Mortality, length of stay, bloodstream and respiratory viral infections in a pediatric intensive care unit

Title

Mortality, length of stay, bloodstream and respiratory viral infections in a pediatric intensive care unit

Creator

Hon KL; Luk MP; Fung WM; Li CY; Yeung HL; Liu PK; Li S; Tsang KY; Li CK; Chan PK; Cheung KL; Leung TF; Koh PL

Identifier

10.1016/j.jcrc.2016.09.019

Publisher

Journal of Critical Care

Date

2017

Subject

Length Of Stay; Asthma; Bacterial Coinfection; Child; Child Health Services; Child Preschool; Critical Care; Female; Hong Kong/epidemiology; Hospitalization; Humans; Infant; Intensive Care Units Pediatric; Leukemia; Logistic Models; Lymphoma; Male; Odds Ratio; Pediatric Intensive Care; Respiratory Tract Infections/complications/ Epidemiology/microbiology/mortality; Respiratory Virus; Retrospective Studies; Risk Factors; Sepsis/complications/ Epidemiology/microbiology/mortality; Survival Analysis

Description

OBJECTIVES: We investigated whether diagnostic categories and presence of infections were associated with increased mortality or length of stay (LOS) in patients admitted to a pediatric intensive care unit (PICU). METHODS: A retrospective study of all PICU admissions between October 2002 and April 2016 was performed. Oncologic vs nononcologic, trauma/injuries vs nontraumatic, infectious (gram-positive, gram-negative, fungal bloodstream infections, common respiratory viruses) vs noninfectious diagnoses were evaluated for survival and LOS. RESULTS: Pediatric intensive care unit admissions (n = 2211) were associated with a mortality of 5.3%. Backward binary logistic regression showed that nonsurvival was associated with leukemia (odds ratio [OR], 4.81; 95% confidence interval [CI], 2.2-10.10; P < .0005), lymphoma (OR, 21.34; 95% CI, 3.89-117.16; P < .0005), carditis/myocarditis (OR, 7.91; 95% CI, 1.98-31.54; P = .003), encephalitis (OR, 6.93; 95% CI, 3.27-14.67; P < .0005), bloodstream infections with gram-positive organisms (OR, 5.32; 95% CI, 2.67-10.60; P < .0005), gram-negative organisms (OR, 8.23; 95% CI, 4.10-16.53; P < .0005), fungi (OR, 3.93; 95% CI, 1.07-14.42; P = .039), and pneumococcal disease (OR, 3.26; 95% CI, 1.21-8.75; P = .019). Stepwise linear regression revealed that LOS of survivors was associated with bloodstream gram-positive infection (B = 98.2; 95% CI, 75.7-120.7; P < .0005). CONCLUSIONS: Patients with diagnoses of leukemia, lymphoma, cardiomyopathy/myocarditits, encephalitis, and comorbidity of bloodstream infections and pneumococcal disease were significantly at risk of PICU mortality. Length of stay of survivors was associated with bloodstream gram-positive infection. The highest odds for death were among patients with leukemia/lymphoma and bloodstream coinfection. As early diagnosis of these childhood malignancies is desirable but not always possible, adequate and early antimicrobial coverage for gram-positive and gram-negative bacteria might be the only feasible option to reduce PICU mortality in these patients. In Hong Kong, a subtropical Asian city, none of the common respiratory viruses were associated with increased mortality or LOS in PICU.

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Citation List Month

November 2017 List

Notes

1557-8615
Hon, Kam Lun
Luk, Man Ping
Fung, Wing Ming
Li, Cho Ying
Yeung, Hiu Lee
Liu, Pui Kwun
Li, Shun
Tsang, Kathy Yin Ching
Li, Chi Kong
Chan, Paul Kay Sheung
Cheung, Kam Lau
Leung, Ting Fan
Koh, Pei Lin
Journal Article
United States
J Crit Care. 2017 Apr;38:57-61. doi: 10.1016/j.jcrc.2016.09.019. Epub 2016 Sep 30.

Citation

Hon KL; Luk MP; Fung WM; Li CY; Yeung HL; Liu PK; Li S; Tsang KY; Li CK; Chan PK; Cheung KL; Leung TF; Koh PL, “Mortality, length of stay, bloodstream and respiratory viral infections in a pediatric intensive care unit,” Pediatric Palliative Care Library, accessed September 21, 2021, https://pedpalascnetlibrary.omeka.net/items/show/11009.

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