tetano
Editor, Senior Moderator
Am J Emerg Med
. 2023 Jul 6;72:20-26.
doi: 10.1016/j.ajem.2023.06.050. Online ahead of print. Predictors of disease severity and outcomes in pediatric patients with croup and COVID-19 in the pediatric emergency department
En-Pei Lee[SUP] 1 [/SUP], Chun-Ting Mu[SUP] 2 [/SUP], Chen-Wei Yen[SUP] 3 [/SUP], Shao-Hsuan Hsia[SUP] 1 [/SUP], Jainn-Jim Lin[SUP] 1 [/SUP], Oi-Wa Chan[SUP] 1 [/SUP], Chun-Che Chiu[SUP] 4 [/SUP], Shen-Hao Lai[SUP] 5 [/SUP], Wen-Chieh Yang[SUP] 6 [/SUP], Chun-Yu Chen[SUP] 6 [/SUP], Ya-Ting Su[SUP] 7 [/SUP], Han-Ping Wu[SUP] 8 [/SUP]
Affiliations
Background: Croup caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging disease, and data on the risk factors associated with disease severity are still limited. The Westley croup score (WS) is widely used to assess croup severity. The current study aimed to analyze biomarkers associated with the WS and clinical outcomes in patients with croup and coronavirus disease 2019 in the pediatric emergency department (PED).
Population and method: Patients diagnosed with croup caused by SARS-CoV-2 were admitted at two PEDs. Clinical data including age, WS, length of hospital stay, initial laboratory data, and treatment were analyzed. Clinical parameters were evaluated via multivariate logistic regression analysis. The best cutoff values for predicting croup severity and outcomes were identified using the receiver operating characteristic curve.
Result: In total, 250 patients were assessed. Moreover, 128 (51.2%) patients were discharged from the PED, and 122 (48.8%) were admitted to the hospital. Mild, moderate, and severe croup accounted for 63.6% (n = 159), 32% (n = 80), and 4.4% (n = 11) of all cases, respectively. A high mean age (years), neutrophil count (%), neutrophil-to-lymphocyte ratio (NLR), ALT (U/L), procalcitonin (ng/mL), and hemoglobin (g/dL) level, and length of hospital stay (days), and a low lymphocyte count (%) and blood pH were associated with croup severity and need for intensive care. Based on the multivariate logistic regression model, the NLR remained independent factors associated with croup severity and prognosis. Further, NLR was significantly correlated with WS. The area under the receiver operating characteristic curve of NLR for predicting a WS of ≥3 was 0.895 (0.842-0.948, p < 0.001), and that for predicting ICU admission was 0.795 (0.711-0.879, p < 0.001). The best cutoff values for a WS of ≥3 and ICU admission were 1.65 and 2.06, respectively.
Conclusion: NLR is correlated with WS and is a reliable, easy-to-use, and cheap biomarker for the early screening and prognosis of croup severity in the PED. A higher NLR may indicate severe croup and the need for further treatment. And the WS score remains reliable for estimating the severity of croup caused by SARS-CoV-2 and the risk of intensive care.
Keywords: COVID-19; Croup; Pediatrics; Prognostic indicator; Westley score.
. 2023 Jul 6;72:20-26.
doi: 10.1016/j.ajem.2023.06.050. Online ahead of print. Predictors of disease severity and outcomes in pediatric patients with croup and COVID-19 in the pediatric emergency department
En-Pei Lee[SUP] 1 [/SUP], Chun-Ting Mu[SUP] 2 [/SUP], Chen-Wei Yen[SUP] 3 [/SUP], Shao-Hsuan Hsia[SUP] 1 [/SUP], Jainn-Jim Lin[SUP] 1 [/SUP], Oi-Wa Chan[SUP] 1 [/SUP], Chun-Che Chiu[SUP] 4 [/SUP], Shen-Hao Lai[SUP] 5 [/SUP], Wen-Chieh Yang[SUP] 6 [/SUP], Chun-Yu Chen[SUP] 6 [/SUP], Ya-Ting Su[SUP] 7 [/SUP], Han-Ping Wu[SUP] 8 [/SUP]
Affiliations
- PMID: 37453221
- DOI: 10.1016/j.ajem.2023.06.050
Background: Croup caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging disease, and data on the risk factors associated with disease severity are still limited. The Westley croup score (WS) is widely used to assess croup severity. The current study aimed to analyze biomarkers associated with the WS and clinical outcomes in patients with croup and coronavirus disease 2019 in the pediatric emergency department (PED).
Population and method: Patients diagnosed with croup caused by SARS-CoV-2 were admitted at two PEDs. Clinical data including age, WS, length of hospital stay, initial laboratory data, and treatment were analyzed. Clinical parameters were evaluated via multivariate logistic regression analysis. The best cutoff values for predicting croup severity and outcomes were identified using the receiver operating characteristic curve.
Result: In total, 250 patients were assessed. Moreover, 128 (51.2%) patients were discharged from the PED, and 122 (48.8%) were admitted to the hospital. Mild, moderate, and severe croup accounted for 63.6% (n = 159), 32% (n = 80), and 4.4% (n = 11) of all cases, respectively. A high mean age (years), neutrophil count (%), neutrophil-to-lymphocyte ratio (NLR), ALT (U/L), procalcitonin (ng/mL), and hemoglobin (g/dL) level, and length of hospital stay (days), and a low lymphocyte count (%) and blood pH were associated with croup severity and need for intensive care. Based on the multivariate logistic regression model, the NLR remained independent factors associated with croup severity and prognosis. Further, NLR was significantly correlated with WS. The area under the receiver operating characteristic curve of NLR for predicting a WS of ≥3 was 0.895 (0.842-0.948, p < 0.001), and that for predicting ICU admission was 0.795 (0.711-0.879, p < 0.001). The best cutoff values for a WS of ≥3 and ICU admission were 1.65 and 2.06, respectively.
Conclusion: NLR is correlated with WS and is a reliable, easy-to-use, and cheap biomarker for the early screening and prognosis of croup severity in the PED. A higher NLR may indicate severe croup and the need for further treatment. And the WS score remains reliable for estimating the severity of croup caused by SARS-CoV-2 and the risk of intensive care.
Keywords: COVID-19; Croup; Pediatrics; Prognostic indicator; Westley score.