{"title":"158例以白细胞明显增多为特征的百日咳患儿换血的临床分析及适应证。","authors":"Gaihuan Zheng, Qing Liu, Chuan Gan","doi":"10.1186/s13052-025-02077-6","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Hyperleukocytosis (WBC ≥ 30 × 10⁹/L) strongly associated with fatal outcomes; evidence-based thresholds for initiating exchange transfusion (ET) remain undefined. This study aims to investigate the association between leukocyte elevation and disease severity, and define evidence-based thresholds for initiating exchange transfusion, to assist clinical doctors in determining evidence-based medical indications for ET therapy in pediatric patients with pertussis exhibiting marked leukocytosis (WBC ≥ 30 × 10⁹/L).</p><p><strong>Methods: </strong>We conducted a retrospective cohort study involving 158 children diagnosed with pertussis, who were stratified into three groups based on peak WBC levels: Group A (30-50 × 10⁹/L), Group B (50-70 × 10⁹/L), and Group C (≥ 70 × 10⁹/L). Clinical parameters, including cardiorespiratory indices, complications, and treatment outcomes, were analyzed using the Kruskal-Wallis test and ROC curve analyses.</p><p><strong>Results: </strong>Significant differences were observed across the WBC strata in clinical severity markers: cyanosis (45% vs. 58.2% vs. 78.3%, P = 0.015), fever (41.3% vs. 60% vs. 91.3%, P < 0.001), peak respiratory rate (53.9 ± 11.46 vs. 59.4 ± 12.33 vs. 69.04 ± 14.08 breaths/min, P < 0.001), and peak heart rate (144 vs. 157 vs. 187.5 bpm, P < 0.001). Mortality rates escalated with leukocytosis (0% vs. 3.6% vs. 43.5%, P < 0.001).ROC analysis identified optimal thresholds for predicting the need for ET: WBC > 55.38 × 10⁹/L (AUC = 0.899, 95% CI 0.834-0.963; sensitivity 88.2%, specificity 23.4%),Respiratory rate ≥ 59 breaths/min (AUC = 0.795; 95%CI 0.699 ~ 0.891, sensitivity 94.1%, specificity 36.7%),Heart rate ≥ 159 bpm (AUC = 0.813; 95%CI 0.731 ~ 0.895,sensitivity 100%, specificity 38.1%). Patients who met these thresholds required prolonged ICU stays (median 16 vs. 9 days, P = 0.011) and exhibited higher rates of mechanical ventilation (82.6% vs. 7.7%, P < 0.001).</p><p><strong>Conclusion: </strong>Leukocyte levels are strongly correlated with the severity of pertussis, risks of complications, and mortality. We propose initiating ET when WBC exceeds 55 × 10⁹/L, particularly in conjunction with tachypnea (> 60 breaths/min) or tachycardia (> 160 bpm), to mitigate the risk of life-threatening outcomes.</p>","PeriodicalId":14511,"journal":{"name":"Italian Journal of Pediatrics","volume":"51 1","pages":"224"},"PeriodicalIF":3.2000,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12261707/pdf/","citationCount":"0","resultStr":"{\"title\":\"The clinical analysis and indications for exchange transfusion in 158 children with pertussis characterized by marked leukocytosis.\",\"authors\":\"Gaihuan Zheng, Qing Liu, Chuan Gan\",\"doi\":\"10.1186/s13052-025-02077-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Hyperleukocytosis (WBC ≥ 30 × 10⁹/L) strongly associated with fatal outcomes; evidence-based thresholds for initiating exchange transfusion (ET) remain undefined. This study aims to investigate the association between leukocyte elevation and disease severity, and define evidence-based thresholds for initiating exchange transfusion, to assist clinical doctors in determining evidence-based medical indications for ET therapy in pediatric patients with pertussis exhibiting marked leukocytosis (WBC ≥ 30 × 10⁹/L).</p><p><strong>Methods: </strong>We conducted a retrospective cohort study involving 158 children diagnosed with pertussis, who were stratified into three groups based on peak WBC levels: Group A (30-50 × 10⁹/L), Group B (50-70 × 10⁹/L), and Group C (≥ 70 × 10⁹/L). Clinical parameters, including cardiorespiratory indices, complications, and treatment outcomes, were analyzed using the Kruskal-Wallis test and ROC curve analyses.</p><p><strong>Results: </strong>Significant differences were observed across the WBC strata in clinical severity markers: cyanosis (45% vs. 58.2% vs. 78.3%, P = 0.015), fever (41.3% vs. 60% vs. 91.3%, P < 0.001), peak respiratory rate (53.9 ± 11.46 vs. 59.4 ± 12.33 vs. 69.04 ± 14.08 breaths/min, P < 0.001), and peak heart rate (144 vs. 157 vs. 187.5 bpm, P < 0.001). Mortality rates escalated with leukocytosis (0% vs. 3.6% vs. 43.5%, P < 0.001).ROC analysis identified optimal thresholds for predicting the need for ET: WBC > 55.38 × 10⁹/L (AUC = 0.899, 95% CI 0.834-0.963; sensitivity 88.2%, specificity 23.4%),Respiratory rate ≥ 59 breaths/min (AUC = 0.795; 95%CI 0.699 ~ 0.891, sensitivity 94.1%, specificity 36.7%),Heart rate ≥ 159 bpm (AUC = 0.813; 95%CI 0.731 ~ 0.895,sensitivity 100%, specificity 38.1%). Patients who met these thresholds required prolonged ICU stays (median 16 vs. 9 days, P = 0.011) and exhibited higher rates of mechanical ventilation (82.6% vs. 7.7%, P < 0.001).</p><p><strong>Conclusion: </strong>Leukocyte levels are strongly correlated with the severity of pertussis, risks of complications, and mortality. We propose initiating ET when WBC exceeds 55 × 10⁹/L, particularly in conjunction with tachypnea (> 60 breaths/min) or tachycardia (> 160 bpm), to mitigate the risk of life-threatening outcomes.</p>\",\"PeriodicalId\":14511,\"journal\":{\"name\":\"Italian Journal of Pediatrics\",\"volume\":\"51 1\",\"pages\":\"224\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2025-07-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12261707/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Italian Journal of Pediatrics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s13052-025-02077-6\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Italian Journal of Pediatrics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13052-025-02077-6","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
摘要
背景：白细胞增多症（WBC≥30 × 10⁹/L）与死亡结果密切相关；启动换血（ET）的循证阈值仍未确定。本研究旨在探讨白细胞升高与疾病严重程度之间的关系，并确定启动换血的循证阈值，以协助临床医生确定对白细胞明显增多（WBC≥30 × 10⁹/L）的儿科百日咳患者进行ET治疗的循证医学指征。方法：对158例诊断为百日咳的儿童进行回顾性队列研究，根据WBC峰值水平将其分为3组：a组（30-50 × 10⁹/L）、B组（50-70 × 10⁹/L）和C组（≥70 × 10⁹/L）。采用Kruskal-Wallis检验和ROC曲线分析临床参数，包括心肺指标、并发症和治疗结果。结果：各WBC层临床严重程度指标存在显著差异：发绀（45% vs. 58.2% vs. 78.3%, P = 0.015）、发热(41.3% vs. 60% vs. 91.3%, P 55.38 × 10⁹/L, AUC = 0.899, 95% CI 0.834-0.963；敏感性88.2%，特异性23.4%)，呼吸频率≥59次/min (AUC = 0.795；95%CI 0.699 ~ 0.891，敏感性94.1%，特异性36.7%)，心率≥159 bpm (AUC = 0.813；95%CI 0.731 ~ 0.895，敏感性100%，特异性38.1%)。达到这些阈值的患者需要延长ICU住院时间（中位16天vs. 9天，P = 0.011），机械通气率更高（82.6% vs. 7.7%， P）。结论：白细胞水平与百日咳严重程度、并发症风险和死亡率密切相关。我们建议在WBC超过55 × 10⁹/L时启动ET，特别是与呼吸急促（> 60次/分钟）或心动过速（> 160次/分钟）一起，以减轻危及生命的结果的风险。
The clinical analysis and indications for exchange transfusion in 158 children with pertussis characterized by marked leukocytosis.
Background: Hyperleukocytosis (WBC ≥ 30 × 10⁹/L) strongly associated with fatal outcomes; evidence-based thresholds for initiating exchange transfusion (ET) remain undefined. This study aims to investigate the association between leukocyte elevation and disease severity, and define evidence-based thresholds for initiating exchange transfusion, to assist clinical doctors in determining evidence-based medical indications for ET therapy in pediatric patients with pertussis exhibiting marked leukocytosis (WBC ≥ 30 × 10⁹/L).
Methods: We conducted a retrospective cohort study involving 158 children diagnosed with pertussis, who were stratified into three groups based on peak WBC levels: Group A (30-50 × 10⁹/L), Group B (50-70 × 10⁹/L), and Group C (≥ 70 × 10⁹/L). Clinical parameters, including cardiorespiratory indices, complications, and treatment outcomes, were analyzed using the Kruskal-Wallis test and ROC curve analyses.
Results: Significant differences were observed across the WBC strata in clinical severity markers: cyanosis (45% vs. 58.2% vs. 78.3%, P = 0.015), fever (41.3% vs. 60% vs. 91.3%, P < 0.001), peak respiratory rate (53.9 ± 11.46 vs. 59.4 ± 12.33 vs. 69.04 ± 14.08 breaths/min, P < 0.001), and peak heart rate (144 vs. 157 vs. 187.5 bpm, P < 0.001). Mortality rates escalated with leukocytosis (0% vs. 3.6% vs. 43.5%, P < 0.001).ROC analysis identified optimal thresholds for predicting the need for ET: WBC > 55.38 × 10⁹/L (AUC = 0.899, 95% CI 0.834-0.963; sensitivity 88.2%, specificity 23.4%),Respiratory rate ≥ 59 breaths/min (AUC = 0.795; 95%CI 0.699 ~ 0.891, sensitivity 94.1%, specificity 36.7%),Heart rate ≥ 159 bpm (AUC = 0.813; 95%CI 0.731 ~ 0.895,sensitivity 100%, specificity 38.1%). Patients who met these thresholds required prolonged ICU stays (median 16 vs. 9 days, P = 0.011) and exhibited higher rates of mechanical ventilation (82.6% vs. 7.7%, P < 0.001).
Conclusion: Leukocyte levels are strongly correlated with the severity of pertussis, risks of complications, and mortality. We propose initiating ET when WBC exceeds 55 × 10⁹/L, particularly in conjunction with tachypnea (> 60 breaths/min) or tachycardia (> 160 bpm), to mitigate the risk of life-threatening outcomes.
期刊介绍：
Italian Journal of Pediatrics is an open access peer-reviewed journal that includes all aspects of pediatric medicine. The journal also covers health service and public health research that addresses primary care issues.
The journal provides a high-quality forum for pediatricians and other healthcare professionals to report and discuss up-to-the-minute research and expert reviews in the field of pediatric medicine. The journal will continue to develop the range of articles published to enable this invaluable resource to stay at the forefront of the field.
Italian Journal of Pediatrics, which commenced in 1975 as Rivista Italiana di Pediatria, provides a high-quality forum for pediatricians and other healthcare professionals to report and discuss up-to-the-minute research and expert reviews in the field of pediatric medicine. The journal will continue to develop the range of articles published to enable this invaluable resource to stay at the forefront of the field.
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