Clinical factors associated with ICU admission in hospitalized children with anaphylaxis

To explore factors associated with intensive care unit (ICU) admission in children with anaphylaxis This is a retrospective, observational cohort study. Children hospitalized with anaphylaxis at the Children’s Hospital of Chongqing Medical University were retrospectively enrolled. Univariate and multivariate logistic regression analyses were sequentially performed to identify independent factors for ICU admission, with subsequent covariate adjustment of the multivariate model to control for potential confounders. One hundred and four children with anaphylaxis were retrospectively enrolled. The most common triggers were drugs (57.69%, 60/104) and blood products (20.19%, 21/104), while 15.38% (16/104) had unknown triggers. Cardiovascular (85.58%, 89/104), cutaneous (73.08%, 76/104), respiratory (62.50%, 65/104), and gastrointestinal (46.15%, 48/104) systems were most frequently involved. The ICU admission rate was 22.12% (23/104). Multivariate logistic regression identified administration of ≥2 epinephrine doses (odds ratio [OR] 6.35, 95% confidence interval [CI] 1.63–27.45, p=0.009) and absence of cutaneous involvement (OR 4.49, 95% CI 1.43–14.98, p=0.011) as factors independently associated with ICU admission (Table 3). These associations remained significant in the sensitivity analysis adjusting for age, systolic blood pressure (SBP), diastolic blood pressure (DBP), and oxygen saturation (SpO 2 ) (adjusted odds ratio [aOR] 8.97, 95% CI 2.12–43.12, p=0.004, and aOR 3.65, 95% CI 1.18–11.46, p=0.024, respectively). The use of multiple epinephrine doses and absence of cutaneous manifestations are factors independently associated with ICU admission in pediatric anaphylaxis. Vigilant monitoring for non-cutaneous manifestations is essential to guide timely clinical decision-making and intervention.