Predictor of poor outcome severe pneumonia children in the paediatric intensive care unit

Abstract

INTRODUCTION: Severe pneumonia children frequently have poor outcome during hospitalization in PICU. However, the predicting of mortality is hampered by lacking evidence about the risk factors in Indonesia. This study aimed to determine risk factors that associated with mortality in children with severe pneumonia admitted to the pediatric intensive care unit (PICU).

METHODS: This was a single-center case-control study in the PICU at Prof. Dr. I.G.N.G Ngoerah Hospital, Indonesia between January 2019 and December 2020. Children and adolescents who aged 28 days to 18 years old with severe pneumonia were included and divided into death and survivor groups. Patients with incomplete medical record data, history of perinatal lung disease, major congenital anomaly, or cyanotic congenital heart disease were excluded. Demographic, clinical, and laboratory data were obtained from medical records. Statistical analysis was conducted using χ2-test for bivariate and binary logistic regression for multivariate analysis.

RESULTS: 160 subjects were included with median age was 7 and 9 months in the death and survivor group respectively. Multivariate analysis showed SpO2 < 90% at arrival, PELOD-2 score ≥ 7, hemoglobin < 8 g/dL, lymphopenia, and procalcitonin ≥ 0.5 ng/mL were associated with mortality (adjusted odds ratio [aOR] 17.29, 95%CI 4.82-61.43; aOR 18.37, 95%CI 4.14-81.43; aOR 4.05, 95%CI 1.16-14.13; aOR 3.59, 95%CI 1.09–11.75; aOR 7.64, 95%CI 2.61-22.40, respectively). Invasive mechanical ventilation and malnutrition were not associated with mortality.

CONCLUSION: SpO2 < 90% at arrival, PELOD-2 score ≥ 7, hemoglobin < 8 g/dL, lymphopenia, and procalcitonin ≥ 0.5 ng/mL are risk factors for mortality in children with severe pneumonia.