Retrospective analysis of 104 cases of pediatric severe pertussis in Southern China.

OBJECTIVES: The incidence of pertussis has increased significantly in the past year, with infants at high risk of severe disease and death. We aimed to retrospectively analyze pediatric severe pertussis in southern China. METHODS: Children diagnosed with severe pertussis who were hospitalized in the pediatric intensive care unit (PICU) of Guangzhou Women and Children's Medical Center from August 2023 to May 2024 were included. We compared clinical characteristics among different groups and identified risk factors for outcomes and indications for exchange blood transfusion (EBT) in severe pertussis. RESULTS: A total of 104 children with severe pertussis were included. The deceased patients had higher white blood cell counts (WBC) and higher rates of oliguria, pulmonary hypertension (PAH), and tricuspid regurgitation. Kaplan-Meier survival curves showed a lower survival rate in patients with oliguria, hypotension, WBC ≥ 36.0 × 109/L, neutrophil count ≥ 11.9 × 109/L, PAH, and tricuspid regurgitation. Univariate Cox analysis identified risk factors for prognosis: hypotension (HR = 9.36, 95% CI: 1.89-46.41, P = 0.006), WBC (HR = 1.04, 95% CI: 1.01-1.06, P = 0.002), neutrophil count (HR = 1.04, 95% CI: 1.01-1.08, P = 0.019), and PAH (HR = 12.50, 95% CI: 2.29-68.31, P = 0.004). Multivariate Cox analysis revealed that hypotension (HR = 6.44, 95% CI: 1.28-32.35, P = 0.024) and PAH (HR = 10.33, 95% CI: 1.87-57.18, P = 0.007) were independent risk factors. Receiver operating characteristic (ROC) curve analysis indicated that WBC (AUC = 0.836, cut-off = 30.2 × 109/L, P < 0.001) and lymphocyte count (AUC = 0.765, cut-off = 13.5 × 109/L, P < 0.001) could predict the need for EBT. CONCLUSIONS: In pediatric severe pertussis with oliguria, hypotension or shock, WBC ≥ 36.0 × 109/L, neutrophil count ≥ 11.9 × 109/L, or PAH, the survival rate decreases significantly, necessitating more aggressive treatments. Both hypotension and PAH have been identified as independent prognostic risk factors. We recommend monitoring for EBT and defining its indications.