Risk Factors For The Development Of Bronchiolitis Obliterans In Children With Severe Adenovirus Pneumonia

Objective: Retrospectively analyze the clinical data of severe adenovirus pneum onia and explore the risk factors for bronchiolitis obliterans.Methods: Patients with severe adenovirus pneumonia who were hospitalized in the Department of Pediatric Respiratory,Shengjing Hospital of China Medical University from 2018 to 2020 were included.They were followed up for at least 2 years after discharge.Patients diagnosed with bronchiolitis obliterans were served as the BO group,and patients without bronchiolitis obliterans were served as the non-BO group.The clinical data of patients with severe adenovirus pneumonia during hospital were collected,including the general condition,clinical manifestations,laboratory data,imaging data and therapeutic process,and the differences between the two groups were compared.Univariate analysis statistically significant results were included in multivariate logistic regression analysis to analyze independent risk factors for bronchiolitis obliterans.The correlation between the timing,course,dosage of medication and risk factors was analyzed.Results of multivariate logistic regression analysis were used to construct the nomogram model.ROC curve and Hosmer-Lemeshow test were used to evaluate the predictive value.Results:Of 91 patients with severe adenovirus pneumonia,46 cases were in BO group and 45 cases were in non-BO group.The length of fever,aerobic time,length of stay,wheezing during the course,extra-pulmonary complications,abso lute neutrophil count,Interleukin 6,alanine aminotransferase(ALT),consolidati on range in chest CT,and hormone course were statistically different between the two groups(P<0.05).In Logistic regression analysis,length of fever,aerobic time,and wheezing during the course were independent risk factors for bronchi olitis obliterans.The timing of gamma globulin and glucocorticoids use was pos itively correlated with the length of fever.The course and dosage of gamma gl obulin were positively correlated with the length of fever andaerobic time.The course and dosage of glucocorticoids were positively correlated with the aerob ic time.There was also a positive correlation between glucocorticoids dosage and the length of fever.The area under the receiver operating characteristic cur ve value of the nomogram was 0.838(95% confidence interval:0.746-0.907),the sensitivitywas 65.22%,and the specificity was 93.33%.The Hosmer-Lemeshow t est resultof the nomogram: χ2=9.356,P=0.313.Conclusion:The incidence rate of bronchiolitis obliterans in children after severe adenovirus pneumonia is high.The length of fever,aerobic time,wheezing duringt he course are independent risk factors for bronchiolitis obliterans.The nomogram model for predicting BO has high sensitivity and specificity.The early applicatio n of glucocorticoids and gamma globulin after diagnosis has positive effect on prevention of BO.