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Prognostic indices for mortality of hospitalized children in central Africa
M Dramaix1, D Brasseur, P Donnen
1School of Public Health, Free University of Brussels (ULB), Belgium.
Insights
This study identified key indicators for predicting child mortality in severely malnourished hospitalized children. A simple index combining edema, arm circumference, serum albumin, and transthyretin effectively identifies at-risk children.
Area of Science:
- Pediatrics
- Public Health
- Tropical Medicine
Background:
- A hospital-based follow-up study was conducted in Zaire (1986-1988).
- Three-quarters of 1,129 children studied were severely malnourished, with a 17.4% mortality rate.
- Analysis focused on hospital mortality to identify prognostic indicators.
Purpose of the Study:
- To evaluate the prognostic power of edema, anthropometric, and biologic indicators for child mortality.
- To identify indices that better predict mortality risk in severely malnourished children.
- To develop a more effective diagnostic test for identifying children at risk of death.
Main Methods:
- Receiver operating characteristic (ROC) curves were used to assess the performance of various indicators and constructed indices.
- Parameters evaluated included edema, arm circumference, serum albumin, and transthyretin.
- Simple indices were created by counting the number of present risk factors.
Main Results:
- Biologic indicators demonstrated the highest areas under the ROC curves.
- Simple indices, based on the count of risk factors, showed the best performance.
- A diagnostic test using at least two of four risk factors (edema, arm circumference <115 mm, serum albumin <16 g/L, transthyretin <6.5 mg/dL) achieved 91.2% sensitivity.
Conclusions:
- In resource-limited settings without biologic data, edema and/or arm circumference <115 mm can classify children at risk.
- When biologic measurements are feasible, incorporating serum albumin and transthyretin improves risk classification.
- The proposed four-factor index offers high sensitivity and negative predictive value for identifying children at high risk of mortality.
Abstract:
A hospital-based follow-up study was conducted between 1986 and 1988 at Lwiro (South Kivu Province, Zaire). Of 1,129 children in the study, three of four were severely malnourished, and 17.4% died. This study analyzes the mortality in hospital; its objectives are to evaluate the prognostic power of edema and anthropometric and biologic indicators and to seek indices that perform better. Receiver operating characteristic curves were established for each parameter under study and for each index constructed. Areas under receiver operating characteristic curves were highest for biologic indicators, and simple indices, obtained by counting the number of risk factors present, performed best. In the absence of biologic parameters, the authors suggest classifying children as at risk of dying when they present with edema and/or with arm circumference of less than 115 mm. When biologic measurements are possible, in addition to edema and arm circumference, the authors suggest taking serum albumin and transthyretin into account. For serum albumin and transthyretin, mortality risk is defined in terms of values of less than 16 g/liter and 6.5 mg/dl, respectively. Children will be classified as at risk of dying when they present with at least two of the four risk factors. The resulting diagnostic test has a high sensitivity (91.2%) and positive and negative predictive values of 40.8% and 97.9%, respectively.