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Factors associated with mortality in severely malnourished hospitalized children who developed septic shock
Visnu Pritom Chowdhury1, Monira Sarmin1, Mehnaz Kamal1
1Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Insights
Severe malnutrition in children with septic shock increases death risk when requiring vasopressors, advanced antibiotics, and corticosteroids. Close monitoring and early interventions are crucial for better outcomes in pediatric septic shock.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Nutritional science
Background:
- Septic shock in severely malnourished children presents a high mortality risk.
- Effective management strategies for pediatric septic shock, especially in undernourished populations, require further investigation.
Purpose of the Study:
- To identify factors associated with mortality in severely malnourished children with septic shock.
- To evaluate the impact of early versus late blood transfusion on outcomes in this patient group.
Main Methods:
- A case-control study involving under-five children with severe malnutrition and septic shock admitted to the ICU between 2013 and 2017.
- Cases were children who died (n=54), and controls were survivors (n=39).
- Descriptive and multivariate analyses were performed to assess associations with mortality.
Main Results:
- Mortality was significantly associated with the use of fourth-line antibiotics, corticosteroids, and vasopressors (in addition to dopamine).
- Decreased serum calcium levels were also significantly associated with death after adjustment.
- While early blood transfusion was more common in survivors, the difference was not statistically significant.
Conclusions:
- Severely malnourished children with septic shock are at increased risk of death when requiring vasopressors, advanced antibiotics, corticosteroids, and presenting with hypocalcemia.
- These findings highlight the critical need for vigilant monitoring and timely interventions in managing pediatric septic shock in malnourished children.
Introduction:
Septic shock can often lead to death, even in resourceful settings, if not handled carefully. Therefore, we sought to evaluate the factors associated with deaths in the context of severe malnutrition and also the effects of early, i.e., within 3 hours of diagnosing septic shock vs. late blood transfusion.
Methodology:
Here, all under-five severely malnourished septic shock children were admitted to ICU during 2013-2017. Children who died constituted cases (n = 54), and the survived (n = 39) represented controls. We excluded children who received the blood transfusion for other causes and who left against medical advice.
Results:
In both descriptive and multivariate analysis, we found that death was significantly associated with the use of fourth-line antibiotics, corticosteroids, and the addition of vasopressors on top of dopamine (all p < 0.05). However, the decrease of serum calcium level was found significantly associated with death only after adjusting (p < 0.05). Even though the cases more often received early blood transfusion than the controls, the difference was insignificant (p = 0.134).
Conclusions:
When a severely malnourished under-five child develops septic shock, requiring vasopressors, fourth-line antibiotic, and corticosteroid, with reduced serum calcium, the probability of death increases significantly. Our findings underscore the gravity of close monitoring at these points and the niches for early interventions.
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