Clinical profile and risk factors of severe adenoviral infections among hospitalised children in South India: a cross-sectional study.

BACKGROUND

Adenoviral infections are a significant cause of morbidity in children, with a wide spectrum of clinical manifestations. Early identification of children at risk for severe disease is critical for timely intervention.

OBJECTIVES

To characterise the clinical profile and identify risk factors associated with severe adenoviral infection in hospitalised children in South India.

METHODS

In this cross-sectional study, children aged <13 years admitted with PCR confirmed adenoviral infection between January 2023 and December 2023 were included. Severe infection was defined as severe pneumonia, severe bronchiolitis, shock, acute encephalitis syndrome or multiorgan involvement based on standard guideline definitions. Clinical, laboratory and radiological data were collected and multivariate logistic regression was performed to identify independent predictors of severity after first converting lab parameters to binary using receiver operating characteristic curves and Youden's J index.

RESULTS

A total of 138 children were included whose average age was 44±33.2 months and the majority (63.8%) of whom were males. Factors associated with severity were assessed after excluding children with co-infections in whom other pathogens were predominant, reducing the study size to 88. Of these, only 28 (31.8%) children had severe infection. Independent predictors of severity included breathlessness at presentation, elevated procalcitonin (≥0.59 ng/mL), elevated serum glutamic-oxaloacetic transaminase (SGOT) (≥39 U/L) and low haemoglobin (≤11.0 g/dL). Severe disease required significantly greater respiratory support and longer hospital stay. Overall mortality was only 2.2%.

CONCLUSIONS

About one-third of hospitalised children with predominantly adenoviral infection developed severe disease in this cohort. Breathlessness at presentation, elevated procalcitonin, raised SGOT and low haemoglobin were independent predictors of severity. These readily available clinical and laboratory markers may help identify children requiring closer monitoring and early escalation of supportive care.