Clinical characteristics and potential biomarkers predicting disease progression in severe adenoviral pneumonia: A pediatric intensive care unit experience

Abstract

Background

Respiratory tract infections (RTIs) are a major global threat to children, with adenovirus being a leading cause of severe RTIs in this age group. Treatment options are limited, and understanding the factors affecting mortality is essential for developing effective management strategies. This study aims to analyze adenovirus infections in critically ill children and identify biomarkers associated with a poor outcomes.

Methods

This prospective observational study was conducted in children aged 1 month to 14 years with severe adenoviral RTI. Demographic information and clinical data were collected; polymerase chain reaction (PCR) testing was conducted on nasopharyngeal swabs. Survival and non-survival groups were compared using the Mann-Whitney U test and independent sample t tests. Associations with outcomes were evaluated using the chi-square test, and diagnostic evaluation was conducted using receiver operating characteristics (ROC) analysis.

Results

In 70 children with severe adenoviral infection, common symptoms included fever, cough, and respiratory distress. Most patients required respiratory support, including invasive mechanical ventilation support. Chest radiograph findings revealed patchy infiltration and right upper lobar consolidation. Forty percent of the cases resulted in death. Children with lower hemoglobin and lymphocyte counts and higher CRP, LDH, and ferritin levels had poorer outcomes. Hemoglobin (≤9 gm/dL), serum ferritin (>897 ng/mL), and serum LDH (>1172 U/L) showed high sensitivity and specificity, making them good outcome markers.

Conclusion

Low hemoglobin, high serum ferritin, and high LDH in the second week are markers of disease progression and poor prognostic markers in severe adenoviral infections, emphasizing further research and targeted interventions.