Background: Pertussis-related hyperleukocytosis is a major driver of pediatric mortality. While exchange transfusion (ET) improves survival, predictors of death in ET-treated children remain poorly defined. We sought to identify independent predictors of death to refine treatment strategies.
Methods: A single-center retrospective cohort study analysis of 44 children with pertussis-related hyperleukocytosis treated with ET was conducted. Patients were stratified into survival (n = 27) and mortality (n = 17) groups. Univariate comparisons of clinical, laboratory, and ET-related parameters were performed. Multivariate logistic regression identified independent mortality risk factors.
Results: The mortality group exhibited a younger median age at onset (55 vs. 103 days, p = 0.006), higher peak white blood cell (WBC) count (82.19 ± 21.95 vs. 68.10 ± 18.78 × 10⁹/L, p = 0.023), and greater incidence of pre-ET cardiovascular failure (94.1% vs. 22.2%, p < 0.001). In multivariable analysis using Firth's penalized logistic regression, pre-ET cardiovascular failure (OR 53.69, 95% CI 3.63-795.10), higher peak WBC count (OR 1.09 per 1 × 10⁹/L increase, 95% CI 1.02-1.17), and younger age at onset (OR 0.97 per day increase, 95% CI 0.95-0.99) showed significant associations with mortality.
Conclusion: Younger age at onset, marked leukocytosis, and pre-ET cardiovascular failure were associated with increased mortality in children with pertussis complicated by hyperleukocytosis. These factors may help identify patients at higher risk and highlight the importance of early recognition, close monitoring, and timely supportive management. Further prospective studies with larger sample sizes are warranted to validate these findings and to inform optimized management strategies in this vulnerable population.
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