Risk factors for complicated community-acquired pneumonia in Egyptian children: a hospital-based 6-month study

Abstract Background Community-acquired pneumonia (CAP) remains among the primary cause of morbidity and mortality in children globally. Despite improved treatment guidelines, still there is a vast increase in the incidence of complications linked to CAP. Identifying various risk factors predisposing to the development of complicated community-acquired pneumonia (CCAP) paves the way to verify and determine new approaches for prevention, early diagnosis, and effective management of such complications. Aim To identify and elucidate risk factors that predispose children diagnosed with community-acquired pneumonia (CAP) to develop local pulmonary complications (complicated community-acquired pneumonia) in our Egyptian community. Methods One-hundred pediatric cases with CAP were involved in a case–control study, where cases were classified into 2 groups depending on the absence (41 cases) or the presence (59 cases) of local pulmonary complications. Data on demographics, medical history, physical examination, and laboratory and radiological findings were collected and analyzed. Logistic regression analysis was utilized to predict various risk factors enhancing the incidence of local pulmonary complications in our population. Results Median age among studied patients was 3.5 years ranging between 0.5 and 13 years. Gender wise, 55 (55%) of our population were males. Patients living in urban areas were 47 (47%) patients. High-grade fever was reported in 91% of patients, and 63% of them received antipyretic in the form of NSAID. Previous COVID-19 infection was positive in 29% of the patients, while 26% had previous hospital admission for pneumonia. Patients below 5th percentile for weight and height represented 19%. Logistic regression showed the following factors predisposing for pulmonary complication starting with the age where children over 2.5 years were more likely to develop complications, with an odds ratio (OR) and 95% confidence interval (95% CI) of 11.875 (3.626–38.885) ( P = 0.000). Urban residence emerged as another critical factor, with 61.0% of complicated cases being urban dwellers and an OR (95% CI) of 4.269 (1.794–10.155) ( P = 0.001) respectively. Clinical history showed that fever with OR (95% CI) 5.868 (1.152–29.883) ( P = 0.033), NSAID use with OR (95% CI) of 2.822 (1.219–6.532) ( P = 0.015), and a past history of COVID-19 with OR (95% CI) 2.888 (1.095–7.616) ( P = 0.028) were more prevalent in complicated cases. Additionally, children with CCAP were often below the 5th percentile for weight and height with OR (95% CI ) 4.713 (1.274–17.434) ( P = 0.020) and showed anemia with OR (95% CI ) 3.420 (1.158–10.103) ( P = 0.041) and thrombocytosis with OR (95% CI ) 4.889 (1.935–12.351) ( P = 0.023). Conclusion The study highlights the predisposing risk factors for complications in pediatric cases with CAP including the following: age more than 2.5 years, residence in urban areas, weight and height below 5th percentile, the presence of fever, use of NSAID, early weaning of breastfeeding, exposure to environmental tobacco smoke (ETS), daycare center attendance, previous history of COVID-19, hemoglobin level equal to or less than 8.9 g/dl, and thrombocytosis. Early identification targeted interventions for prevention and treatment of these factors will lower morbidity incidence of CCAP in Egyptian children.