Risk factors for a poor outcome among children admitted with clinically severe pneumonia to a university hospital in Rabat, Morocco
Por:
Jroundi I, Mahraoui C, Benmessaoud R, Moraleda C, Tligui H, Seffar M, Kettani SE, Benjelloun BS, Chaacho S, Munoz-Almagro C, Ruiz J, Alonso PL and Bassat Q
Publicada:
1 nov 2014
Ahead of Print:
8 oct 2014
Resumen:
Objectives: Data on prognostic factors among children with severe pneumonia are scarce in middle-income countries. We investigated prognostic factors for an adverse outcome among children admitted to the Hopital d'Enfants de Rabat, Morocco with World Health Organization-defined clinically severe pneumonia (CSP).
Methods: Children aged 2-59 months admitted to the hospital and fulfilling the CSP definition were recruited into this 13-month prospective study. A poor prognosis was defined as death, a need for intensive care, or a Respiratory Index of Severity in Children (RISC) score >= 3. Multivariate logistic regression was performed to ascertain independent predictive factors for a poor prognosis.
Results: Of the 689 children included in this analysis, 55 (8.0%) required intensive care and 28 died (4.0%). Five hundred and two (72.8%) children were classified as having a good prognosis and 187 (27.2%) as having a poor prognosis. A history of prematurity (odds ratio (OR) 2.50, 95% confidence interval (CI) 1.24-5.04), of fever (OR 2.25, 95% CI 1.32-3.83), living in a house with smokers (OR 1.79, 95% CI 1.18-2.72), impaired consciousness (OR 10.96, 95% CI 2.88-41.73), cyanosis (OR 2.09, 95% CI 1.05-4.15), pallor (OR 2.27, 95% CI 1.34-3.84), having rhonchi on auscultation (OR 2.45, 95% CI 1.58-3.79), and human metapneumovirus infection (OR 2.13, 95% CI 1.13-4.02) were all independent risk factors for an adverse outcome, whereas a history of asthma (OR 0.46, 95% CI 0.25-0.84) was the only independent risk factor for a positive outcome.
Conclusions: The early identification of factors associated with a poor prognosis could improve management strategies and the likelihood of survival of Moroccan children with severe pneumonia. (C) 2014 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-SA license.
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