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Prevalence of Cardiac Dysfunction in Malawian Children With Severe Febrile Illness
Rachel S Bensman1,2, Zachary Berrens3,4, Treasure Mkaliainga5
1Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
Insights
Left ventricular systolic dysfunction (LVSD) affects nearly 26% of Malawian children with severe febrile illness. While cardiac dysfunction was not linked to mortality, these critically ill children face high death rates.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Severe febrile illness in children can lead to serious complications.
- Left ventricular systolic dysfunction (LVSD) is a potential complication that requires investigation in pediatric populations.
- Understanding the prevalence and impact of LVSD in febrile illnesses is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the prevalence of left ventricular systolic dysfunction (LVSD) in Malawian children experiencing severe febrile illness.
- To examine the relationship between LVSD and mortality rates in this patient group.
- To explore the association between LVSD and serum lactate levels.
Main Methods:
- A prospective observational study was conducted in a tertiary hospital in Malawi.
- Children aged 60 days to 10 years with severe febrile illness were enrolled.
- Focused cardiac ultrasound (FoCUS) and serum lactate measurements were performed at enrollment, with repeat FoCUS the following day.
Main Results:
- Left ventricular systolic dysfunction (LVSD) was identified in 25.9% of the 54 enrolled children.
- A significant proportion of children had elevated lactate levels (60% > 2.5 mmol/L, 40% > 5 mmol/L).
- Mortality was high at 18.5%, with LVSD not significantly associated with mortality or elevated lactate levels.
Conclusions:
- Cardiac dysfunction is prevalent in Malawian children with severe febrile illness, affecting approximately one in four.
- Mortality rates among these children are notably high.
- Further research with larger cohorts is recommended to clarify the role of cardiac dysfunction in mortality and develop bedside assessment tools for resuscitation strategies.
Objectives:
To investigate the prevalence of left ventricular systolic dysfunction (LVSD) in Malawian children with severe febrile illness and to explore associations between LVSD and mortality and lactate levels.
Design:
Prospective observational study.
Setting:
Pediatric ward of a tertiary government referral hospital in Malawi.
Patients:
Children between 60 days and 10 years old with severe febrile illness (fever with at least one sign of impaired perfusion plus altered mentation or respiratory distress) were enrolled at admission from October 2017 to February 2018.
Interventions:
Focused cardiac ultrasound (FoCUS) was performed, and serum lactate was measured for each child at enrollment, with repeat FoCUS the following day. LV systolic function was later categorized as normal, reduced, severely reduced, or hyperdynamic by two pediatric cardiologists blinded to clinical course and outcomes.
Measurements And Main Results:
Fifty-four children were enrolled. LVSD was present in 14 children (25.9%; 95% CI, 15.4-40.3%), of whom three had severely reduced function. Thirty patients (60%) had a lactate greater than 2.5 mmol/L, of which 20 (40%) were markedly elevated (>5 mmol/L). Ten children died during admission (18.5%). Of children who survived, 22.7% had decreased LV systolic function versus 40% of those who died. Dysfunction was not associated with mortality or elevated lactate.
Conclusions:
Cardiac dysfunction may be present in one in four Malawian children with severe febrile illness, and mortality in these patients is especially high. Larger studies are needed to further clarify the role cardiac dysfunction plays in mortality and integrate practical bedside assessments for decision support around individualized resuscitation strategies.
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