Being Underweight Is an Independent Risk Factor for Poor Outcomes Among Acutely Critically Ill Children

Area of Science:

• Pediatric Critical Care Medicine
• Nutritional Status Assessment
• Clinical Outcomes Research

Background:

• Malnutrition impairs immune function, making nutrition status assessment critical in critical care.
• Investigating the impact of underweight and overweight status on pediatric intensive care unit (PICU) patients.
• Focus on healthy children without underlying chronic diseases.

Purpose of the Study:

• To determine the association between nutritional status (underweight/overweight) and major adverse outcomes in critically ill children.
• To identify risk factors for poor clinical outcomes in this population.

Main Methods:

• Retrospective study of 282 pediatric patients (1 month-18 years) admitted to the ICU.
• Exclusion of patients with chronic diseases, transfers, or against-medical-advice discharges.
• Categorization into underweight, normal weight, and overweight based on weight-for-age (W/A) z-scores.

Main Results:

• Prevalence of underweight was 8.2%, overweight was 5.7%.
• Underweight children were younger, with higher mortality, poor outcomes, and longer mechanical ventilation duration.
• Underweight status, noninfectious diseases, hypotension, higher PIM2 score, and creatinine were associated with mortality/sequelae (P < .01).
• Multivariate analysis identified W/A z-score ≤-2 and PIM2 score as independent risk factors for poor outcomes (P < .001).

Conclusions:

• Being underweight is an independent risk factor for poor clinical outcomes in critically ill children without underlying diseases.
• Pediatric Index of Mortality 2 (PIM2) score on admission is also an independent predictor of adverse outcomes.