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Clinical and laboratory predictors of 30‐day mortality in severe acute malnourished children with severe pneumonia
Author(s) -
Shahrin Lubaba,
Chisti Mohammod J.,
Brintz Benjamin,
Islam Zahidul,
Shahid Abu S.M.S.B.,
Hassan Md. Zakiul,
Leung Daniel T.,
Chowdhury Fahmida
Publication year - 2020
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13484
Subject(s) - medicine , pneumonia , logistic regression , severe acute malnutrition , confounding , malnutrition , odds ratio , pediatrics
Objective To determine the predictors of mortality within 30 days of hospital admission in a diarrhoeal disease hospital in Bangladesh. Methods Cohort study of hospitalised children aged 0–59 months with severe acute malnutrition (SAM) and severe pneumonia in Dhaka Hospital, icddr,b, Bangladesh from April 2015 to March 2017. Those discharged were followed up, and survival status at 30 days from admission was determined. Children who died were compared with the survivors in terms of clinical and laboratory biomarkers. Multivariable logistic regression analysis was used for calculating adjusted odds ratio for death within 30 days of hospital admission. Results We enrolled 191 children. Mortality within 30 days of admission was 6% (14/191). After adjusting for potential confounders (hypoxia, CRP and haematocrit) in logistic regression analysis, independent factors associated with death were female sex (aOR = 5.80, 95% CI: 1.34–25.19), LAZ <−4 (aOR = 6.51, 95% CI: 1.49–28.44) and Polymorphonuclear Leucocytes (PMNL) (>6.0 × 10 9 /L) (aOR = 1.06, 95% CI: 1.01–1.11). Using sex, Z‐score for length for age (LAZ), and PMNL percentage, we used random forest and linear regression models to achieve a cross‐validated AUC of 0.83 (95% CI: 0.82, 0.84) for prediction of 30‐day mortality. Conclusions The results of our data suggest that female sex, severe malnutrition (<−4 LAZ) and higher PMNL percentage were prone to be associated with 30‐day mortality in children with severe pneumonia. Association of these factors may be used in clinical decision support for prompt identification and appropriate management for prevention of mortality in this population.