Clinical characteristics and inflammatory response of adenovirus viremia in children with severe adenoviral pneumonia: a prospective cohort study

INTRODUCTION: Critically ill children with adenoviral pneumonia usually require intensive care treatment. In this study, the prevalence of viremia secondary to respiratory adenovirus infection and the host characteristics and inflammatory response of children with severe adenoviral pneumonia in the PICU were investigated. METHODS: We prospectively recruited children who were admitted to the PICU of a tertiary pediatric hospital due to severe adenoviral pneumonia from September 2022 to April 2025. Sputum and blood samples were tested for adenovirus DNA with polymerase chain reaction. The clinical characteristics, blood laboratory parameters, and outcomes of the patients were collected. Plasma cytokines were also detected by flow cytometry. RESULTS: Fifty-one patients with severe adenoviral pneumonia were enrolled, 20 of whom had viremia. The proportion of children with comorbidities in the viremia group and nonviremia group was 40.0% and 71.0%, respectively. The viral loads in sputum; CRP, PCT, D-dimer, AST, LDH, IL-6, IL-8, IL-10, and IFN-γ levels; and pSOFA, PSS and PRISM-Ⅲ scores were significantly greater in the viremia group than in the nonviremia group, whereas the IL-5 and albumin levels were markedly lower in the viremia group. The number of Natural killer cells in the viremia group was lower than that in the nonviremia group, but there was no statistical difference. Multivariate logistic regression found that sputum viral load was an independent risk factor associated with viremia. The areas under the receiver operating characteristic curves for AST, LDH, PCT, CRP, D-dimer, IL-6 and IFN-γ could predict viremia. The mortality rate of the viremia group was higher than that of the nonviremia group, while the difference was not significant. CONCLUSIONS: The prevalence of viremia is nearly 40% in children with severe adenoviral pneumonia in the PICU. Compared with the nonviremia group, the viremia group had higher sputum viral loads, CRP, PCT, IL-6, IL-8, IL-10, and IFN-γ levels; and more serious disease severity.