Characteristics Of Complications In 165 Children With Severe Adenovirus Pneumonia

Objective: This study intends to analyze and summarize the clinical characteristics and complications of children with severe human adenovirus(HAd V)pneumonia,providing reference for early identification and intervention.Methods: The clinical data of children with severe HAd V pneumonia in pediatric intensive care unit(PICU)of the First Affiliated Hospital of Hunan Normal University(Hunan Provincial People’s Hospital)from November 2018 to October 2019 were summarized retrospectively.In addition,the clinical characteristics were further summarized according to the prognosis and complications.Results:1.A total of 165 children with severe HAd V pneumonia were enrolled,with a male-to-female ratio of 2.4:1 and a median age of 12(10,27)months.Mixed infection was more common(39.4%,65/165).The respiratory tract samples of 131 children were genotyped by adenoviral genotyping,of which type 7(86.2%)was the most common.The most common complications were respiratory failure(87.9%,145/165)and acute respiratory distress syndrome(ARDS)(70.3%,116/165),followed by sepsis(85.4%,141/165),toxic encephalopathy(58.8%,97/165),liver function injury(39.4%,65/165),myocardial injury(21.8%,36/165)and acute renal injury(17.6%,29/165).The number of children with more than three kinds of complications was as high as 67.3%(111/165).Most of the children had a good prognosis,9 cases(5.45%)died,and 54 cases(34.8%)developed bronchitis obliterans(BO)in the later stage of survival.2.The occurrence and prognosis of different complications in children with severe HAd V pneumonia were compared and the related factors were analyzed.1)Compared with the normal liver function group,the onset course,total fever course,PICU hospitalization time,creatine kinase-MB,lactate dehydrogenase,troponin and the incidence of myocardial injury in the liver function injury group were higher than those in the normal liver function group(P<0.05).According to the logistic multivariate regression analysis,severe HAd V pneumonia complicated with liver function injury was related to the length of stay of PICU and aspertate aminotransferase at admission.2)Compared with the group without myocardial injury,the onset course,fever peak,PICU hospitalization time,aspertate aminotransferase,acute renal injury incidence and mortality were higher in the myocardial injury group.According to the logistic multivariate regression analysis,myocardial injury in children with severe HAd V pneumonia was related to the length of stay of PICU and the incidence of acute renal injury.3)Compared with the group without acute kidney injury(AKI),the incidence of fever peak and ARDS was higher in the group with AKI.According to the logistic multivariate regression analysis,children with severe HAd V pneumonia complicated with AKI were more likely to develop ARDS.4)Compared with the less than or equal to three kinds of complications group,the onset course,total fever course,PICU hospitalization time and aspertate aminotransferase at admission were higher in the more than three kinds of complications group.According to the logistic multivariate regression analysis,the occurrence of more than three kinds of complications was related to the course of onset,the length of stay of PICU and aspertate aminotransferase at admission.5)Compared with the non-BO group,the BO group had longer total fever course,longer hospital stay of PICU,higher incidence of respiratory failure,ARDS,acute renal injury and creatine kinase-MB at admission,and more common complications.According to the logistic multivariate regression analysis,patients with BO were correlated with aspertate aminotransferase,creatine kinase-MB and more than three kinds of complications at admission.Conclusion: Severe HAd V pneumonia in children is common in infants,and type 7 is the main type.This kind of children are easy to be complicated with many kinds of complications.In addition,the sequelae of BO are related to aspertate aminotransferase,creatine kinase-MB,and more than three kinds of complications on admission.Clinicians should focus on the complications of severe HAd V pneumonia,early identification and timely intervention.