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

Abstract Objectives We investigated whether diagnostic categories and presence of infections were associated with increased mortality or length-of-stay in patients admitted to a pediatric intensive care unit (PICU). Methods A retrospective study of all PICU admissions between October 2002 and April...

Full description

Saved in:
Bibliographic Details
Published in:Journal of critical care 2017-04, Vol.38, p.57-61
Main Authors: Hon, Kam Lun, Luk, Man Ping, Fung, Wing Ming, Li, Cho Ying, Yeung, Hiu Lee, Liu, Pui Kwun, Li, Shun, Tsang, Yin Ching Kathy, Li, Chi Kong, Chan, Paul Kay Sheung, Cheung, Kam Lau, Leung, Ting Fan, Koh, Pei Lin
Format: Article
Language:English
Subjects:
Asthma
Bacteria
Bacterial coinfection
Bronchitis
Cardiomyopathy
Child
Child Health Services
Child, Preschool
Critical Care
Demographics
Diabetes
Encephalitis
Female
Fungi
Gram-negative bacteria
Hong Kong - epidemiology
Hospitalization
Humans
Infant
Infections
Influenza
Intensive care
Intensive Care Units, Pediatric
Laboratories
Length of Stay
Leukemia
Logistic Models
Lymphoma
Male
Mortality
Odds Ratio
Pediatric intensive care
Pediatrics
Respiratory syncytial virus
Respiratory Tract Infections - complications
Respiratory Tract Infections - epidemiology
Respiratory Tract Infections - microbiology
Respiratory Tract Infections - mortality
Respiratory virus
Retrospective Studies
Risk Factors
Sepsis - complications
Sepsis - epidemiology
Sepsis - microbiology
Sepsis - mortality
Streptococcus pneumoniae
Studies
Survival Analysis
Trauma
Viral infections
Viruses
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Objectives We investigated whether diagnostic categories and presence of infections were associated with increased mortality or length-of-stay 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 versus non-oncologic, trauma/injuries versus non-traumatic, infectious (Gram-positive, Gram-negative, fungal blood-stream infections, common respiratory viruses) versus non-infectious diagnoses were evaluated for survival and length-of-stay. Results PICU admissions (n = 2211) were associated with a mortality of 5.3%. Backward binary logistic regression showed non-survival was associated with leukemia (OR, 4.81; 95% CI, 2.29 to 10.10; P < .0005), lymphoma (OR, 21.34; 95% CI, 3.89 to 117.16; P < .0005), carditis/myocarditis (OR, 7.91; 95% CI, 1.98 to 31.54; P = .003), encephalitis (OR, 6.93; 95% CI, 3.27 to 14.67; P < .0005), blood-stream infections with Gram-positive organisms (OR, 5.32; 95% CI, 2.67 to 10.60; P < .0005), Gram-negative organisms (OR, 8.23; 95% CI, 4.10 to 16.53; P < .0005), fungi (OR, 3.93; 95% CI, 1.07 to 14.42; P = .039) and pneumococcal disease (OR, 3.26; 95% CI, 1.21 to 8.75; P = .019) Stepwise linear regression revealed that LOS of survivors was associated with blood-stream Gram-positive infection (B = 98.2; 95% CI, 75.7 to 120.7; P < .0005). Conclusions Patients with diagnoses of leukemia, lymphoma, cardiomyopathy/myocarditits, encephalitis and co-morbidity of blood-stream bacterial infections and pneumococcal disease were significantly at risk of PICU mortality. Length-of-stay of survivors was associated with blood-stream gram-positive infection. The highest odds for death were among patients with leukemia/lymphoma and blood-stream co-infection. 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 length-of-stay in PICU.
ISSN:0883-9441
1557-8615
DOI:10.1016/j.jcrc.2016.09.019