Author:
Sutrisna Lea,Triasih Rina,Laksanawati Ida Safitri
Abstract
Background Respiratory infection is a common morbidity and a major cause of mortality in immunocompromised children. Hence, identification of clinical parameters that predict mortality among immunocompromised children with respiratory infections is of importance to provide timely and appropriate intervention.
Objective To determine predictors of mortality in immunocompromised children with respiratory infections.
Methods We conducted a prospective cohort study of immunocompromised children aged 18 years or younger with respiratory tract infections who were admitted to Dr. Sardjito Hospital, Yogyakarta, Indonesia. All eligible children were prospectively followed up until hospital discharge. Clinical and laboratory parameters during the first 24 hours of hospitalization were collected.
Results Of 79 eligible children, the overall mortality was 11 subjects (13.9%). Fever, tachycardia, tachypnea, cyanosis, leukopenia, neutropenia, thrombocytopenia, and pleural effusion were predictive factors of mortality in bivariate analysis (P<0.25). A logistic regression model showed that neutropenia (absolute neutrophil count <125/mm3) and tachycardia were the best independent predictors of mortality in immunocompromised children with respiratory infections. The children with tachycardia had 15.8 times higher probability of mortality (95%CI 5.0 to 4.4) and those with neutropenia had 8.24 times higher probability of mortality. Cyanosis and pleural effusion were also independent mortality predictors.
Conclusion The risk of mortality is significantly increased in immunocompromised children with respiratory infection when tachycardia and neutropenia are also present.
Publisher
Paediatrica Indonesiana - Indonesian Pediatric Society
Subject
Pediatrics, Perinatology and Child Health
Reference25 articles.
1. 1. Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012;379:2151-61. DOI: https://doi.org/10.1016/S0140-6736(12)60560-1.
2. 2. Ghimire M, Battacharya SK, Narain JP. Pneumonia in South-East Asia region: public health perspective. Indian J Med Res. 2012;135:459-68.
3. 3. Rudan I, O'Brien KL, Nair H, Liu L, Theodoratou E, Qazi S, et al. Epidemiology and etiology of childhood pneumonia in 2010: estimates of incidence, severe morbidity, mortality, underlying risk factors and causative pathogens for 192 countries. J Glob Health. 2013;3:010401. DOI: https://doi.org/10.7189/jogh.03.010401.
4. 4. Ghazi BMS, Aghamohammadi A, Kouhi A, Farhoudi A, Moin M, Rezaei N, Doost PS, et al. Mortality in primary immunodeficient patients, registered in Iranian primary immunodeficiency registry. Iran J Allergy Asthma Immunol. 2004;3:31-6.
5. 5. Preidis GA, McCollum ED, Mwansambo C, Kazembe PN, Schutze GE, Kline MW. Pneumonia and malnutrition are highly predictive of mortality among African children hospitalized with human immunodeficiency virus infection or exposure in the era of antiretroviral therapy. J Pediatr. 2011;159:484-9.DOI: https://doi.org/10.1016/j.jpeds.2011.02.033.