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Risk factors for mortality in children with pneumonia admitted to the pediatric intensive care unit
Jia Wen Janine Cynthia Koh1, Judith Ju-Ming Wong2,3, Rehena Sultana4
1Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Insights
Severe pediatric pneumonia is a significant cause of pediatric intensive care unit admissions, with hospital-acquired pneumonia and bacteremia being key risk factors for mortality. Understanding these factors improves outcomes for critically ill children.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
- Respiratory medicine
Background:
- Severe pneumonia represents a substantial burden on pediatric intensive care units (PICUs).
- Identifying epidemiological patterns and risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To describe the epidemiology of severe pneumonia in children admitted to the PICU.
- To identify risk factors associated with poor outcomes, including mortality.
Main Methods:
- A retrospective study analyzed data from children admitted to the PICU between 2010 and 2014 with pneumonia.
- Clinical, microbiological, and ventilation data were collected.
- Logistic regression models identified risk factors for PICU mortality.
Main Results:
- Severe pneumonia accounted for 6.7% of PICU admissions, with a 13.5% mortality rate.
- Hospital-acquired pneumonia and bacteremia were independently associated with increased mortality.
- Viral pneumonias were linked to acute respiratory distress syndrome, while bacterial pneumonias were associated with lung abscess and necrotizing pneumonia.
Conclusions:
- Severe pediatric pneumonia significantly impacts PICU admissions and carries a high mortality risk.
- Hospital-acquired pneumonia and bacteremia are critical early prognostic indicators for adverse clinical outcomes in children with severe pneumonia.
Aims:
To describe the epidemiology of children with severe pneumonia and identify risk factors for poor outcomes.
Methods:
We conducted a retrospective study of children admitted to pediatric intensive care unit (PICU) from 2010 to 2014 with a diagnosis of pneumonia. Clinical microbiological, ventilation and other pertinent PICU data were collected. Primary outcome was PICU mortality. Univariate and multivariate logistic regression model were used to identify risk factors for mortality.
Results:
Severe pneumonia consisted of 237/3539 (6.7%) of PICU admissions. Of these, 162/237 (68.4%) required mechanical ventilation. 32/237 (13.5%) patients died. The majority of patients had no organisms identified 82/237 (34.6%). A sole bacterial or viral pathogen was identified in 48/237 (20.1%) and 41/237 (17.9%) patients, respectively. Patients with viral pneumonias were more likely to develop acute respiratory distress syndrome compared to other etiologies (7/41[17.1%] vs 8/196 [4.0%]; P = 0.006). Bacterial pneumonias were associated with lung abscess (4/48 [8.3%] vs 2/189 [1.5%]; P = 0.016) and necrotizing pneumonia (18/48 [37.5%] vs 15/189 [7.9%]; P < 0.001) compared to other etiologies. Co-detections (>1 respiratory pathogens isolated) occurred in 62/237 (26.2%) patients and were associated a higher rate of mechanical ventilation, and decreased ventilator and PICU free days. After adjusting for severity of illness, risk factors for mortality were: hospital acquired pneumonia (HAP) (aOR: 2.92 [95%CI 1.15, 7.40]; P = 0.024) and bacteremia (aOR: 5.03 [95%CI 1.77, 14.35]; P = 0.003).
Conclusions:
Severe pediatric pneumonia accounts for a significant number of PICU admissions and is associated with significant mortality risk. The presence of co-morbidities, HAP and bacteremia were early prognostic variables independently associated with poor clinical outcomes.