Clinical Characteristics With Severe Adenovirus Pneumonia And Relationship Between Serum C-reactive Protein To Serum Albumin Radio And The Prognosis In Children

Objective To explore the clinical characteristics in children with severe adenovirus pneumonia(SAP)and to disuss the predictive value of serum c-reactive protein(CRP)to serum albumin(ALB)radio on prognosis of children with SAP.Strengthen the understanding of the disease,and provide a theoretical basis for identification of critically ill children early and reduce the occurrence of adverse outcomes.Methods Continuous collection of clinical data of 149 children were retrospectively analyzed,who were diagnosed with SAP in the pediatric ward of the First People’s Hospital of Changde City from January,2018 to December,2019.All the patients were divided into two group according to their condition when discharged,including a good prognosis group(132 cases)and a poor prognosis group(17 cases).Multivariate logistic regression analysis was performed on meaningful indicators in univariate analysis,and ROC curve was further used to assess the relationship between CRP/ALB and the prognosis of children with SAP.Results 1.Among the 149 children with SAP,50 were females and 99 were males,and 84(56.38%)children is 6 months to 2 years old,with males to females ratio of 1.98:1.111 cases(74.50%)occurred in spring and summer.All patients had fever,88 cases(59.06%)with the high temperature of 40.0℃-40.9℃.All patients had cough,63 cases(42.28%)with wheeze and 19 cases(12.75%)with diarrhea.138cases(92.62%)with wheezing and 142 cases(95.30%)with moist rales in the lung.In the lung imaging findings,110(73.83%)children with SAP showed mostly patch and large exudative change in both lungs.The disease is susceptible to co-infected with other pathogens.The most common virus was respiratory syncytial virus(7.38%)and the mainly bacteria is streptococcus pneumoniae(16.11%),meanwhile,mycoplasma pneumoniae(16.10%)is also common.9 cases(6.04%)had underlying cardiopulmonary diseases.The disease is prone to complications,120 cases(80.54%)have complications.Pleural effusion,pleurisy and respiratory failure were common among intrapulmonary complications.Common extrapulmonary complications of the disease are circulatory,hematological and digestion system.Treatment of SAP were comprehensive.The average length of hospital stay is 12.29 days.The PCIS score showed 107 cases(71.83%)of non-critically ill patients,37 cases(24.83%)of critically ill patients,and 5 cases(3.36%)of extremely critically ill patients.There are132 cases(88.59%)with good prognosis and 17 cases(11.41%)with poor prognosis.2.Among 149 children,71 cases(47.65%)were with adenovirus infection alone and 78 cases(52.35%)were accompanied by other pathogens.The patients were divided into two groups and compare them showed wheezing,respiratory failure,circulatory complications,digestive complications and multiple organ failure were statistically different(P <0.05).3.According to the pathogen,it can be divided into four group including 71cases(47.65%)with single adenovirus infection,9 cases(6.04%)co-infected with adenovirus and other viruses,45 cases(30.20%)with virus and bacterial infection,17cases(11.41%)were infected by viruses and atypical pathogens.Children in adenovirus-virus infection group were prone to wheeze than single adenovirus infection(P <0.05);Children with virus-typical bacteria detected were younger,longer fever time,prone to respiratory failure,other systemic complications and multiple organ failure than children with single adenovirus infection(P <0.05);and children with viruses-atypical pathogens detected were older than children with virus co-infection typical bacteria(P <0.05).4.Univariate analysis showed that ALB,aspartate aminotransferase(AST),CRP/ALB,CRP,adenovirus load,mixed infection,circulatory complications,hematological complications and PCIS score in the poor prognosis group compared with the good prognosis group,the difference was statistically significant(P<0.05).5.Multivariate logistic regression analysis exhibit that CRP/ALB,AST and PCIS score have independent effects on the prognosis assessment of children with SAP(P<0.05).6.The ROC curve shows that the area under the curve(AUC)of CRP/ALB is0.934,which is higher than CRP(AUC=0.905)and ALB(AUC=0.907).When the CRP/ALB cut-off value is 1.091,the prognostic value of children with SAP is the highest,with a specificity of 85.60% and a sensitivity of 100%.The value of CRP/ALB in predicting the poor prognosis of children with SAP is better than CRP and ALB.7.The ROC curve analysis showed that the combination of CRP/ALB,AST and PCIS score had an AUC of 0.978,which was significantly larger than the AUC of each indicator alone(P <0.05),with a sensitivity of 100% and a specificity of 93.90%.Conclusion 1.Children with SAP are more mostly 6 months and 2 years old,with high incidence in spring and summer.The clinical manifestations of SAP patients is serious,long fever time,easy to be infected with other pathogenic,easily suffer multiple complications,but no specific clinical features in the early stage.Therefore,it is important for better prognosis to early identification,early diagnosis,comprehensive treatment,prevention and treatment of complications.2.CRP/ALB,AST and PCIS score are independent risk factors for evaluating the prognosis of children with SAP.3.The value of CRP/ALB in predicting the poor prognosis of children with SAP is better than CRP and ALB alone.4.The integration of CRP/ALB,AST and PCIS score could improve the accuracy of prediction in the prognosis of children with SAP.