Predictors of Death in Under-Five Children with Sepsis Attending an Urban Diarrheal Treatment Centre in Bangladesh

Abstract

SETTING: Special Care Ward (SCW) of the Dhaka Hospital of icddr,b, Bangladesh. OBJECTIVE: To evaluate the clinical and laboratory predictors of death in under-five children with clinically defined sepsis presenting with diarrhea. METHODS: We prospectively enrolled all the diarrheal children (n = 151) aged 0 to 59 months with clinical sepsis admitted in the SCW during September’2007 through December’2007. Comparison was made between deaths (n = 23) and survivors (n = 128). Sepsis is defined as presence of inflammation [abnormal WBC count (>11 × 109/L or, <4 × 109/L or, band and neutrophil ratio ≤0.10] plus presence or presumed presence of infection with thermo-instability [hypo (≤35.0) or hyperthermia (≥38.5)], tachycardia, tachypnea, and/or the indications of altered organ function (altered mental status and bounding pulse) in the absence of clinical dehydration or after correction of dehydration. RESULTS: The median (inter-quartile range) age (months) of the children who survived and died was comparable [4.0 (2.0, 12.0) vs. 1.5 (0.8, 10.0); p = 0.703]. In the logistic regression analysis, after adjusting for potential confounders, such as abnormal WBC count, use of intravenous fluid, patient with fatal outcome more often presented with hypernatremia (odds ratio = 16.48, 95% confidence interval = 2.21 - 123.12; p = 0.006), lobar consolidation (odds ratio = 19.9, 95% confidence interval = 2.99 - 132.80; p = 0.002), hypoxemia (odds ratio = 14.78, 95% confidence interval = 1.38 157.90; p = 0.026) and severe under-nutrition (odds ratio = 7.57, 95% confidence interval = 1.24 - 46.11; p = 0.028). CONCLUSIONS: Our data suggest that children under-five with clinical sepsis who present with lobar pneumonia, hypoxaemia, severe acute malnutrition and hyperntaemia are at higher risk of death and identification of these simple factors may help clinicians to take prompt initiative for the aggressive management of such children especially in a resource-limited setting like Bangladesh.

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K. Shahunja, A. Shahid, H. Ashraf, A. Faruque, S. Das, M. Kamruzzaman, F. Flora and M. Chisti, "Predictors of Death in Under-Five Children with Sepsis Attending an Urban Diarrheal Treatment Centre in Bangladesh," Food and Nutrition Sciences, Vol. 4 No. 7, 2013, pp. 709-714. doi: 10.4236/fns.2013.47090.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] M. J. Chisti , S. Saha, C. N. Roy and M. A. Salam, “Predictors of Bacteremia in Infants with Diarrhea and Systemic Inflammatory Response Syndrome Attending an Urban Diarrheal Treatment Center in a Developing Country,” Pediatric Critical Care Medicine, Vol. 11, No. 1, 2010, pp. 92-97. doi:10.1097/PCC.0b013e3181b063e1
[2] A. C. Cheng, T. E. West, D. Limmathurotsakul and S. J. Peacock, “Strategies to Reduce Mortality from Bacterial Sepsis in Adults in Developing Countries,” PLoS Medicine, Vol. 5, No. 8, 2008, p. e175. doi:10.1371/journal.pmed.0050175
[3] L. Liu, H. L. Johnson , S. Cousens , J. Perin, S. Scott and J. E. Lawn, “Global, Regional, and National Causes of Child Mortality: An Updated Systematic Analysis for 2010 with Time Trends since 2000,” Lancet, Vol. 379, No. 9832, 2012, pp. 2151-2161. doi:10.1016/S0140-6736(12)60560-1
[4] G. S. Martin, D. M. Mannino, S. Eaton and M. Moss, “The Epidemiology of Sepsis in the United States from 1979 through 2000,” New England Journal of Medicine, Vol. 348, No. 16, 2003, pp. 1546-1554.
[5] S. Finfer, R. Bellomo, J. Lipman, C. French, G. Dobb and J. Myburgh, “Adult-Population Incidence of Severe Sepsis in Australian and New Zealand Intensive Care Units,” Intensive Care Medicine, Vol. 30, No. 4, 2004, pp. 589596. doi:10.1007/s00134-004-2157-0
[6] D. C. Angus, W. T. Linde-Zwirble, J. Lidicker, G. Clermont, J. Carcillo and M. R. Pinsky, “Epidemiology of Severe Sepsis in the United States: Analysis of Incidence, Outcome, and Associated Costs of Care,” Critical Care Medicine, Vol. 29, No. 7, 2001, pp. 1303-1310. doi:10.1097/00003246-200107000-00002
[7] V. Y. Dombrovskiy, A. A. Martin, J. Sunderram and H. L. Paz, “Rapid Increase in Hospitalization and Mortality Rates for Severe Sepsis in the United States: A Trend Analysis from 1993 to 2003,” Critical Care Medicine, Vol. 35, No. 5, 2007, pp. 1244-1250. doi:10.1097/01.CCM.0000261890.41311.E9
[8] M. J. Chisti, T. Duke, C. F. Robertson, T. Ahmed, A. S. G. Faruque and P. K. Bardhan. “Co-Morbidity: Exploring the Clinical Overlap between Pneumonia and Diarrhoea in a Hospital in Dhaka, Bangladesh,” Annals of Tropical Paediatrics, Vol. 31, No. 4, 2011, pp. 311-319. doi:10.1179/1465328111Y.0000000033
[9] C. Riley and D. S. Wheeler. “Prevention of Sepsis in Children: A New Paradigm for Public Policy,” Critical Care Research and Practice, Vol. 2012, No. 437139, 2012, p. 8. doi:10.1155/2012/437139
[10] R. P. Dellinger, M. M. Levy, A. Rhodes, D. Annane, H. Gerlach, S. M. Opal, J. E. Sevransky, C. L. Sprung, I. S. Douglas, R. Jaeschke, T. M. Osborn, M. E. Nunnally, S. R. Townsend, K. Reinhart, R. M. Kleinpell, D. C. Angus, C. S. Deutschman, F. R. Machado, G. D. Rubenfeld, S. A. Webb, R. J. Beale, J. L. Vincent and R. Moreno, “Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock,” Critical Care Medicine, Vol. 41, No. 2, 2013, pp. 580-637. doi:10.1097/CCM.0b013e31827e83af
[11] T. Ahmed , M. Ali, M. M. Ullah, I. A. Choudhury, M. E. Haque and M. A. Salam, “Mortality in Severely Malnourished Children with Diarrhea and Use of a Standardized Management Protocol,” Lancet, Vol. 353, No. 9168, 1999, pp. 1919-1922.
[12] WHO, “WHO Management of Severe Malnutrition: A Manual for Physicians and other Senior Health Workers,” World Health Organization, Geneva, 1999.
[13] M. J. Chisti, T. Ahmed, A. S. Faruque and M. A. Salam, “Clinical and Laboratory Features of Radiologic Pneumonia in Severely Malnourished Infants Attending an Urban Diarrhea Treatment Center in Bangladesh,” Pediatric Infectious Disease Journal, Vol. 29, No. 2, 2010, pp. 174-177. doi:10.1097/INF.0b013e3181b9a4d5
[14] M. J. Chisti, M. Tebruegge, S. L. Vincente, S. M. Graham and T. Duke, “Pneumonia in Severely Malnourished Children in Developing Countries—Mortality Risk, Aetiology and Validity of WHO Clinical Signs: A Systematic review,” Tropical Medicine & International Health, Vol. 14, No. 10, 2009, pp. 1173-1179. doi:10.1111/j.1365-3156.2009.02364.x
[15] G. Morgan, “What, If Any, Is the Effect of Malnutrition on Immunological Competence?” Lancet, Vol. 349, No. 9066, 1997, pp. 1693-1695. doi:10.1016/S0140-6736(96)12038-9
[16] L. Liu, Q. Li, R. A. Lee, I. K. Friberg, J. Perin, N. Walker and R. E. Black, “Trends in Causes of Death among Children under 5 in Bangladesh, 1993-2004: An Exercise Applying a Standardized Computer Algorithm to Assign Causes of Death Using Verbal Autopsy Data,” Population Health Metrics, Vol. 9, 2011, p. 43. doi:10.1186/1478-7954-9-43
[17] M. W. Weber, S. Usen, A. Palmer, S. Jaffar and E. K. Mulholland, “Predictors of Hypoxaemia in Hospital Admissions with Acute Lower Respiratory Tract Infection in a Developing Country,” Archives of Disease in Childhood, Vol. 76, No. 4, 1997, pp. 310-314. doi:10.1136/adc.76.4.310
[18] H. J. Adrogue and N. E. Madias, “Hypernatremia,” New England Journal of Medicine, Vol. 342, No. 20, 2000, pp. 1493-1499. doi:10.1056/NEJM200005183422006
[19] A. R. Sadmani , M. A. Wahed, M. R. Islam and S. M. Ahmed, “Consequence of Hypernatraemia and Hypernatraemia in Children with Acute Diarrhoea in Bangladesh,” British Medical Journal (Clinical Research Ed), Vol. 286, No. 6366, 1983, pp. 671-673. doi:10.1136/bmj.286.6366.671

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