急诊肺炎患儿进展为重症肺炎的危险因素分析

Risk factors for progression to severe pneumonia in children visiting the emergency department with pneumonia

目的确定5岁以下肺炎患儿发展为重症肺炎的危险因素。方法采用病例对照研究,选取2019年5月至2021年5月南京医科大学附属儿童医院急诊就诊的出生2~59个月的肺炎患儿共246例,依据世界卫生组织(WHO)诊断标准筛选重症肺炎患儿。回顾患儿的病例信息,以获取有关社会人口、营养状况和潜在风险因素。分别用单因素分析和多因素Logistic回归分析重症肺炎的独立危险因素。结果246例肺炎患儿纳入分析,其中男性125例,女性121例;平均年龄(21.0±2.9)个月;重症肺炎患儿84例。人口流行病学特征结果显示,重症肺炎组与肺炎组患儿在性别、年龄及居住地等方面差异无统计学意义。是否早产儿、是否低出生体质量、是否有先天畸形、是否贫血、重症监护病房(ICU)住院时间、营养支持、有无治疗延迟、是否营养不良、有无侵入性治疗、有无呼吸道感染史均是发生重症肺炎的相关因素(重症肺炎组比肺炎组:早产儿比例为9.52%比1.23%,低出生体质量为19.05%比6.79%,先天畸形为22.62%比9.26%,贫血为27.38%比16.05%,ICU住院时间>48 h为63.10%比38.89%,肠内营养支持为34.52%比20.99%,治疗延迟为42.86%比29.63%,营养不良为27.38%比8.64%,侵入性治疗为9.52%比1.85%,呼吸道感染史为67.86%比40.74%,均P<0.05),而是否母乳喂养、感染类型、是否雾化吸入、是否使用激素、是否使用抗菌药物等不是影响重症肺炎的危险因素。多因素Logistic回归分析显示,早产史、低出生体质量、先天畸形、治疗延迟、营养不良、侵入性治疗、呼吸道感染史是重症肺炎的独立危险因素〔早产史:优势比(OR)=2.346,95%可信区间(95%CI)为1.452~3.785;低出生体质量:OR=15.784,95%CI为5.201~47.946;先天畸形:OR=7.135,95%CI为1.519~33.681;治疗延迟:OR=11.541,95%CI为2.734~48.742;营养不良:OR=14.453,95%CI为4.264~49.018;侵入性治疗:OR=6.373,95%CI为1.542~26.343;呼吸道感染史:OR=5.512,95%CI为1.891~16.101,均P<0.05〕。结论早产史、低出生体质量、先天畸形、治疗延迟、营养不良、侵入性治疗、呼吸道感染史是5岁以下肺炎患儿发展为重症肺炎的独立危险因素。

Objective To determine the risk factors for developing severe pneumonia in children under 5 years old with pneumonia.Methods A case-control study was conducted 246 children with pneumonia between 2 and 59 months old who were admitted to the department of emergency of the Children's Hospital of Nanjing Medical University from May 2019 to May 2021 were enrolled.The children with pneumonia were screened according to the diagnostic criteria of the World Health Organization(WHO).Case information of the children was reviewed to obtain relevant socio-demographic,nutritional status and potential risk factors.The independent risk factors for severe pneumonia were analyzed by univariate analysis and multivariate Logistic regression respectively.Results Among the 246 patients with pneumonia,125 were male and 121 were female.The average age was(21.0±2.9)months,184 children with severe pneumonia.The results of population epidemiological characteristics showed that there were no significant differences in gender,age and place of residence between the severe pneumonia group and the pneumonia group.Prematurity,low birth weight,congenital malformation,anemia,length of intensive care unit(ICU)stay,nutritional support,treatment delay,malnutrition,invasive treatment,history of respiratory infection were all related factors affecting the occurrence of severe pneumonia(severe pneumonia group vs.pneumonia group:the proportion of premature infants was 9.52%vs.1.23%,low birth weight was 19.05%vs.6.79%,congenital malformation was 22.62%vs.9.26%,anemia was 27.38%vs.16.05%,length of ICU stay>48 hours was 63.10%vs.38.89%,enteral nutritional support was 34.52%vs.20.99%,treatment delay was 42.86%vs.29.63%,malnutrition was 27.38%vs.8.64%,invasive treatment was 9.52%vs.1.85%,respiratory tract infection history was 67.86%vs.40.74%,all P<0.05).However,breastfeeding,type of infection,nebulization,use of hormones,use of antibiotics,etc.were not risk factors affecting severe pneumonia.Multivariate Logistic regression analysis showed that history of premature birth,low birth weight,congenital malformation,treatment delay,malnutrition,invasive treatment,and history of respiratory infection were independent risk factors for severe pneumonia[history of premature birth:odds ratio(OR)=2.346,95%confidence interval(95%CI)was 1.452-3.785;low birth weight:OR=15.784,95%CI was 5.201-47.946;congenital malformation:OR=7.135,95%CI was 1.519-33.681;treatment delay:OR=11.541,95%CI was 2.734-48.742;malnutrition:OR=14.453,95%CI was 4.264-49.018;invasive treatment:OR=6.373,95%CI was 1.542-26.343;history of respiratory infection:OR=5.512,95%CI was 1.891-16.101,all P<0.05].Conclusion Premature birth history,low birth weight,congenital malformation,delayed treatment,malnutrition,invasive treatment,and history of respiratory infection are independent risk factors for severe pneumonia in children under 5 years old.