Background and Objectives: Romania has experienced the highest measles incidence rate in the European Union since late 2023, driven by suboptimal measles–mumps–rubella (MMR) uptake. Contemporary data on bedside predictors of clinical deterioration are scarce. The objective was to characterise demographic, clinical and
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Background and Objectives: Romania has experienced the highest measles incidence rate in the European Union since late 2023, driven by suboptimal measles–mumps–rubella (MMR) uptake. Contemporary data on bedside predictors of clinical deterioration are scarce. The objective was to characterise demographic, clinical and laboratory differences between severe and non-severe measles and derive a multivariable model for intensive-care-unit (ICU) admission.
Methods: We undertook a retrospective cohort study at the “Victor Babeș” University Hospital for Infectious Diseases, Timișoara. All admissions from 1 November 2023 to 15 May 2025 with serological or RT-PCR confirmation and a complete baseline laboratory panel were included. Descriptive statistics compared ward-managed versus ICU-managed patients; independent predictors of ICU transfer were identified through logistic regression that incorporated age, vaccination status, leukocyte count, C-reactive protein (CRP) and interleukin-6 (IL-6).
Results: Among 455 patients (median age 3.0 y, interquartile range [IQR] 1.0–7.0), 17 (3.7%) required ICU care. Vaccine coverage was 18.0% overall and 0% among ICU cases. Compared with ward peers, ICU patients exhibited higher leukocyte counts (8.1 × 10
9 L vs. 6.0 × 10
9 L;
p = 0.003) and a near-five-fold elevation in IL-6 (18 pg mL vs. 4 pg mL;
p < 0.001), while CRP, procalcitonin and fibrinogen were similar. ICU admission prolonged median length of stay from 5 days (IQR 4–7) to 8 days (5–12;
p = 0.004). In multivariable modelling, IL-6 remained the sole independent predictor (odds ratio [OR] 1.07 per pg mL; 95% confidence interval [CI] 1.03–1.12;
p = 0.001); the model’s AUC was 0.83, indicating good discrimination. Complete separation precluded reliable estimation of the protective effect of vaccination, but no vaccinated child required ICU care.
Conclusions: A simple admission panel centred on IL-6 accurately identified Romanian measles patients at risk of critical deterioration, whereas traditional markers such as CRP and leukocyte count added little incremental value. Even a single documented MMR dose was associated with the complete absence of ICU transfers, underscoring the urgent need for catch-up immunisation campaigns. Integrating IL-6-guided triage with intensified vaccination outreach could substantially reduce measles-related morbidity and health-system strain in low-coverage EU settings.
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