Clinical and laboratory predictors of 30‐day mortality in severe acute malnourished children with severe pneumonia

Abstract

Objective To determine the predictors of mortality within 30 days of hospital admission in a diarrhoeal disease hospital in Bangladesh. Methods Cohort study of hospitalised children aged 0–59 months with severe acute malnutrition (SAM) and severe pneumonia in Dhaka Hospital, icddr,b, Bangladesh from April 2015 to March 2017. Those discharged were followed up, and survival status at 30 days from admission was determined. Children who died were compared with the survivors in terms of clinical and laboratory biomarkers. Multivariable logistic regression analysis was used for calculating adjusted odds ratio for death within 30 days of hospital admission. Results We enrolled 191 children. Mortality within 30 days of admission was 6% (14/191). After adjusting for potential confounders (hypoxia, CRP and haematocrit) in logistic regression analysis, independent factors associated with death were female sex (aOR = 5.80, 95% CI: 1.34–25.19), LAZ <−4 (aOR = 6.51, 95% CI: 1.49–28.44) and Polymorphonuclear Leucocytes (PMNL) (>6.0 × 109/L) (aOR = 1.06, 95% CI: 1.01–1.11). Using sex, Z‐score for length for age (LAZ), and PMNL percentage, we used random forest and linear regression models to achieve a cross‐validated AUC of 0.83 (95% CI: 0.82, 0.84) for prediction of 30‐day mortality. Conclusions The results of our data suggest that female sex, severe malnutrition (<−4 LAZ) and higher PMNL percentage were prone to be associated with 30‐day mortality in children with severe pneumonia. Association of these factors may be used in clinical decision support for prompt identification and appropriate management for prevention of mortality in this population.

Intravenous Amoxicillin Plus Intravenous Gentamicin for Children with Severe Pneumonia in Bangladesh: An Open-Label, Randomized, Non-Inferiority Controlled Trial

“…Eighty-eight percent of our enrolled patients were discharged from hospital after recovery, 3% left against medical advice, 5.4% referred to other medical facility and remaining 5.4% expired. This proportion of hospital outcome is similar to that of other published report from this study site [14]. Our results demonstrated that children who received IV amoxicillin and IV gentamicin experienced 56% less treatment failure than children who received IV ampicillin and IV gentamicin.…”

“…The patients usually presented with diarrhea, pneumonia, malnutrition, sepsis, and other associated complications and received free of cost treatment from the hospital. Details of the other facility of the settings are described elsewhere [14]. A data safety and monitoring board (DSMB) worked independently to monitor serious adverse events (SAE)s related to treatment.…”

Clinical features of pneumonia in severely malnourished children with diarrhoea compared to those without diarrhoea

“…Out of 191 children, 6% died within 30 days of admission (14/191). In our study 24 (9.9%) and 3 (3.4%) children from the PD group and PO group, respectively died, which is almost similar to the rates that documented by others [22]. This is an important but unsurprising observation of our study.…”

Physical Quality of Life of Sepsis Survivor Severely Malnourished Children after Hospital Discharge: Findings from a Retrospective Chart Analysis

“…Studies found that septic children are at risk of mortality both during and after hospitalization [ 5 ]. The post-discharge mortality rate varies between 7–43% in the 1st year [ 15 ] and 82% within five years [ 7 , 33 ]. Nearly half of the patients admitted to the Intensive Care Unit (ICU) of the Dhaka Hospital of icddr,b present with sepsis, and despite standard care, some septic children develop septic shock [ 11 ].…”