Association between Gastrointestinal Involvement and PICU Admission in Children with Human Metapneumovirus Infection in China: A Retrospective Cohort Study
Objectives: We aimed to explore the association between human metapneumovirus (hMPV) infection and extrapulmonary involvement risk in children admitted to the pediatric intensive care unit (PICU), and identify risk factors for severe hMPV infections. Methods: A retrospective cohort study was conducted on 752 hospitalized children with hMPV infection from January 2022 to June 2023. Demographic, clinical, laboratory, imaging, extrapulmonary involvement, comorbidity and co-infection data were collected. Logistic regression was used to screen factors linked to PICU admission, and the variance inflation factor (VIF) was applied to identify independent risk factors. Subgroup analyses and interaction tests were performed to verify the stability of the association between extrapulmonary involvement and PICU admission risk. Results: The PICU admission rate was 4.9% (37/752). Univariate analysis showed a significantly higher incidence of extrapulmonary involvement in the PICU group than in the general ward group. Variables with severe multicollinearity (VIF > 5) were excluded from the final model. After adjustment, gastrointestinal involvement was an independent risk factor for PICU admission (OR = 5.52, 95% CI: 1.33 - 22.93). Multiple diagnoses, viral co-infections, respiratory distress, congenital airway anomalies and metabolic disorders also independently increased PICU admission risk. The association between gastrointestinal involvement and PICU admission was strengthened in children with severe pneumonia or without multiple diagnoses, and amplified by respiratory distress. No significant interactions were found between sex and major comorbidity subgroups (all P > 0.05). Conclusion: hMPV can cause severe infections leading to PICU admission. Gastrointestinal involvement may serve as a critical clinical indicator for PICU admission in hospitalized children with hMPV infection.
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