Risk factors for complicated community-acquired pneumonia in children: a retrospective cohort study in the United Arab Emirates

Abstract Background Community-acquired pneumonia (CAP) is a major global health concern. Despite advances in vaccination and diagnostic tools, CAP remains a major cause of mortality, especially in children younger than five years of age. CAP may be complicated by parapneumonic effusion, empyema, necrotizing pneumonia, lung abscess, pneumothorax, and/or bronchopleural fistula. The present study aimed to characterize CAP and identify risk factors for developing complicated CAP (CCAP) to facilitate early diagnosis, effective management, and improved outcomes. Methods A retrospective chart review was conducted to collect and analyze data from children admitted with CAP or CCAP. Eligible participants were previously healthy children aged 1 month to 13 years who were admitted to the Pediatric Ward or Pediatric Intensive Care Unit between January 2018 and April 2023 with a diagnosis of CAP or CCAP. Results We conducted both univariable and multivariable analyses to identify risk factors associated with CCAP. Univariable analyses using chi-square tests and univariable logistic regression indicated that gender, chest recession, distress, and prior antibiotic use were not significantly associated with CCAP. Comparisons of numerical risk factors between the CAP and CCAP groups using two-sample t-tests, Mann–Whitney U tests, and univariable logistic regression revealed significant differences in age, white blood cell count, C-reactive protein (CRP), platelet count, creatinine level, hemoglobin level, and duration of fever. Multivariable logistic regression analyses, evaluated via likelihood ratio tests, were then used to refine the prediction model. The final model identified the presence of chest recession, older age, longer duration of fever, and elevated levels of CRP as significant predictors of CCAP. Conclusion According to our findings, older age, longer duration of fever, elevated creatinine, elevated CRP, the presence of chest recession, and thrombocytosis are significant predictors of CCAP.