Abstract
BACKGROUND: Severe adenovirus pneumonia (SAP) in immunocompetent children can progress rapidly despite conventional treatment, posing significant clinical challenges. The objective of this study to assess the factors influencing mortality in immunocompetent children with SAP undergoing conventional therapies. Early identification of risk factors for mortality is essential to guide timely intervention and optimize management strategies. METHODS: In this study, we conducted a retrospective study of 156 immunocompetent pediatric patients diagnosed with SAP, who were divided into the conventional treatments survivor group and death group, without receiving extracorporeal membrane oxygenation (ECMO). Baseline clinical features, laboratory data, imaging findings, treatments and complications were collected. Patients were followed until discharge or death, with mortality confirmed from medical records. RESULTS: There were 156 children included, with 142 patients in the survivor group and 14 patients in the death group. The mean age was 30.12±28.78 months, with no significant differences in age or sex between the survivor group and the death group (P>0.05). In univariate analysis, significant differences were observed in shortness of breath, tachycardia, low oxygen saturation (SpO(2)), partial pressure of oxygen (PO(2)), partial pressure of carbon dioxide (PCO(2)), and pulmonary consolidation involving two or more lobes and so on (all P<0.05). Respiratory failure, septic shock, and acute respiratory distress syndrome (ARDS) were significantly more common in the death group (P<0.05). In the multivariate analysis, the independent risk factors for death included decreased SpO(2) [odds ratio (OR): 32.336, 95% confidence interval (CI): 2.385-619.473, P=0.02], increased pressure of carbon dioxide in arterial blood (PaCO(2)) (OR: 2.187, 95% CI: 1.079-4.434, P=0.03), and pulmonary consolidation affecting two or more lobes (OR: 9.071, 95% CI: 1.123-73.248, P=0.04). CONCLUSIONS: These findings emphasize the importance of close monitoring of SpO(2), PaCO(2) levels, and extent of lung consolidation in children with SAP undergoing conventional treatment. Recognizing these risk factors early may prompt consideration of advanced supportive therapies beyond conventional measures to improve survival outcomes.