Predicting Malignant Pertussis

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Malignant pertussis
That sounds bad doesn't it.  By way of reminder, most cases of pertussis are not fatal.  But some cases are severe.  Malignant pertussis is a syndrome of respiratory failure, marked leukocytosis, and pulmonary hypertension.  But how can you tell which kids with pertussis may do poorly?  152 kids in New Zealand had pertussis; 11 had malignant pertussis.  They came up with a simple multivariate model that predicted malignant pertussis with area under the curve of 0.96.  All kids with malignant pertussis had one of the following three: heart rate >180; total white blood cell count >25,000; neutrophil to lymphocyte ratio > 1.

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HR > 180, WBC > 25K, and neutrophil:lymphocyte ratio > 1 were good predictors of malignant pertussis.


Abstract

Pediatr Crit Care Med. 2016 Nov 1. [Epub ahead of print]

Identifying Children at Risk of Malignant Bordetella pertussis Infection.

Ganeshalingham A1, McSharry BAnderson BGrant CBeca J.

Author information:

11Pediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand. 2Department of General Pediatrics, Starship Children's Hospital, Auckland, New Zealand.

Abstract

OBJECTIVE:

To identify factors associated with malignant pertussis.

DESIGN:

A retrospective case notes review from January 2003 to August 2013. Area under the receiver-operator characteristic curve was used to determine how well vital sign and white cell characteristics within 48 hours of hospital presentation identified children with malignant pertussis.

SETTING:

The national children's hospital in Auckland, New Zealand.

PATIENTS:

One hundred fifty-two children with pertussis.

MEASUREMENTS AND MAIN RESULTS:

There were 152 children with confirmed pertussis identified, including 11 children with malignant pertussis. The area under the receiver-operator characteristic curve was 0.88 (95% CI, 0.78-0.97) for maximum heart rate. The optimal cut-point was 180 beats/min, which predicted malignant pertussis with a sensitivity of 73% and a specificity of 91%. The area under the receiver-operator characteristic curve was 0.92 (95% CI, 0.81-1.0) for absolute neutrophil count, 0.85 (95% CI, 0.71-0.99) for total WBC count, 0.80 (95% CI, 0.63-0.96) for neutrophil-to-lymphocyte ratio, and 0.77 (95% CI, 0.58-0.92) for absolute lymphocyte count. All children with malignant pertussis had one or more of heart rate greater than 180 beats/min, total WBC count greater than 25 × 10/L, and neutrophil-to-lymphocyte ratio greater than 1.0 with an area under the receiver-operator characteristic curve of 0.96 (95% CI, 0.91-1.0) for a multivariate model that included these three variables.

CONCLUSIONS:

Clinical predictors of malignant pertussis are identifiable within 48 hours of hospital presentation. Early recognition of children at risk of malignant pertussis may facilitate early referral to a PICU for advanced life support and selection for trials of investigational therapies.

PMID: 27811532 [PubMed - as supplied by publisher]