(1197) Factors Associated With Respiratory Failure in Pediatric Patients With Adenovirus Infection

Introduction: Respiratory failure represents a significant cause of morbidity and mortality among patients admitted to the pediatric intensive care unit. Viral infection is a significant cause of respiratory failure, and adenovirus is a commonly encountered virus in the pediatric population. This study sought to determine which factors are associated with respiratory failure among patients with adenovirus infection.

Methods: A retrospective analysis of the 192 pediatric patients who tested positive for adenovirus via respiratory samples (nasopharynx PCR or DFA, BAL PCR) over an 8-year period was completed. Demographic and clinical variables were compared to identify any significant predictors of respiratory failure, defined as use of positive pressure ventilation. Variables included age at admission, gender, race, ethnicity, underlying conditions (respiratory disease, oncologic/hematologic/immunologic disease, and neurologic disorder), other virus or bacteria found in blood or respiratory samples, WBC count, and administration of antibiotics or antivirals. Mann-Whitney U testing was used to compare continuous measures between groups, while chi-squared or Fisher’s exact testing were used for groupwise comparisons. Adjusted logistic regression was employed to further examine significant effects while controlling for clinically relevant covariates.

Results: Compared to patients who were white, patients who were Asian or listed their race as “Other” had significantly higher odds of respiratory failure (p < 0.05). Additionally, significantly higher proportions of patients who developed respiratory failure had underlying neurologic disorder, as well as a positive culture for respiratory bacteria. Respiratory failure was not significantly higher in patients with underlying oncologic/hematologic/immunologic disease, nor in those with underlying chronic respiratory disease (p=0.05). Respiratory failure was also not significantly higher in patients found to have an additional respiratory virus.

Conclusions: This study shows that viral co-infection may play less of a role in developing respiratory failure than expected. The results also demonstrate that comorbid conditions such as neurologic disorders, as well as factors such as race, may be associated with increased likelihood of respiratory failure.