Predictors of disease severity and outcomes in pediatric patients with croup and coronavirus disease 2019 in the pediatric emergency department
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: WS is
associated with the severity of croup caused by SARS-CoV-2. Furthermore,
NLR is correlated with WS and is a cost effective, easily accessible
prognostic biomarker in the PED.
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