Predictors of mortality in immunocompromised children with respiratory infections

Lea Sutrisna; Rina Triasih; Ida Safitri Laksanawati

doi:10.14238/pi62.4.2022.237-42

Lea Sutrisna Universitas Gadjah Mada
Rina Triasih Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Central Java
Ida Safitri Laksanawati Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Central Java

DOI: https://doi.org/10.14238/pi62.4.2022.237-42

Keywords: Mortality predictor, respiratory infection, immunocompromised

Abstract

Background Respiratory infection is a common morbidity and a major cause of mortality in immunocompromised children. Hence, identification of clinical parameters that predict mortality among immunocompromised children with respiratory infections is of importance to provide timely and appropriate intervention.

Objective To determine predictors of mortality in immunocompromised children with respiratory infections.

Methods We conducted a prospective cohort study of immunocompromised children aged 18 years or younger with respiratory tract infections who were admitted to Dr. Sardjito Hospital, Yogyakarta, Indonesia. All eligible children were prospectively followed up until hospital discharge. Clinical and laboratory parameters during the first 24 hours of hospitalization were collected.

Results Of 79 eligible children, the overall mortality was 11 subjects (13.9%). Fever, tachycardia, tachypnea, cyanosis, leukopenia, neutropenia, thrombocytopenia, and pleural effusion were predictive factors of mortality in bivariate analysis (P<0.25). A logistic regression model showed that neutropenia (absolute neutrophil count <125/mm³) and tachycardia were the best independent predictors of mortality in immunocompromised children with respiratory infections. The children with tachycardia had 15.8 times higher probability of mortality (95%CI 5.0 to 4.4) and those with neutropenia had 8.24 times higher probability of mortality. Cyanosis and pleural effusion were also independent mortality predictors.

Conclusion The risk of mortality is significantly increased in immunocompromised children with respiratory infection when tachycardia and neutropenia are also present.

Author Biography

Lea Sutrisna, Universitas Gadjah Mada

Child Health Department, Universitas Gadjah Mada

References

1. Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012;379:2151–61. DOI: https://doi.org/10.1016/S0140-6736(12)60560-1.
2. Ghimire M, Battacharya SK, Narain JP. Pneumonia in South-East Asia region: public health perspective. Indian J Med Res. 2012;135:459–68.
3. Rudan I, O’Brien KL, Nair H, Liu L, Theodoratou E, Qazi S, et al. Epidemiology and etiology of childhood pneumonia in 2010: estimates of incidence, severe morbidity, mortality, underlying risk factors and causative pathogens for 192 countries. J Glob Health. 2013;3:010401. DOI: https://doi.org/10.7189/jogh.03.010401.
4. Ghazi BMS, Aghamohammadi A, Kouhi A, Farhoudi A, Moin M, Rezaei N, Doost PS, et al. Mortality in primary immunodeficient patients, registered in Iranian primary immunodeficiency registry. Iran J Allergy Asthma Immunol. 2004;3:31–6.
5. Preidis GA, McCollum ED, Mwansambo C, Kazembe PN, Schutze GE, Kline MW. Pneumonia and malnutrition are highly predictive of mortality among African children hospitalized with human immunodeficiency virus infection or exposure in the era of antiretroviral therapy. J Pediatr. 2011;159:484–9.DOI: https://doi.org/10.1016/j.jpeds.2011.02.033.
6. Hakim H, Dallas R, Zhou Y, Pei D, Cheng C, Flynn PM, et al. Acute respiratory infections in children and adolescents with acute lymphoblastic leukemia. Cancer. 2016;122:798–805. DOI: https://doi.org/10.1002/cncr.29833.
7. Arias Lopez MP, Fernández AL, Ratto ME, Saligari L, Serrate AS, Ko IJ, et al. Pediatric Index of Mortality 2 as a predictor of death risk in children admitted to pediatric intensive care units in Latin America: a prospective, multicenter study. J Crit Care. 2015;30:1324–30. DOI: https://doi.org/10.1016/j.jcrc.2015.08.001
8. Kisworini P, Setyati A. Mortality predictors of pneumonia in children. Paedriatr Indones. 2010;50:149–53. DOI: https://doi.org/10.14238/pi50.3.2010.149-53
9. Chien YS, Su CP, Tsai HT, Huang AS, Lien CE, Hung MN, et al. Predictors and outcomes of respiratory failure among hospitalized pneumonia patients with 2009 H1N1 influenza in Taiwan. J Infect. 2010;60:168–74. DOI: https://doi.org/10.1016/j.jinf.2009.12.012.
10. Basnet S, Adhikari RK, Gurung CK. Hypoxemia in children with pneumonia and its clinical predictors. Indian J Pediatr. 2006;73:777–81. DOI: https://doi.org/10.1007/BF02790384
11. Njom Nlend AE, Loussikila AB. Predictors of mortality among HIV-infected children receiving highly active antiretroviral therapy. Med Mal Infect. 2017;47:32-7. DOI: https://doi.org/10.1016/j.medmal.2016.07.003.
12 Ford N, Shubber Z, Meintjes G, Grinsztejn B, Eholie S, Mills EJ, et al. Causes of hospital admission among people living with HIV worldwide: a systematic review and meta-analysis. Lancet HIV. 2015;2:e438-44. DOI: https://doi.org/10.1016/S2352-3018(15)00137-X.
13. Duke T, Blaschke AJ, Sialis S, Bonkowsky JL. Hypoxaemia in acute respiratory and non-respiratory illnesses in neonates and children in a developing country. Arch Dis Child. 2002;86:108–12. DOI: https://doi.org/10.1136/adc.86.2.108.
14. Lutz PL, Prentice HM. Sensing and responding to hypoxia, molecular and physiological mechanisms. Integr Comp Biol. 2002;42:463–8. DOI: https://doi.org/10.1093/icb/42.3.463.
15. Fadlinda H, Utomo A, Djuhaeni H. Cyanosis as mortality risk among children with severe pneumonia. AMJ. 2016;3:186–9. DOI: https://doi.org/10.15850/amj.v3n2.799.
16. Usen S, Weber M, Mulholland K, Jaffar S, Oparaugo A, Omosigho C, et al. Clinical predictors of hypoxaemia in Gambian children with acute lower respiratory tract infection: prospective cohort study. BMJ. 1999;318:86-91. DOI: https://doi.org/10.1136/bmj.318.7176.86.
17. Aliberti S, Myers JA, Peyrani P, Blasi F, Menendez R, Rossi P, et al. The role of neutropenia on outcomes of cancer patients with community-acquired pneumonia. Eur Respir J. 2009;33:142–7. DOI: https://doi.org/10.1016/S0873-2159(15)30171-9.
18. Michiels C. Physiological and pathological responses to hypoxia. Am J Pathol. 2004;164:1875–82. DOI: https://doi.org/10.1016/S0002-9440(10)63747-9.
19. Djelantik IGG, Gessner BD, Sutanto A, Steinhoff M, Linehan M, Moulton LH, et al. Case fatality proportions and predictive factors for mortality among children hospitalized with severe pneumonia in a rural developing country setting. J Trop Pediatr. 2003;49:327–32. DOI: https://doi.org/10.1093/tropej/49.6.327.
20. Atwa ZT. Usefulness of gender and abnormal blood count for predicting pneumonia outcome in children. Egypt J Chest Dis Tuberc. 2015;64:169–74. DOI: https://doi.org/10.1016/j.ejcdt.2014.11.022.
21. Khanafer N, Sicot N, Vanhems P, Dumitrescu O, Meyssonier V, Tristan A, et al. Severe leukopenia in Staphylococcus aureus-necrotizing, community-acquired pneumonia: risk factors and impact on survival. BMC Infect Dis. 2013;13:359. DOI: https://doi.org/10.1186/1471-2334-13-359
22. Wang HW, Lin CC, Kuo CF, Liu CP, Lee CM. Mortality predictors of Pneumocystis jirovecii pneumonia in human immunodeficiency virus-infected patients at presentation: experience in a tertiary care hospital of northern Taiwan. J Microbiol Immunol Infect. 2011;44:274–81. DOI: https://doi.org/10.1016/j.jmii.2010.08.006.
23. Ferreira S, Sant CC, March MF, Santos MA, Cunha AJ. Lethality by pneumonia and factors associated to death. J Pediatr. 2014;90:92–7. DOI: https://doi.org/10.1016/j.jped.2013.05.008.
24. Arpitha G, Rehman M, Ashwitha G. Effect of severity of malnutrition on pneumonia in children aged 2M-5Y at a tertiary care center in Khammam, Andhra Pradesh: a clinical study. Sch J Appl Med Sci. 2014;2:3199–203.
25. Wang LJ, Mu SC, Lin CH, Lin MI, Sung TC. Fatal community-acquired pneumonia: 18 years in a medical center. Pediatr Neonatol. 2013;54:22–7. DOI: https://doi.org/10.1016/j.pedneo.2012.11.003.