Predictors of Outcome in an Egyptian Pediatric Intensive Care Unit

Abstract

Background: Pediatric intensive care unit (PICU) has improved the outcome of children in developed countries. However, little is known about the PICU outcomes in resource-limited settings. Objective: This study was aimed to investigate outcomes predictors at an Egyptian PICU. Patients and Methods: This prospective study was conducted at PICU of Sohag University Hospital from March 2018 to June 2020. Collected data included patients' demographics, clinical, laboratory parameters, severity of illness scores, management, and length of stay in days. Main outcomes were PICU mortality and functional status deterioration (assessed by functional status scale) on discharge and after 6 months. Outcome predictors were evaluated by multivariable logistic regression analysis.Results: This study included 451 patients. The median (IQR) age was 7 (3 -24) months. Sepsis was the major diagnosis (60.1%). The PICU mortality rate was 37.9%. Of survivors, 18.9% developed new disability at PICU discharge. At 6 months only 7.5% had a residual new disability. Multivariable analysis showed that presence of multiorgan dysfunction (AOR=44.9, 95%CI (15-134.3), p <0.001), acute kidney injury (AOR = 11.6, 95%CI (1.82-74.2), p = 0.009), need for prolonged intravenous fluid administration (AOR = 1.2, 95%CI (1.1-1.3), p = 0.005), vasoactive inotropic support on first day of admission(AOR = 1, 95%CI (1-1.1), p = 0.038) and antibiotic escalation (AOR = 4.6, 95%CI (1.5-14.1), p =0.007) contributed to higher mortality outcome. Conclusion:It could be concluded that the PICU mortality was high while the rate of developing functional deterioration was relatively low. Factors related to sepsis-induced organ dysfunction and its treatment were associated with the poor outcomes.

Pediatric critical care services in resource-limited settings; a current state and approaches to improvement.

“…However, the mortality outcome may vary between different PICUs within developping countries according to the availability of resources. (5) In Egypt, the mortality outcome in different PICUs was reported as follows: 14.4% in Al-Ahrar Hospital/ Zagazig; (6) 30% in Menoufia University Hospital/ Menoufia; (7) 33.1% in Cairo University Specialized Pediatric Hospitals/Cairo, (8) 37.9% in Sohag University Hospital/Sohag, (9) and 40% in South Egypt Cancer Institute/ Assuit. (10) In other African countries, the mortality is generally high as it was reported to be 32.6% in an Ethiopian PICU (11) and 54.3% in an PICU in Malawi (2) .…”

“…Several studies conducted in developing countries, including Egypt, have shown that most of patients admitted to PICUs are infants, who also have the highest age-related mortality rates. (6,8,9) This ensures the need of allocating more services to reducing the in-hospital mortality of this vulnerable population. A significant number of children admitted to PICUs in LMICs have underlying malnutrition.…”

“…Acute reversible medical illnesses such as infections (pneumonia, gastroenteritis and sepsis) and trauma are the primary reasons for admission to PICUs in RLSs. (9,20,21) In contrast, patients are occasionally admitted for postoperative care in ICUs in RLSs. PICUs, which provide postoperative care, are only available in tertiary specialized hospitals in large cities.…”

“…(17) In addition to the shortage of pediatric intensivists and trained nursing staff, there is a significant lack of the allied healthcare workers such as respiratory therapists, physiotherapists, clinical pharmacists, and dieticians in many resource-restricted units . (9,11,26) In RLSs, many PICUs have a restricted number of mechanical ventilators and may lack other critical life-supporting devices, including renal replacement therapy and extracorporeal life support, as well as monitoring equipment such as invasive blood pressure monitoring and intracranial pressure monitoring devices . (11,18,26) Inadequate space and systems in PICUs in LMICs can lead to overcrowding and disorganization, which may increase the risk of infection, make it difficult to locate essential devices, and limit healthcare staff and family access to patients.…”