Predictors of disease severity and outcomes in pediatric patients with croup and COVID-19 in the pediatric emergency department

• Published in: The American journal of emergency medicine 2023-10, Vol.72, p.20-26
• Main Authors: Lee, En-Pei, Mu, Chun-Ting, Yen, Chen-Wei, Hsia, Shao-Hsuan, Lin, Jainn-Jim, Chan, Oi-Wa, Chiu, Chun-Che, Lai, Shen-Hao, Yang, Wen-Chieh, Chen, Chun-Yu, Su, Ya-Ting, Wu, Han-Ping
• Format: Article
• Language: English
• Subjects: Airway management; Biomarkers; Cell number; Coronaviruses; COVID-19; Croup; Cytokine storm; Emergency medical care; Hemoglobin; Infections; Intubation; Laboratories; Length of stay; Leukocytes (neutrophilic); Lymphocytes; Medical prognosis; Neutrophils; Patients; Pediatrics; Procalcitonin; Prognosis; Prognostic indicator; Regression analysis; Respiratory failure; Risk factors; Severe acute respiratory syndrome coronavirus 2; Ventilators; Westley score
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2023.06.050

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). 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. 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