Capillary Blood Gas in Children Hospitalized Due to Influenza Predicts the Risk of Lower Respiratory Tract Infection
Background: Influenza may impair respiratory exchange in the case of lower respiratory tract infections (LRTIs). Capillary blood gas (CBG) reflects arterial blood values but is a less invasive method than arterial blood sampling. We aimed to retrospectively verify the usefulness of CBG in pediatric...
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MDPI AG
2022-10-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/12/10/2412 |
| _version_ | 1797473847249731584 |
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| author | August Wrotek Teresa Jackowska |
| author_facet | August Wrotek Teresa Jackowska |
| author_sort | August Wrotek |
| collection | DOAJ |
| description | Background: Influenza may impair respiratory exchange in the case of lower respiratory tract infections (LRTIs). Capillary blood gas (CBG) reflects arterial blood values but is a less invasive method than arterial blood sampling. We aimed to retrospectively verify the usefulness of CBG in pediatric influenza. Material and methods: CBG parameters (pH, pCO<sub>2</sub>, pO<sub>2</sub>, SatO<sub>2</sub>) in laboratory confirmed influenza cases hospitalized in 2013–2020 were verified in terms of LRTI, chest X-ray (CXR) performance, radiologically confirmed pneumonia (CXR + Pneumonia), prolonged hospitalization, and intensive care transfer. A theoretical CBG-based model for CXR performance was created and the odds ratios were compared to the factual CXR performance. Results: Among 409 children (aged 13 days–17 years 3/12, median 31 months), the usefulness of CBG decreased with the age. The SatO<sub>2</sub> predicted the LRTI with AUC = 0.74 (95%CI: 0.62–0.86), AUC = 0.71 (0.61–0.82), and AUC = 0.602 (0.502–0.702) in children aged <6 months old (mo), 6–23 mo, 24–59 mo, respectively, while pO<sub>2</sub> revealed AUC = 0.73 (0.6–0.85), AUC = 0.67 (0.56–0.78), and AUC = 0.601 (0.501–0.702), respectively. The pCO<sub>2</sub> predicted the LRTI most precisely in children <6 months with AUC = 0.75 (0.63–0.87), yet not in older children. A high negative predictive value for CXR + Pneumonia was seen for SatO<sub>2</sub> < 6 mo (96.7%), SatO<sub>2</sub> 6–23 mo (89.6%), pO<sub>2</sub> < 6 mo (94.3%), pO<sub>2</sub> 6–23 mo (88.9%). The use of a CBG-driven CXR protocol (based on SatO<sub>2</sub> and pO<sub>2</sub>) would decrease the odds of an unnecessary CXR in children <2 years old (yo) by 84.15% (74.5–90.14%) and 86.15% (66.46–94.28%), respectively. SatO<sub>2</sub> and pO<sub>2</sub> also predicted a prolonged hospitalization <6 mo AUC = 0.71 (0.59–0.83) and AUC = 0.73 (0.61–0.84), respectively, and in 6–23 mo AUC = 0.66 (0.54–0.78) and AUC = 0.63 (0.52–0.75), respectively. Conclusions: The CBG is useful mainly in children under two years, predicts the risk of LRTI, and can help exclude the risk of CXR + pneumonia. Children under six months of age represent the group that would benefit the most from CBG. A CBG-based protocol for the performance of CXR could significantly decrease the number of unnecessary CXRs. |
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| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-09T20:22:22Z |
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| series | Diagnostics |
| spelling | doaj.art-71e7602484334b26b0a3f6c3659c66c72023-11-23T23:44:52ZengMDPI AGDiagnostics2075-44182022-10-011210241210.3390/diagnostics12102412Capillary Blood Gas in Children Hospitalized Due to Influenza Predicts the Risk of Lower Respiratory Tract InfectionAugust Wrotek0Teresa Jackowska1Department of Pediatrics, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813 Warsaw, PolandDepartment of Pediatrics, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813 Warsaw, PolandBackground: Influenza may impair respiratory exchange in the case of lower respiratory tract infections (LRTIs). Capillary blood gas (CBG) reflects arterial blood values but is a less invasive method than arterial blood sampling. We aimed to retrospectively verify the usefulness of CBG in pediatric influenza. Material and methods: CBG parameters (pH, pCO<sub>2</sub>, pO<sub>2</sub>, SatO<sub>2</sub>) in laboratory confirmed influenza cases hospitalized in 2013–2020 were verified in terms of LRTI, chest X-ray (CXR) performance, radiologically confirmed pneumonia (CXR + Pneumonia), prolonged hospitalization, and intensive care transfer. A theoretical CBG-based model for CXR performance was created and the odds ratios were compared to the factual CXR performance. Results: Among 409 children (aged 13 days–17 years 3/12, median 31 months), the usefulness of CBG decreased with the age. The SatO<sub>2</sub> predicted the LRTI with AUC = 0.74 (95%CI: 0.62–0.86), AUC = 0.71 (0.61–0.82), and AUC = 0.602 (0.502–0.702) in children aged <6 months old (mo), 6–23 mo, 24–59 mo, respectively, while pO<sub>2</sub> revealed AUC = 0.73 (0.6–0.85), AUC = 0.67 (0.56–0.78), and AUC = 0.601 (0.501–0.702), respectively. The pCO<sub>2</sub> predicted the LRTI most precisely in children <6 months with AUC = 0.75 (0.63–0.87), yet not in older children. A high negative predictive value for CXR + Pneumonia was seen for SatO<sub>2</sub> < 6 mo (96.7%), SatO<sub>2</sub> 6–23 mo (89.6%), pO<sub>2</sub> < 6 mo (94.3%), pO<sub>2</sub> 6–23 mo (88.9%). The use of a CBG-driven CXR protocol (based on SatO<sub>2</sub> and pO<sub>2</sub>) would decrease the odds of an unnecessary CXR in children <2 years old (yo) by 84.15% (74.5–90.14%) and 86.15% (66.46–94.28%), respectively. SatO<sub>2</sub> and pO<sub>2</sub> also predicted a prolonged hospitalization <6 mo AUC = 0.71 (0.59–0.83) and AUC = 0.73 (0.61–0.84), respectively, and in 6–23 mo AUC = 0.66 (0.54–0.78) and AUC = 0.63 (0.52–0.75), respectively. Conclusions: The CBG is useful mainly in children under two years, predicts the risk of LRTI, and can help exclude the risk of CXR + pneumonia. Children under six months of age represent the group that would benefit the most from CBG. A CBG-based protocol for the performance of CXR could significantly decrease the number of unnecessary CXRs.https://www.mdpi.com/2075-4418/12/10/2412influenzachildrenpneumoniacapillary blood gasacidosishypercapnia |
| spellingShingle | August Wrotek Teresa Jackowska Capillary Blood Gas in Children Hospitalized Due to Influenza Predicts the Risk of Lower Respiratory Tract Infection Diagnostics influenza children pneumonia capillary blood gas acidosis hypercapnia |
| title | Capillary Blood Gas in Children Hospitalized Due to Influenza Predicts the Risk of Lower Respiratory Tract Infection |
| title_full | Capillary Blood Gas in Children Hospitalized Due to Influenza Predicts the Risk of Lower Respiratory Tract Infection |
| title_fullStr | Capillary Blood Gas in Children Hospitalized Due to Influenza Predicts the Risk of Lower Respiratory Tract Infection |
| title_full_unstemmed | Capillary Blood Gas in Children Hospitalized Due to Influenza Predicts the Risk of Lower Respiratory Tract Infection |
| title_short | Capillary Blood Gas in Children Hospitalized Due to Influenza Predicts the Risk of Lower Respiratory Tract Infection |
| title_sort | capillary blood gas in children hospitalized due to influenza predicts the risk of lower respiratory tract infection |
| topic | influenza children pneumonia capillary blood gas acidosis hypercapnia |
| url | https://www.mdpi.com/2075-4418/12/10/2412 |
| work_keys_str_mv | AT augustwrotek capillarybloodgasinchildrenhospitalizedduetoinfluenzapredictstheriskoflowerrespiratorytractinfection AT teresajackowska capillarybloodgasinchildrenhospitalizedduetoinfluenzapredictstheriskoflowerrespiratorytractinfection |