Factors associated with mortality in severely malnourished hospitalized children who developed septic shock.

Visnu Pritom Chowdhury,Mohammad Abubakar Siddik,Mohammod Jobayer Chisti,Tahmeed Ahmed,Monira Sarmin,Farzana Afroze,Mehnaz Kamal,Muhammad Waliur Rahman,Shafiul Islam

doi:10.3855/jidc.15135

Visnu Pritom Chowdhury, Mohammad Abubakar Siddik + Show 7 more

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https://doi.org/10.3855/jidc.15135

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Abstract

Septic shock can often lead to death, even in resourceful settings, if not handled carefully. Therefore, we sought to evaluate the factors associated with deaths in the context of severe malnutrition and also the effects of early, i.e., within 3 hours of diagnosing septic shock vs. late blood transfusion. Here, all under-five severely malnourished septic shock children were admitted to ICU during 2013-2017. Children who died constituted cases (n = 54), and the survived (n = 39) represented controls. We excluded children who received the blood transfusion for other causes and who left against medical advice. In both descriptive and multivariate analysis, we found that death was significantly associated with the use of fourth-line antibiotics, corticosteroids, and the addition of vasopressors on top of dopamine (all p < 0.05). However, the decrease of serum calcium level was found significantly associated with death only after adjusting (p < 0.05). Even though the cases more often received early blood transfusion than the controls, the difference was insignificant (p = 0.134). When a severely malnourished under-five child develops septic shock, requiring vasopressors, fourth-line antibiotic, and corticosteroid, with reduced serum calcium, the probability of death increases significantly. Our findings underscore the gravity of close monitoring at these points and the niches for early interventions.

Highlights

Septic shock can often lead to death, even in resourceful settings, if not handled carefully
Out of 276,523 under-five children admitted to icddr,b Dhaka hospital between 2013 to 2017, we found 93 severely malnourished children who developed septic shock and received the blood transfusion (Figure 1)
We found that in cases – i.e., those who died - the serum potassium and calcium levels were less than the survivors, while these differences were not statistically significant (p-value ≥ 0.05)

Summary

Introduction

Septic shock can often lead to death, even in resourceful settings, if not handled carefully. We sought to evaluate the factors associated with deaths in the context of severe malnutrition and the effects of early, i.e., within 3 hours of diagnosing septic shock vs late blood transfusion. Conclusions: When a severely malnourished under-five child develops septic shock, requiring vasopressors, fourth-line antibiotic, and corticosteroid, with reduced serum calcium, the probability of death increases significantly. Septic shock – a medical emergency – is associated with high mortality in developed and developing countries [1,2] and is one of the leading causes of death in underfive children worldwide [3]. Appropriate antibiotics, and early fluid resuscitation, it is possible to significantly reduce the mortality in septic shock [7–9] even though few recent studies in children without severe malnutrition suggest that aggressive fluid bolus (crystalloid solution) in septic shock may increase the mortality [10]. In children with severe malnutrition, such clinical signs often remain absent – due to their low immune response – which further complicates the situation [12]

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