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Clinical profiles and mortality risk factors in pediatric pulmonary hemorrhage: a singlecenter study in Saudi Arabia
Moath K Alabdulsalam1, Robayeh A Asiry2, Raghad T Alhuthil3
1From the Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Insights
Pulmonary hemorrhage (PH) in children is a life-threatening event with a very high mortality rate. Sepsis, multiorgan dysfunction, and altered code status are key predictors of death in pediatric intensive care units.
Area of Science:
- Pediatric Critical Care Medicine
- Pulmonary Medicine
- Hematology
Background:
- Pulmonary hemorrhage (PH) is a rare but life-threatening condition involving bleeding in the airways and lung parenchyma.
- Pediatric patients, particularly those with complex medical histories, are susceptible to PH.
Purpose of the Study:
- To characterize the clinical profile of pediatric patients experiencing PH.
- To identify risk factors associated with mortality in this vulnerable population.
Main Methods:
- A retrospective cohort study was conducted.
- Data were collected from pediatric patients (1 month to 14 years) admitted with PH between January 2014 and September 2019.
- Clinical characteristics, outcomes, and mortality predictors were analyzed.
Main Results:
- The study included 80 pediatric patients, with a median age of 24 months.
- High rates of underlying conditions such as bone marrow transplant, oncology, chemotherapy, chest infections, and immunosuppressant use were observed.
- The overall Pediatric Intensive Care Unit (PICU) mortality rate was 82.5%.
- Sepsis, multiorgan dysfunction, and altered code status were identified as significant predictors of mortality in multivariate analysis.
Conclusions:
- The extremely high mortality rate underscores the critical nature of PH in children.
- There is a clear need for targeted interventions and increased vigilance, especially in immunocompromised children.
- Further research is essential to refine management protocols and improve outcomes for pediatric PH patients.
Background:
Pulmonary hemorrhage (PH) is a rare, life-threatening event characterized by bleeding into the airways and lung parenchyma.
Objectives:
To explore the clinical characteristics of PH patients and investigate mortality-related risk factors, providing a holistic understanding of patient outcomes in this population.
Design:
A retrospective cohort study.
Settings:
The Pediatric Intensive Care Unit (PICU) at King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh, Saudi Arabia.
Patients And Methods:
Pediatric patients with PH episodes (aged 1 month to 14 years) who were admitted from January 2014 to September 2019.
Main Outcomes Measures:
Clinical characteristics, outcomes, and mortality-related risk factors.
Sample Size:
80 children.
Results:
The cohort had a sex ratio of 1:1 and a median age of 24 months [interquartile range: 9-78]. Medical histories included bone marrow transplant (51.3%), oncology cases (40.0%), chemotherapy (61.3%), chest infection (86.3%), and immunosuppressant use (71.3%). Additionally, most patients (87.5%) had acute respiratory distress syndrome during the PH episode. The overall PICU mortality rate was 82.5% (66/80), and was associated with thrombocytopenia, sepsis, renal impairment, liver dysfunction, multiorgan dysfunction, and altered code status in univariable analysis (all P <.05). Multivariate analysis identified sepsis, multiorgan dysfunction, and altered code status as key predictors of PICU mortality (P <.05).
Conclusion:
The high mortality rate reported emphasizes the need for tailored interventions and heightened vigilance, particularly in immunocompromised children. Future research will expand on these findings to refine current management protocols and further improve patient care in pediatric PH.
Limitations:
Retrospective study, single-center.
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