Inflammatory Markers as Predictors of Complications in Pediatric Measles: Evidence From a Vietnamese Cohort

Background: Measles remains a major cause of pediatric morbidity, with complications that prolong hospitalization and increase mortality risk. Identifying accessible prognostic markers could support early risk stratification. Methods: We analyzed 403 children with confirmed measles admitted to the infectious diseases ward of Soc Trang Hospital for Women and Children, Vietnam, between June and December 2024. Epidemiologic, clinical and laboratory data were collected at admission. Multivariable regression and time-to-event analyses were used to evaluate predictors of complications and prolonged hospitalization (≥7 days). Results: Pneumonia and intestinal infections were the most frequent complications. In adjusted models, malnutrition, leukocytosis and neutrophilia independently predicted pneumonia, although associations were attenuated in penalized models. Intestinal infection was predicted by elevated C-reactive protein levels and neutrophil-to-lymphocyte ratio. Consistent findings were observed in time-to-discharge analyses, with high C-reactive protein levels, lymphopenia and elevated red cell distribution width, which also identified lymphadenitis as a risk factor for delayed discharge. Subgroup analyses suggested stronger effects of C-reactive protein levels and neutrophil-to-lymphocyte ratio in infants, while malnutrition was a robust independent predictor of pneumonia; interactions with lymphopenia and red cell distribution width were not significant. Models demonstrated modest improvement in predictive performance for prolonged stay and marked improvements for intestinal infection. Conclusions: Malnutrition and elevated inflammatory markers predicted intestinal infection and prolonged hospitalization. These readily available measures may assist clinical risk stratification and prioritization during measles outbreaks, particularly in resource-limited settings.