tetano
Editor, Senior Moderator
Diagnostics (Basel)
. 2022 Oct 5;12(10):2412.
doi: 10.3390/diagnostics12102412.
Capillary Blood Gas in Children Hospitalized Due to Influenza Predicts the Risk of Lower Respiratory Tract Infection
August Wrotek[SUP] 1 2 [/SUP], Teresa Jackowska[SUP] 1 2 [/SUP]
Affiliations
Abstract
Background: Influenza may impair respiratory exchange in the case of lower respiratory tract infections (LRTIs). Capillary blood gas (CBG) reflects arterial blood values but is a less invasive method than arterial blood sampling. We aimed to retrospectively verify the usefulness of CBG in pediatric influenza.
Material and methods: CBG parameters (pH, pCO[SUB]2[/SUB], pO[SUB]2[/SUB], SatO[SUB]2[/SUB]) in laboratory confirmed influenza cases hospitalized in 2013-2020 were verified in terms of LRTI, chest X-ray (CXR) performance, radiologically confirmed pneumonia (CXR + Pneumonia), prolonged hospitalization, and intensive care transfer. A theoretical CBG-based model for CXR performance was created and the odds ratios were compared to the factual CXR performance.
Results: Among 409 children (aged 13 days-17 years 3/12, median 31 months), the usefulness of CBG decreased with the age. The SatO[SUB]2[/SUB] predicted the LRTI with AUC = 0.74 (95%CI: 0.62-0.86), AUC = 0.71 (0.61-0.82), and AUC = 0.602 (0.502-0.702) in children aged <6 months old (mo), 6-23 mo, 24-59 mo, respectively, while pO[SUB]2[/SUB] revealed AUC = 0.73 (0.6-0.85), AUC = 0.67 (0.56-0.78), and AUC = 0.601 (0.501-0.702), respectively. The pCO[SUB]2[/SUB] predicted the LRTI most precisely in children <6 months with AUC = 0.75 (0.63-0.87), yet not in older children. A high negative predictive value for CXR + Pneumonia was seen for SatO[SUB]2[/SUB] < 6 mo (96.7%), SatO[SUB]2[/SUB] 6-23 mo (89.6%), pO[SUB]2[/SUB] < 6 mo (94.3%), pO[SUB]2[/SUB] 6-23 mo (88.9%). The use of a CBG-driven CXR protocol (based on SatO[SUB]2[/SUB] and pO[SUB]2[/SUB]) would decrease the odds of an unnecessary CXR in children <2 years old (yo) by 84.15% (74.5-90.14%) and 86.15% (66.46-94.28%), respectively. SatO[SUB]2[/SUB] and pO[SUB]2[/SUB] also predicted a prolonged hospitalization <6 mo AUC = 0.71 (0.59-0.83) and AUC = 0.73 (0.61-0.84), respectively, and in 6-23 mo AUC = 0.66 (0.54-0.78) and AUC = 0.63 (0.52-0.75), respectively.
Conclusions: The CBG is useful mainly in children under two years, predicts the risk of LRTI, and can help exclude the risk of CXR + pneumonia. Children under six months of age represent the group that would benefit the most from CBG. A CBG-based protocol for the performance of CXR could significantly decrease the number of unnecessary CXRs.
Keywords: acidosis; capillary blood gas; children; hypercapnia; influenza; pneumonia.
. 2022 Oct 5;12(10):2412.
doi: 10.3390/diagnostics12102412.
Capillary Blood Gas in Children Hospitalized Due to Influenza Predicts the Risk of Lower Respiratory Tract Infection
August Wrotek[SUP] 1 2 [/SUP], Teresa Jackowska[SUP] 1 2 [/SUP]
Affiliations
- PMID: 36292102
- DOI: 10.3390/diagnostics12102412
Abstract
Background: Influenza may impair respiratory exchange in the case of lower respiratory tract infections (LRTIs). Capillary blood gas (CBG) reflects arterial blood values but is a less invasive method than arterial blood sampling. We aimed to retrospectively verify the usefulness of CBG in pediatric influenza.
Material and methods: CBG parameters (pH, pCO[SUB]2[/SUB], pO[SUB]2[/SUB], SatO[SUB]2[/SUB]) in laboratory confirmed influenza cases hospitalized in 2013-2020 were verified in terms of LRTI, chest X-ray (CXR) performance, radiologically confirmed pneumonia (CXR + Pneumonia), prolonged hospitalization, and intensive care transfer. A theoretical CBG-based model for CXR performance was created and the odds ratios were compared to the factual CXR performance.
Results: Among 409 children (aged 13 days-17 years 3/12, median 31 months), the usefulness of CBG decreased with the age. The SatO[SUB]2[/SUB] predicted the LRTI with AUC = 0.74 (95%CI: 0.62-0.86), AUC = 0.71 (0.61-0.82), and AUC = 0.602 (0.502-0.702) in children aged <6 months old (mo), 6-23 mo, 24-59 mo, respectively, while pO[SUB]2[/SUB] revealed AUC = 0.73 (0.6-0.85), AUC = 0.67 (0.56-0.78), and AUC = 0.601 (0.501-0.702), respectively. The pCO[SUB]2[/SUB] predicted the LRTI most precisely in children <6 months with AUC = 0.75 (0.63-0.87), yet not in older children. A high negative predictive value for CXR + Pneumonia was seen for SatO[SUB]2[/SUB] < 6 mo (96.7%), SatO[SUB]2[/SUB] 6-23 mo (89.6%), pO[SUB]2[/SUB] < 6 mo (94.3%), pO[SUB]2[/SUB] 6-23 mo (88.9%). The use of a CBG-driven CXR protocol (based on SatO[SUB]2[/SUB] and pO[SUB]2[/SUB]) would decrease the odds of an unnecessary CXR in children <2 years old (yo) by 84.15% (74.5-90.14%) and 86.15% (66.46-94.28%), respectively. SatO[SUB]2[/SUB] and pO[SUB]2[/SUB] also predicted a prolonged hospitalization <6 mo AUC = 0.71 (0.59-0.83) and AUC = 0.73 (0.61-0.84), respectively, and in 6-23 mo AUC = 0.66 (0.54-0.78) and AUC = 0.63 (0.52-0.75), respectively.
Conclusions: The CBG is useful mainly in children under two years, predicts the risk of LRTI, and can help exclude the risk of CXR + pneumonia. Children under six months of age represent the group that would benefit the most from CBG. A CBG-based protocol for the performance of CXR could significantly decrease the number of unnecessary CXRs.
Keywords: acidosis; capillary blood gas; children; hypercapnia; influenza; pneumonia.