PIBO developed in 11.2%(34/303)of patients.(2).In < 6 months group: respiratory failure rate was the highest,while fever peak、duration of fever、serum lactate dehydrogenase(LDH)、load of adenovirus,incidence of lung consolidation and pleural effusion were the lowest compared with other groups(P<0.05).In 6-12 months group: the incidence of complications、serum LDH、load of adenovirus,incidence of lung consolidation and PIBO were the highest,while the recovery rate was the lowest compared with other groups(P<0.05).1-3 years group had the longest duration of fever;serum LDH and load of adenovirus were relatively high(P<0.05).> 3 years group: the incidence of complications and PIBO were the lowest,while values of C-reactive protein、incidence of pleural effusion、recovery rate were the highest compared with other groups(P<0.05).(3).Independent risk factors for PIBO were invasive mechanical ventilation,administration of intravenous steroid,duration of fever,and male.Independent risk factors for death were hypercapnia,low albumin levels,and invasive mechanical ventilation.Serum LDH levels(area under the curve [AUC] = 0.842)had a maximum specificity for death(93.4%),with a cutoff value of 1608.3 U/L.(4).32 of 34 PIBO children were returned,with a return rate of 94.1%.The follow-up duration was 10 months to 5 years and 7 months,and no dead case was reported.Children were divided into two groups according to the degree of clinical symptoms remission: 18 children in the remission group(cough and wheeze attacks ≤ 3 times/year)and 14 children in the un-remission group(cough and wheeze attacks > 3 times/year).Result showed that the incidence of initial invasive mechanical ventilation,rate of using oral and inhaled corticosteroid(ICS)after discharge were significantly higher in un-remission group compared with remission group(P<0.05).5 of 32 children showed improvement in Chest CT.5 of 10 children showed improvement in lung function.Conclusions:(1).The clinical features and prognosis of SAP were affected by children’s ages.Child patient with longer duration of fever,hypercapnia,low serum albumin levels,invasive mechanical ventilation and intravenous steroid use were more likely to develop poor prognosis in SAP,especially for male.(2).There is lacking specific treatment of PIBO,and the overall prognosis is poor.Glucocorticoid therapy could partially relieve the clinical symptoms of PIBO,but the lung lesions and lung function damage still persist.