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

• Published in: Journal of critical care Vol. 38; pp. 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: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2017; Elsevier Limited
• 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; Hong Kong; leukemia; lymphoma; bacterial co-infection; respiratory syncytial virus (RSV); asthma; pediatric intensive care; PICU; Respiratory virus; Bacterial coinfection; Pediatric intensive care; Lymphoma; Leukemia; Asthma
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2016.09.019

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.