Malignant pertussis in infants: factors associated with mortality in a multicenter cohort study

Annals of Intensive Care

Julien-Frederic Baleine¹  Yoav Hoffmann²  Anne Millet³  Marie Cotillon⁴  Didier Pinquier⁴  Jérôme Rambaud⁵  Hugues Patural⁶  Benoît Boeuf⁷  Mathilde Coquaz-Garoudet⁸  Robin Pouyau⁸  Dominique Ploin⁹  Etienne Javouhey^1,10  Marc Labenne^1,11  Renaud Vialet^1,12 

[1] Département de Pédiatrie Néonatale et Réanimations, Hôpital Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier cedex 5, France;Pediatric Intensive Care Unit, Western Galilee Medical Centre, PO Box 21, 22100, Nahariya, Israel;Service de Médecine Néonatale et Réanimation Pédiatrique, Centre Hospitalier Universitaire de Grenoble, Hôpital Couple Enfant, Boulevard de la Chantourne, 38700, La Tronche, France;Service de Pédiatrie Néonatale et Réanimation, Centre Hospitalier Universitaire de Rouen, Pôle Femme Mère Enfant, 1 rue de Germont, 76031, Rouen cedex, France;Service de Réanimation Néonatale Pédiatrique, Hôpital Trousseau, Assistance Publique-Hôpitaux de Paris, 26 Avenue du Dr Arnold Netter, 75571, Paris, France;Service de Réanimation Néonatale et Pédiatrique, Centre Hospitalier Universitaire de Saint-Etienne, Hôpital Nord, Pôle Mère-Enfant, 42055, Saint-Étienne cedex 2, France;Service de Réanimation Pédiatrique, Centre Hospitalier Universitaire Estaing, 1 Place Lucie Aubrac, 63003, Clermont Ferrand cedex 1, France;Service de Réanimation et Urgences Pédiatriques, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron cedex, France;Service de Réanimation et Urgences Pédiatriques, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron cedex, France;Laboratoire de Virologie et Pathologie Humaine—VirPath Team, Faculté de Médecine RTH Laennec, CNRS, UMR5308, INSERM U1111, Centre International de Recherche en Infectiologie (CIRI), École Normale Supérieure de Lyon, 7-11 rue Guillaume Paradin, 69372, Lyon cedex 08, France;Service de Réanimation et Urgences Pédiatriques, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron cedex, France;Université Claude Bernard, Lyon 1, 8 Avenue Rockefeller, 69008, Lyon, France;Service d’ Anesthésie et de Réanimation Pédiatrique, Assistance Publique-Hôpitaux de Marseille, Hôpital de La Timone, 264 Rue Saint-Pierre, 13385, Marseille cedex 5, France;Service d’ Anesthésie et de Réanimation Pédiatrique, Chemin Des Bourrely, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, 13915, Marseille cedex 20, France;

关键词: Malignant pertussis;    Pediatric intensive care;    Hyperleukocytosis;    Leukodepletion;    Risk factors of death;   

DOI  :  10.1186/s13613-021-00856-y

来源: Springer

【 摘 要 】

BackgroundMalignant pertussis (MP) affects young infants and is characterized by respiratory distress, perpetual tachycardia and hyperleukocytosis up to 50 G/l, leading to multiple organ failure and death in 75% of cases. Leukodepletion may improve prognosis. A therapeutic strategy based on leukodepletion and extracorporeal life support (ECLS) according to different thresholds of leucocytes has been proposed by Rowlands and colleagues. We aimed at identifying factors associated with death and assess whether the respect of the Rowlands’ strategy is associated with survival.MethodsWe reviewed all MP infants hospitalized in eight French pediatric intensive care units from January 2008 to November 2013. All infants younger than 3 months of age, admitted for respiratory distress with a diagnosis of pertussis and WBC count ≥ 50 G/l were recorded. Evolution of WBC was analyzed and an optimal threshold for WBC growth was obtained using the ROC-curve method. Clinical and biological characteristics of survivors and non-survivors were compared. Therapeutic management (leukodepletion and/or ECLS) was retrospectively assessed for compliance with Rowlands’ algorithm (indication and timing of specific treatments).ResultsTwenty-three infants were included. Nine of 23 (40%) died: they presented more frequently cardiovascular failure (100% vs 36%, p = 0.003) and pulmonary hypertension (PHT; 100% vs 29%, p = 0.002) than survivors and the median [IQR] WBC growth was significantly faster among them (21.3 [9.7–28] G/l/day vs 5.9 [3.0–6.8] G/l/day, p = 0.007).WBC growth rate > 12 G/l/day and lymphocyte/neutrophil ratio < 1 were significantly associated with death (p = 0.001 and p = 0.003, respectively).Ten infants (43%) underwent leukodepletion, and seven (30%) underwent ECLS. Management following Rowlands’ strategy was associated with survival (100% vs 0%; p < 0.001, relative risk of death = 0.18, 95%-CI [0.05–0.64]).ConclusionsA fast leukocyte growth and leukocytosis with neutrophil predominance during acute pertussis infection were associated with death. These findings should prompt clinicians to closely monitor white blood cells in order to early identify infants at risk of fatal outcome during the course of malignant pertussis. Such an early signal in infants at high risk of death would increase feasibility of compliant care to Rowlands’ strategy, with the expectation of a better survival.

【 授权许可】

CC BY