Clinical Characteristics, Risk Factors, and Outcomes of Complicated Pneumonia in Children: A 10-Year Retrospective Cohort Study

Complicated pneumonia (CP) is associated with substantial morbidity in children. This retrospective cohort study evaluated demographic, clinical, and laboratory predictors of CP and factors associated with delayed recovery among children hospitalized at a tertiary pediatric pulmonology center between 2008 and 2018. Of 303 patients, 204 (67.3%) developed CP, most commonly parapneumonic effusion. Malnutrition was associated with CP in univariate analysis, while independent predictors included lack of pneumococcal vaccination, prolonged symptom duration, chest pain, anemia, thrombocytosis, and hypoalbuminemia. Malnutrition, anemia, hypoalbuminemia, hyponatremia, prolonged pre-admission fever, prior antipyretic use, elevated inflammatory markers, and positive pleural fluid microbiology were associated with delayed recovery. Readily available admission parameters may facilitate early risk stratification, whereas maintaining high pneumococcal vaccination coverage may contribute to reducing the burden of CP in children. Radiological recovery typically occurred after approximately 60 days, supporting continued clinical observation despite persistent radiographic abnormalities.