Children with Down Syndrome Are High-Risk for Severe Respiratory Syncytial Virus Disease
Children with Down Syndrome Are High-Risk for Severe Respiratory Syncytial Virus Disease
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DOI：
10.1016/j.jpeds.2014.11.058
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发表时间：
2015-03-01
影响因子：
5.1
通讯作者：
Eberly, Matthew D.
中科院分区：
文献类型：
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作者：
Stagliano, David R.;Nylund, Cade M.;Eberly, Matthew D.
目的评估唐氏综合征作为一个独立的危险因素呼吸道合胞病毒（RSV）住院治疗的儿童年龄小于3岁，并评估疾病severity.Study设计一个回顾性队列研究的儿童参加军事卫生系统数据库进行。通过考克斯比例风险模型评估唐氏综合征对RSV住院的影响，同时控制危险因素。疾病的严重程度进行了评估，住院时间的长短，呼吸支持的需要，和年龄在hospital.Results研究包括633 200名儿童和3 209 378人年。患有唐氏综合症的儿童的住院率为9.6%，而没有唐氏综合症的儿童为2.8%。与大多数风险因素相比，唐氏综合征的RSV住院校正风险比（HR）更大，为3.46（95% CI 2.75-4.37）。敏感性分析显示，0-23月龄唐氏综合征患者的HR为3.21（95% CI 2.51-4.10），24-36月龄患者的HR为5.07（95% CI 2.21-11.59）。患有和不患有唐氏综合征的儿童的中位（IQR）住院时间分别为4天（2-7）和2天（1-4）（P < .001）。唐氏综合征患者需要呼吸支持的风险更大（相对风险5.5; 95%CI，2.5-12.3）。患有和不患有唐氏综合征的儿童入院时的中位数（IQR）年龄分别为9.8个月（5.5-17.7）和3.5个月（1.7-8.7）（P <0.001）。患有唐氏综合征的儿童在RSV住院时年龄较大，并且比没有唐氏综合征的儿童患有更严重的RSV疾病。这种住院风险的增加持续超过24个月。
Objective To assess Down syndrome as an independent risk factor for respiratory syncytial virus (RSV) hospitalization in children younger than 3 years of age and to evaluate illness severity.Study design A retrospective cohort study of children enrolled in the military health system database was conducted. The effect of Down syndrome on RSV hospitalization was assessed by Cox proportional hazards model, while we controlled for risk factors. Disease severity was assessed by length of hospital stay, need for respiratory support, and age at hospitalization.Results The study included 633 200 children and 3 209 378 person-years. Children with Down syndrome had a hospitalization rate of 9.6% vs 2.8% in children without Down syndrome. Down syndrome had a greater adjusted hazard ratio (HR) for RSV hospitalization than most risk factors, 3.46 (95% CI 2.75-4.37). A sensitivity analysis demonstrated HR 3.21 (95% CI 2.51-4.10) for patients with Down syndrome ages 0-23 months and HR 5.07 (95% CI 2.21-11.59) ages 24-36 months. The median (IQR) length of stay of children with and without Down syndrome was 4 days (2-7) and 2 days (1-4) (P < .001). Patients with Down syndrome had a greater risk of requiring respiratory support (relative risk 5.5; 95% CI, 2.5-12.3). The median (IQR) ages at admission for children with and without Down syndrome were 9.8 months (5.5-17.7) and 3.5 months (1.7-8.7) (P < .001).Conclusions Down syndrome is independently associated with an increased risk for RSV hospitalization. Children with Down syndrome are older at time of RSV hospitalization and have more severe RSV illness than children without Down syndrome. This increased risk for hospitalization continues beyond 24 months.