Risk Factors in Predicting Mortality among Children admitted for PCAP C and D at Philippine Children&rsquo;s Medical Center

Excelle Grace  M. Canonizado,; Mary Therese  M. Leopando,

Risk Factors in Predicting Mortality among Children admitted for PCAP C and D at Philippine Children’s Medical Center

Excelle Grace M. Canonizado | Mary Therese M. Leopando

Abstract:

OBJECTIVE: The study aimed to identify risk factors associated with mortality among patients admitted for PCAP C and D. METHODOLOGY: The study was a cross-sectional study involving children admitted for PCAP C and D at PCMC from January 2017 to December 2019. Univariate and multivariate analyses through binomial logistic regression were used to determine significant predictors of mortality. RESULTS: A total of 472 patients were included in the study, of whom 77% had PCAP C and 23% had PCAP D. More than half in each patient group were infants; male; and of normal nutritional status. Most common comorbidities in both groups were neurologic and cardiovascular in nature. Leukocytosis, thrombocytosis, and anemia were the most common hematologic findings. Overall mortality rate among patients was 5.08%. On univariate analysis, being severely underweight (cOR 8.28 [95% CI 2.52–27.23]), with history of antibiotic use (cOR 3.01 [95% CI 1.18–7.62], neurologic comorbidities (cOR 4.04 [95% CI 1.42–11.43]), cardiac comorbidities (cOR 5.33 [95% CI 1.31–21.75]), Down syndrome (cOR 22.11 [95% CI 2.44-200.30]), and thrombocytopenia (cOR 22.11 [95% CI 2.44-200.30]) were associated with greater odds of mortality among PCAP-D patients. On multivariate analysis, the odds of mortality were 5.02 (95% CI 1.05-23.96) for severely underweight patients, 4.51 (95% CI 1.13-17.95) in patients with neurologic disease, and 73.62 (95% CI 3.63–1491.10) in patients with Down syndrome. CONCLUSION: Patients with PCAP D who have severe malnutrition, Down syndrome, cardiac and neurologic abnormalities, and thrombocytopenia should be managed more aggressively to decrease mortality in these patients.

References:

Huang C-Y, et al. Risk factors of progressive community-acquired pneumonia in hospitalized children: A prospective study. Journal of Microbiology, Immunology and Infection. 2015; 48(1):36-42.
Koh et al. Risk factors for mortality in children with pneumonia admitted to the pediatric intensive care unit. Pediatric Pulmonology. 2017; 9999:1–9.
Negash, A., Asrat, D., Abebe, W., Hailemariam, T., Hailu, T., Assefa, A., Vaneechoutte, M., Bacteremic Community-Acquired Pneumonia in Ethiopian Children: Etiology, Antibiotic Resistance, Risk Factors, and Clinical Outcome. Open Forum Infect Dis. 2019; 6(3): ofz029.
Dembele BPP, et al. Aetiology and risk factors associated with the fatal outcomes of childhood pneumonia among hospitalized children in the Philippines from 2008 to 2016: a case series study. BMJ Open. 2019;9:e026895.
Lupisan et al. Predictors of death from severe pneumonia among children 2–59 months old hospitalized in Bohol, Philippines: implications for referral criteria at a first-level health facility. Tropical Medicine and International Health. 2007; 12(8):962–971.
Philippine Academy of Pediatric Pulmonologists. 3rd PAPP Update [2016] in the Evaluation and Management of Pediatric Community-acquired Pneumonia. 2016. Available from: http://www.papp.org.ph
Tumanan-Mendoza, B. A., Mendoza, V. L., Frias, M. V. G., & Bonzon, D. D. (2017). Economic Burden of Community-Acquired Pneumonia Among Pediatric Patients (Aged 3 Months to <19 Years) in the Philippines. Value Health Reg Issues. 2017;12:115-122.
Kelsey et al., Methods in Observational Epidemiology 2nd Edition, Table 12-15, Fleiss, Statistical Methods for Rates and Proportions, formulas 3.18&3.19
World Health Organization. Nutrition Landscape Information System (NLIS) country profile indicators: interpretation guide. 2010. Available from: https://apps.who.int/iris/handle/10665/44397
Ramachandran, P., Krishnamoorthi, N., Vengatesan, A. Risk Factors for Mortality in Community Acquired Pneumonia Among Children Aged 1 Month to 59 Months Admitted in a Referral Hospital. Indian Pediatrics. 2012; 49(11).
Shi, T. et al. Risk factors for mortality from severe community-acquired pneumonia in hospitalized children transferred to the pediatric intensive care unit. Pediatr Neonatol. 2020;S1875-9572(20)30098-X.
Zhang, Q. et al. A 4-year prospective study to determine risk factors for severe community acquired pneumonia in children in southern China. Pediatr Pulmonol. 2013;48(4):390-7.
Mirsaeidi, M. Thrombocytopenia and thrombocytosis at time of hospitalization predict mortality in patients with community-acquired pneumonia. Chest. 2010;137(2):416-20.
Jain, A., Awasthi, N., Awasthi, S. Low platelet counts predict mortality in severe community acquired pneumonia in children under 5 years of age: A hospital-based observational study. Clinical Epidemiology and Global Health. 2018; 6(4).
Millman, A., et al. Community-Acquired Pneumonia Hospitalization among Children with Neurologic Disorders. Journal of Pediatrics. 2016;173:188-195.e4.
Bloemers, BLP., et al. Increased risk of respiratory tract infections in children with Down syndrome: the consequence of an altered immune system. Microbes and Infection. 2010;12(11):799-808.
Jroundi, I., et al. Risk factors for a poor outcome among children admitted with clinically severe pneumonia to a university hospital in Rabat, Morocco. International Journal of Infectious Diseases. 2014;28:164-70.