Analysis of clinical features and risk factors for severe pertussis in children

Objective: To explore the clinical characteristics and risk factors of severe pertussis in children, aiming to provide evidence for early identification of severe cases and optimization of intervention strategies.

Methods: Retrospectively analyze the clinical data of children with pertussis who were hospitalized in the Children's Hospital affiliated to Shandong University from 2018 to 2022, and analyze the clinical characteristics and risk factors of severe pertussis.

Results: A total of 544 hospitalized children were enrolled, including 53 severe cases (9.74%). Compared with non-severe children, severe group children were more likely to have symptoms such as circumoral cyanosis, post-cough vomiting, wheezing, and apnea, with significantly prolonged hospital stay (all P<0.05). They also had significantly higher incidences of elevated white blood cell count, platelet count, CRP >10mg/L, and ALT >44U/L (all P<0.05). The groups of <3 months old and unimmunized were prone to circumoral cyanosis and apnea, with prolonged average hospital stay (all P<0.05). Logistic regression analysis showed that <3 months old, unvaccinated, elevated white blood cell count, CRP >10mg/L, and ALT >44U/L were independent risk factors for severe pertussis. ROC curve indicated that when white blood cell count reached 18.30×10?/L, the sensitivity for diagnosing severe pertussis was 0.64, and the specificity was 0.70.

Conclusion: Children under 3 months of age and unimmunized children are high-risk populations for developing severe pertussis. Perioral cyanosis, post-tussive vomiting, wheezing, apnea, WBC> 18.30×10?/L, CRP > 10 mg/L, and ALT > 44 U/L can serve as warning indicators for severe disease. It is recommended to prioritize prevention and treatment strategies for high-risk groups and implement dynamic monitoring of these warning indicators to prevent the progression to severe pertussis.

Yan Jinyan, Female, Master of Medicine, graduated from Shandong University. She has been working at Jinan Children's Hospital since 2013 and currently serves as an Attending Physician. With over 10 years of clinical practice in the Department of Pediatric Internal Medicine, she has accumulated rich clinical experience and specializes in the treatment of pediatric infectious diseases and communicable diseases. She has published several papers in core journals and national-level journals, and has led and participated in 2 scientific and technological projects under the Science and Technology Program of Jinan Municipal Health Commission.