Clinical characteristics and risk factors of severe and critical influenza in children / 中华传染病杂志

ABSTRACT

Objective:To explore the clinical characteristics and risk factors of severe and critical influenza in children.Methods:The clinical data of 214 inpatient children with severe and critical influenza hospitalized in the Second Affiliated Hospital & Yuying Children′s Hospital of Wenzhou Medical University from January 1, 2016 to December 31, 2019 were retrospectively collected. The clinical characteristics including age, gender, symptoms, signs, underlying diseases, C-reactive protein (CRP), treatment and outcome of children with severe and critical influenza were compared. Chi-Square test was used for statistical analysis. A binary logistic regression model was constructed to analyze the risk factors for critically ill influenza.Results:Of the 214 children, 153 were male (71.5%), 177(82.7%) were under 5 years old. There were 52 children with underlying diseases. Fever occurred in 207 cases. Among the 54 cases that had convulsion during the course of the disease, three developed acute necrotizing encephalopathy. The influenza subtype was mainly type A, accounting for 190(88.79%). A total of 42(19.6%) children were critically ill. The incidence of critical influenza in children with underlying diseases (61.9%, 26/42) was higher than that in severe influenza children (15.1%, 26/172), and the difference was statistically significant ( χ2=40.175, P<0.01). The incidence of critical influenza in children with CRP≥40 mg/L was higher than that of severe influenza in children with CRP ≥40 mg/L (33.3%(14/42) vs 9.3%(16/172)), and the difference was statistically significant ( χ2=16.173, P<0.01). Multivariate logistic regression showed that underlying diseases (odds ratio ( OR)=8.794, 95% confidence interval ( CI) 3.845-20.111) and CRP ≥40 mg/L ( OR=5.050, 95% CI 1.966-12.970) were risk factors for critical influenza. All severe cases were improved and discharged.Among the 42 critically ill children, seven children died. Conclusions:Among the severe and critical influenza in children, the majority of children are under five years old.Underlying diseases and CRP ≥40 mg/L are risk factors for critical influenza.