Analysis Of Spectrum And Risk Factors Of Death In Patients With Severe Viral Pneumonia In Pediatric Intensive Care Unit

Objective: To investigate spectrum and risk factors of death in patients with severe viral pneumonia in Pediatric intensive care unit(PICU).Methods: We conducted a retrospective analysis of clinical data from 764 patients with severe viral pneumonia who were hospitalized and received treatment in the Pediatric Intensive Care Unit(PICU)of Shenzhen Children’s Hospital from January 2017 to December 2021.The patients were divided into two groups based on survival outcomes:the survival group and the death group.Epidemiological and clinical characteristics between the two groups were analyzed using the chi-square test.Multivariate logistic regression was used to identify independent risk factors for death.Results: A total of 764 cases were included in our study,including 499 males and 265 females.The median duration of illness before admission to the PICU was 3.00(2.00,6.00)days,and the median age of the patients was 1.30(0.50,4.00)years.Children under the age of six years accounted for 85.47% of cases,and 46 cases were hospitalized at least twice.In terms of viral etiology,257 cases were diagnosed with influenza virus(IV),including 182 cases of type A(IVA)and 75 cases of type B(IVB),followed by 217 cases of respiratory syncytial virus(RSV),134 cases of human rhinovirus(HRV),90 cases of adenovirus(ADV),52 cases of human parainfluenza virus(HPIV),44 cases of cytomegalovirus(CMV),34 cases of human boca virus(HBoV),19 cases of human metapneumovirus(HMPV),and 8 cases of coronavirus(HCoV).Before the COVID-19 epidemic,the incidence of IVA,RSV,and ADV ranked in the top three.However,during the COVID-19 epidemic,HRV,RSV,and HPIV became the most common viruses.Other pathogens were also identified in 303 cases,including bacterial infections(227 cases),atypical pathogen infections(83 cases),and fungal infections(31 cases).In terms of comorbidities,430 cases were accompanied by underlying diseases,such as moderate or severe protein-energy malnutrition(205 cases),respiratory diseases(127 cases),and cardiovascular diseases(94 cases).Of these patients,482 cases experienced acute respiratory failure,and 50 cases developed acute respiratory distress syndrome.Other organs were involved in351 cases.All cases received oxygen therapy and respiratory support,but unfortunately,65 cases did not survive.Logistic multiple regression analysis suggested that moderate or severe protein-energy malnutrition,congenital metabolic disorders,posttransplantation,primary immunodeficiency diseases,spinal muscular atrophy and complications(involving the nervous and cardiovascular systems complications,rhabdomyolysis,sepsis,multiple organ dysfunction syndrome)are risk factors for mortality in children with severe viral pneumonia in the pediatric intensive care unit(all P-values <0.05).Conclusion: Severe viral pneumonia can seriously endanger the health and life of children.The spectrum of viruses has undergone significant changes before and during the COVID-19 epidemic.Having underlying conditions(moderate or severe proteinenergy malnutrition,congenital metabolic defects,spinal muscular atrophy,posttransplant,primary immunodeficiency diseases)and complications(involving the nervous and cardiovascular systems complications,rhabdomyolysis,sepsis,multiple organ dysfunction syndrome)are risk factors for death in children with severe viral pneumonia.