ArticleItalian journal of pediatrics2025
The clinical analysis and indications for exchange transfusion in 158 children with pertussis characterized by marked leukocytosis.
Article in Italian journal of pediatrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- Severe Pertussis During Early Infancy from a High-Altitude Region: Two Clinical Cases and Literature Review.Journal of clinical medicine · 2026Article
- Clinical characteristics and macrolide resistance analysis of pertussis in children: a retrospective study.Frontiers in public health · 2026Article
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Abstract
backgroundHyperleukocytosis (WBC ≥ 30 × 10⁹/L) strongly associated with fatal outcomes; evidence-based thresholds for initiating exchange transfusion (ET) remain undefined. This study aims to investigate the association between leukocyte elevation and disease severity, and define evidence-based thresholds for initiating exchange transfusion, to assist clinical doctors in determining evidence-based medical indications for ET therapy in pediatric patients with pertussis exhibiting marked leukocytosis (WBC ≥ 30 × 10⁹/L).
methodsWe conducted a retrospective cohort study involving 158 children diagnosed with pertussis, who were stratified into three groups based on peak WBC levels: Group A (30-50 × 10⁹/L), Group B (50-70 × 10⁹/L), and Group C (≥ 70 × 10⁹/L). Clinical parameters, including cardiorespiratory indices, complications, and treatment outcomes, were analyzed using the Kruskal-Wallis test and ROC curve analyses.
resultsSignificant differences were observed across the WBC strata in clinical severity markers: cyanosis (45% vs. 58.2% vs. 78.3%, P = 0.015), fever (41.3% vs. 60% vs. 91.3%, P < 0.001), peak respiratory rate (53.9 ± 11.46 vs. 59.4 ± 12.33 vs. 69.04 ± 14.08 breaths/min, P < 0.001), and peak heart rate (144 vs. 157 vs. 187.5 bpm, P < 0.001). Mortality rates escalated with leukocytosis (0% vs. 3.6% vs. 43.5%, P < 0.001).ROC analysis identified optimal thresholds for predicting the need for ET: WBC > 55.38 × 10⁹/L (AUC = 0.899, 95% CI 0.834-0.963; sensitivity 88.2%, specificity 23.4%),Respiratory rate ≥ 59 breaths/min (AUC = 0.795; 95%CI 0.699 ~ 0.891, sensitivity 94.1%, specificity 36.7%),Heart rate ≥ 159 bpm (AUC = 0.813; 95%CI 0.731 ~ 0.895,sensitivity 100%, specificity 38.1%). Patients who met these thresholds required prolonged ICU stays (median 16 vs. 9 days, P = 0.011) and exhibited higher rates of mechanical ventilation (82.6% vs. 7.7%, P < 0.001).
conclusionLeukocyte levels are strongly correlated with the severity of pertussis, risks of complications, and mortality. We propose initiating ET when WBC exceeds 55 × 10⁹/L, particularly in conjunction with tachypnea (> 60 breaths/min) or tachycardia (> 160 bpm), to mitigate the risk of life-threatening outcomes.
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