Predictors of severe disease in a hospitalized population of children with acute viral lower respiratory tract infections

Abstract

Although predictors of severe viral acute lower respiratory infections (ALRIs) in children have been reported, there have been few research studies performed in low- and middle-income countries (LMIC). The aim of the present study was to determine predictors of disease severity in a population of Colombian children <5 years of age with ALRI. In a prospective cohort study, we determined independent predictors of severe ALRI in a hospitalized population of children under 5 years old with ALRI during a 1-year period. We included both underlying disease conditions and the infecting respiratory viruses as predictor variables of severe disease. We defined severe disease as the necessity of pediatric intensive care unit admission. Of a total of 1,180 patients admitted with a diagnosis of ALRI, 416 (35.3%) were included because they were positive for any kind of respiratory virus. After controlling for potential confounders, it was found that a history of pulmonary hypertension (RR 3.62; CI 95% 2.38-5.52; P < 0.001) and a history of recurrent wheezing (RR 1.77; CI 95% 1.12-2.79; P = 0.015) were independent predictors of severe disease. The present study shows that respiratory viruses are significant causes of ALRI in infants and young children in Colombia, a typical tropical LMIC, especially during the rainy season. Additionally, the results of the present study show that clinical variables such as a history of pulmonary hypertension and a history of recurrent wheezing are more relevant for predicting ALRI severity than the infecting respiratory viruses.

Fatores prognósticos da infeção respiratória aguda baixa grave em crianças menores de 5 anos na Colômbia

“…Este resultado está en concordancia con los hallazgos del estudio Argentino de Cerqueiro et al, quienes demostraron una asociación entre el antecedente de nacimiento pretérmino y la severidad del curso clínico de la irab (24). Tras el análisis multivariante, no se encontraron otros factores asociados a severidad o a hospitalización prolongada o ingreso a ucip; sin embargo, otras investigaciones nacionales han establecido factores predictores de severidad para irab como la historia de hipertensión pulmonar y la presencia de sibilancias recurrentes al ingreso (25).…”

Predictors of Prolonged Length of Hospital Stay for Infants with Bronchiolitis

“…Although in general acute bronchiolitis is a self-limited condition that can be managed conservatively at home without significant medical care, a non-negligible proportion of children often require hospitalization for observation and supportive therapy 2. Among inpatients suffering from bronchiolitis, approximately a quarter may undergo a prolonged length of stay (LOS) for the treatment of their respiratory condition 3 4.…”

Pulmonary hypertension during respiratory syncytial virus bronchiolitis: a risk factor for severity of illness

“…Furthermore, significant associations between pulmonary hypertension and clinical outcomes, including ICU admission, endotracheal intubation, high frequency oscillator ventilation, prolonged ICU stay, and mortality, were also demonstrated as previously described by others. 8,13 After intubation, more than half of the patients with pulmonary hypertension were treated with high frequency oscillator ventilation. We only observed a mild-to-moderate form of pulmonary hypertension which is similar to the report by Fitzgerald.…”

“…6,7 Recent studies have shown that a history of pulmonary hypertension is associated with increased severity of illness during acute lower respiratory tract infection. 8 Worsening pulmonary hypertension secondary to respiratory syncytial virus infection in infants with CHD is a challenging issue for paediatric cardiologists, cardiac surgeons, and intensivists, and in severe cases can result in mortality. [9][10][11][12] Pulmonary hypertension during acute bronchiolitis is observed by echocardiography in 29-67% of infants and associated with prolonged hospitalisation.…”