Real-Time Estimation of the Case Fatality Ratio and Risk Factors of Death

Objective To discuss the clinical features and risk factors of death in children with severe pneumonia treated with invasive mechanical ventilation. Methods Through a retrospective analysis of children with severe pneumonia treated with invasive mechanical ventilation, who were hospitalized in PICU of Tianjin Children′s Hospital from Jan 2011 to Dec 2014, we analyzed the distribution of age, etiologic characteristics, mechanical ventilation, complications and background diseases.The single factor analysis and multiple factors Logistic regression analysis were performed to evaluate the risk factors of death. Results A total of 214 pediatric patients were included, 134 were male, and 80 were female.The case fatality rate was 6.17%, the relevance ratio of pathogenic microorganism was 16.36%.The median age of death group was older than that of the survival group(4 mouths vs 2 mouths, P=0.039). The pediatric patients who were more than 1 year old in death group were more than the survival group(21.43% vs 15.8%, P<0.001). The common complications included dencephalopathy(11.68%) and electrolyte imbalance(8.41%). Anemia, cardiopathy and alloplasia of respiratory system were the top background diseases.The results of Logistic multivariate regression analysis showed that there were significant differences in the age above 1 year old(OR: 1.019, 95%CI: 1.003-1.030, P=0.019), secondary acute respiratory distress syndrome(OR: 7.254, 95%CI: 1.581-33.277, P=0.011) and accompanying cardiopathy(OR: 0.47, 95%CI: 0.273-0.81, P=0.007). Conclusion The risk factors of death in children with severe pneumonia treated with invasive mechanical ventilation are the following: the age above 1 year old, secondary acute respiratory distress syndrome or accompanying cardiopathy. Key words: Severe pneumonia; Invasive mechanical ventilation; Clinical feature; Risk factors of death,

BackgroundDiarrhea is the second leading cause of death in children younger than 5 years of age globally. The burden of diarrheal mortality is concentrated in low-resource settings. Little is known about the risk factors for childhood death from diarrheal disease in low- and middle-income countries.MethodsData from the World Health Organization (WHO)-coordinated Global Rotavirus and Pediatric Diarrhea Surveillance Networks, which are composed of active, sentinel, hospital-based surveillance sites, were analyzed to assess mortality in children <5 years of age who were hospitalized with diarrhea between 2008 and 2018. Case fatality risks were calculated, and multivariable logistic regression was performed to identify risk factors for mortality.ResultsThis analysis comprises 234 781 cases, including 1219 deaths, across 57 countries. The overall case fatality risk was found to be 0.5%. Risk factors for death in the multivariable analysis included younger age (for <6 months compared with older ages, odds ratio [OR] = 3.54; 95% confidence interval [CI], 2.81–4.50), female sex (OR = 1.18; 95% CI, 1.06–1.81), presenting with persistent diarrhea (OR = 1.91; 95% CI, 1.01–3.25), no vomiting (OR = 1.13; 95% CI, .98–1.30), severe dehydration (OR = 3.79; 95% CI, 3.01–4.83), and being negative for rotavirus on an enzyme-linked immunosorbent assay test (OR = 2.29; 95% CI, 1.92–2.74). Cases from the African Region had the highest odds of death compared with other WHO regions (OR = 130.62 comparing the African Region with the European Region; 95% CI, 55.72–422.73), whereas cases from the European Region had the lowest odds of death.ConclusionsOur findings support known risk factors for childhood diarrheal mortality and highlight the need for interventions to address dehydration and rotavirus-negative diarrheal infections.

Objective To investigate the clinical features and prognostic factors of Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) in adults. Methods Clinical data of 40 adult patients with EBV-HLH admitted in the First Affiliated Hospital of Nanjing Medical University during January 2010 and September 2013 were retrospectively analyzed. The patients were divided into fatal group or survival group based on the results of 1-month follow-up. Logistic regression analysis was performed to identify risk factors of early death. Results EBV-HLH in clinic were characterized by fever, hepatosplenomegaly and lymphadenopathy. The incidences of peripheral blood cytopenias in 2 or 3 lines, hepatic dysfunction and hyperferritinemia in EBV-HLH patients were 60.0% (24/40), 95.0% (38/40) and 94.9%(37/39), respectively. Hemophagocytic phenomenon in bone marrow was observed in 83.8% patients (31/37). Soluble CD25 (sCD25) was detected in 12 patients, and all were higher than 2 400 pg/mL. Nineteen patients died 1 month after final diagnosis with a fatality rate of 47.5%. Univariate logistic regression analysis indicated that EBV-DNA>105 copies/mL (OR=4.85, 95%CI: 1.14-25.83, P 50 μmol/L (OR=6.91, 95%CI: 1.24-38.52, P 5 000 μg/L (OR=8.75, 95%CI: 2.03-37.67, P<0.01) and polyserositis (OR=5.40, 95%CI: 1.18-24.64, P<0.05) were risk factors of death within 1 month after final diagnosis, while chemotherapy was a protective factor of early death (OR=0.15, 95%CI: 0.03-0.81, P<0.05). Conclusions EBV-HLH in adult has a poor prognosis. Significant elevated EBV-DNA, total bilirubin or serum ferritin, and notable decrease of peripheral blood platelet count or albumin level may indicate a poor prognosis, while chemotherapy may reduce the risk of early death. Key words: Lymphohistiocytosis, hemophagocytic; Epstein-barr virus; Clinical feature; Prognosis; Risk factors

BackgroundKnowledge of COVID-19 epidemiology remains incomplete and crucial questions persist. We aimed to examine risk factors for COVID-19 death.MethodsA total of 80 543 COVID-19 cases reported in China, nationwide, through 8 April 2020 were included. Risk factors for death were investigated by Cox proportional hazards regression and stratified analyses.ResultsOverall national case-fatality ratio (CFR) was 5.64%. Risk factors for death were older age (≥80: adjusted hazard ratio, 12.58; 95% confidence interval, 6.78–23.33), presence of underlying disease (1.33; 1.19–1.49), worse case severity (severe: 3.86; 3.15–4.73; critical: 11.34; 9.22–13.95), and near-epicenter region (Hubei: 2.64; 2.11–3.30; Wuhan: 6.35; 5.04–8.00). CFR increased from 0.35% (30–39 years) to 18.21% (≥70 years) without underlying disease. Regardless of age, CFR increased from 2.50% for no underlying disease to 7.72% for 1, 13.99% for 2, and 21.99% for ≥3 underlying diseases. CFR increased with worse case severity from 2.80% (mild) to 12.51% (severe) and 48.60% (critical), regardless of region. Compared with other regions, CFR was much higher in Wuhan regardless of case severity (mild: 3.83% vs 0.14% in Hubei and 0.03% elsewhere; moderate: 4.60% vs 0.21% and 0.06%; severe: 15.92% vs 5.84% and 1.86%; and critical: 58.57% vs 49.80% and 18.39%).ConclusionsOlder patients regardless of underlying disease and patients with underlying disease regardless of age were at elevated risk of death. Higher death rates near the outbreak epicenter and during the surge of cases reflect the deleterious effects of allowing health systems to become overwhelmed.

Objective To describe the characteristics of healthcare-associated infective endocarditis (HAIE) and to investigate the risk factors of infective endocarditis (IE) case fatality. Methods All consecutive cases of definite IE diagnosed from 1992 to 2012 were collected and categorized into HAIE and community acquired IE (CAIE). The epidemiological and clinical features of HAIE and CAIE were compared. Risk factors for in-hospital case fatality were analyzed by Logistic regression. Results One hundred and fifty-four patients with IE were enrolled; 126 (81.8%) were CAIE and 28 (18.2%) were HAIE. Compared with CAIE patients, HAIE patients were in poorer condition (Charlson comorbidity scale≥2: 35.7% vs 15.1%; χ2=6.382, P=0.012), more frequently associated with a history of prosthetic valve replacement (35.7% vs 7.1%; χ2=17.291, P<0.01), more rheumatic heart disease (35.7% vs 10.3%; χ2=11.631, P=0.002), more recieved immunosuppressive or glucocorticoid therapy (21.4% vs 4.0%; χ2=10.530, P=0.005) and more acute heart failure (17.9% vs 4.8%; χ2=5.923, P=0.029). Viridans group streptococci infection predominated in CAIE (χ2=5.489, P=0.019), while staphylococci and enterococci infections (50.1%) were frequent in HAIE. Other bacterial pathogen infections were more common in HAIE (χ2=5.870, P=0.026). Ten patients died before discharge and the case fatality rate in-hospital was 6.5% (10/154). Case fatality rate in HAIE (17.9%) was significantly higher than CAIE (4.0%; χ2=7.278, P=0.018). Surgery treatment, albumin level, stroke and HAIE were independent risk factors for IE-related deaths. Odds ratios (OR) were 0.081 (95%CI: 0.008-0.873), 0.754 (95%CI: 0.587-0.967), 33.777 (95%CI: 2.751-414.743) and 11.952 (95%CI: 1.045-136.709), respectively. Conclusion HAIE is common and distinctive from CAIE in epidemiology and prognosis, which increases patient fatality. Key words: Endocarditis, bacterial; Community-acquired infections; Healthcare-associated infective endocarditis; Epidemiology; Risk factors

Objective To analyze clinical features, treatment, prognosis and risk factors for death of capillary leak syndrome (CLS) in neonates. Methods This retrospective study involved 68 neonates with CLS treated in the Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University from January 2013 to December 2017. Clinical data, including features, causes, treatment and outcomes of those CLS cases were analyzed. Chi-square test and multivariate logistic regression analysis were performed. Results Among the 68 cases consisting of 49 males and 19 females, 86.7% (59/68) were born at ≥ 35 gestational weeks. Fifty-three neonates (77.9%) developed symptoms within three days after admission. Forty-two cases (61.8%) had respiratory distress syndrome and 35 (51.5%) had septicemia. The mortality rate was 23.5% (16/68). Among the survivors, 38.5% (20/52) showed abnormal cranial MRI. Univariate analysis with Chi-square test showed that neonatal death due to CLS was associated with the lactic acid level >10 mmol/L, oliguria lasting for 12 h or anuria for 8 h, no negative fluid balance occured within seven days, adrenaline infusion >0.6 μg/(kg·min) and administration of 3% sodium chloride. Multivariate logistic regression analysis showed that lactic acid level, oliguria/anuria duration and the time achieve negative fluid balance were independent risk factors for neonatal death of CLS. Conclusions Neonatal CLS is a condition with high fatality rate and poor prognosis. Respiratory distress syndrome and septicemia are the common causes. The prognosis of CLS might be improved by treatment with 3% sodium chloride. Lactic acid level, oliguria/anuria duration and the time achieve negative fluid balance are independent risk factors for neonatal death due to CLS. Key words: Capillary leak syndrome; Death; Risk factors; Infant, newborn

BackgroundInpatient case fatality from severe malaria remains high in much of sub-Saharan Africa. The majority of these deaths occur within 24 hours of admission, suggesting that pre-hospital management may have an impact on the risk of case fatality.MethodsProspective cohort study, including questionnaire about pre-hospital treatment, of all 437 patients admitted with severe febrile illness (presumed to be severe malaria) to the paediatric ward in Sikasso Regional Hospital, Mali, in a two-month period.FindingsThe case fatality rate was 17.4%. Coma, hypoglycaemia and respiratory distress at admission were associated with significantly higher mortality. In multiple logistic regression models and in a survival analysis to examine pre-admission risk factors for case fatality, the only consistent and significant risk factor was sex. Girls were twice as likely to die as boys (AOR 2.00, 95% CI 1.08–3.70). There was a wide variety of pre-hospital treatments used, both modern and traditional. None had a consistent impact on the risk of death across different analyses. Reported use of traditional treatments was not associated with post-admission outcome.InterpretationAside from well-recognised markers of severity, the main risk factor for death in this study was female sex, but this study cannot determine the reason why. Differences in pre-hospital treatments were not associated with case fatality.

BackgroundAn outbreak of the Middle East respiratory syndrome (MERS), comprising 185 cases linked to healthcare facilities, occurred in the Republic of Korea from May to July 2015. Owing to the nosocomial nature of the outbreak, it is particularly important to gain a better understanding of the epidemiological determinants characterizing the risk of MERS death in order to predict the heterogeneous risk of death in medical settings.MethodsWe have devised a novel statistical model that identifies the risk of MERS death during the outbreak in real time. While accounting for the time delay from illness onset to death, risk factors for death were identified using a linear predictor tied to a logit model. We employ this approach to (1) quantify the risks of death and (2) characterize the temporal evolution of the case fatality ratio (CFR) as case ascertainment greatly improved during the course of the outbreak.ResultsSenior persons aged 60 years or over were found to be 9.3 times (95 % confidence interval (CI), 5.3–16.9) more likely to die compared to younger MERS cases. Patients under treatment were at a 7.8-fold (95 % CI, 4.0–16.7) significantly higher risk of death compared to other MERS cases. The CFR among patients aged 60 years or older under treatment was estimated at 48.2 % (95 % CI, 35.2–61.3) as of July 31, 2015, while the CFR among other cases was estimated to lie below 15 %. From June 6, 2015, onwards, the CFR declined 0.3-fold (95 % CI, 0.1–1.1) compared to the earlier epidemic period, which may perhaps reflect enhanced case ascertainment following major contact tracing efforts.ConclusionsThe risk of MERS death was significantly associated with older age as well as treatment for underlying diseases after explicitly adjusting for the delay between illness onset and death. Because MERS outbreaks are greatly amplified in the healthcare setting, enhanced infection control practices in medical facilities should strive to shield risk groups from MERS exposure.

To determine the case fatality rate and risk factors for death in children with invasive meningococcal infection, 163 children admitted with meningococcal disease to the Instituto Materno Infantil de Pernambuco, a tertiary paediatric teaching hospital in Recife, Brazil, were included in this retrospective cohort study. Cases were categorised as meningitis, septicaemia and septicaemia with meningitis. Forty-six (28.2 per cent) children had meningitis alone, 88 (54 per cent) septicaemia and meningitis and 29 (17.8 per cent) only septicaemia. Four of the patients with meningitis died (8.7 per cent), compared to 31 out of the 88 (35.2 per cent) with septicaemia and meningitis and 18 of the 29 (62.1 per cent) with septicaemia alone (p < 0.001). Symptoms <24 h (AOR 3.8, 95 per cent CI 1.1-13.1), platelet count <100 000 mm(3) (AOR 13.8, 95 per cent CI 3.1-60.9) and acidosis (AOR 6.0, 95 per cent CI 1.7-21) were the significant risk factors for death. Invasive meningococcal infection has a high case-fatality rate in this tertiary centre in Recife, especially in the septic forms. The identification of risk factors for death could contribute to the early recognition of patients with higher risk on admission in a middle-income country population.

Prevalence and incidence of advanced schistosomiasis and risk factors for case fatality in Hunan Province, China

Clinical Course of Avian Influenza A(H5N1) in Patients at the Persahabatan Hospital, Jakarta, Indonesia, 2005–2008

Smeed's law and expected road fatality reduction: An assessment of the Italian case

Background: The emergence of the SARS-CoV-2 and the COVID-19 have become a global health crisis. The infection has been present in all the social sectors. Subjects under 18 years are one of them. The objective was to analyze the case fatality ratio of COVID-19 cases in the Mexican population under 18 years of age registered in the National Epidemiological Surveillance System from March 2020 to December 31, 2020.Material and Methods: The design is cross-sectional, quantitative, and analytical. All the suspected cases of respiratory viral disease, with a real-time polymerase chain reaction (RT-PCR) test result, aged from 0 to 17 years, were included. Descriptive statistics are presented for all the variables. Epidemiological curves were designed. The chi-squared test and its P-values were obtained to show the relationship between comorbidities and death. The case fatality ratio was computed for each comorbidity, sex, and age group. Multivariable logistic regression models were fitted to study the effect between comorbidities with the fatality of cases, adjusting for sex and age group as potential confounders. The alpha value was fixed to 0.05 to assess significance.Results: The number of records for this study was 167,856. Among them, 48,505 were from SARS-CoV-2-positive patients (28.90%), and 119,351 (71.10%) were negative. Of those who died, males (55.29%) (P < 0.05) and those under 2 years of age (50.35%) (P < 0.05) predominated. Unlike in older populations, from the comorbidities considered risk factors for death by COVID-19, only immunosuppression showed a statistically significant effect on the fatality of cases after adjustment by the other related variables. Sex and age group were not confounders for the models in those under 18 years old. Pneumonia, being younger than 5 years, and immunosuppression are related to death.Conclusion: The case fatality ratio in those under 18 years old is low. Special attention must be paid to those children under 5 years. The development of pneumonia is a warning indicator while treating them. On the other hand, having an open database of cases allows the researchers to analyze the impact of COVID-19 in different population sectors, which has clear benefits for public health.

Relatively little is known about the effects of mechanical ventilation (MV; including invasive MV [IMV] and noninvasive ventilation) on clinical outcomes of patients with idiopathic pulmonary fibrosis (IPF) and connective tissue disease-associated interstitial lung disease (CTD-ILD) in the intensive care unit (ICU) and risk factors for ICU death remain to be determined. Our objective was to determine and compare mortality rates between IPF and CTD-ILD patients receiving MV and to identify risk factors for ICU death in these patients. We conducted a retrospective cohort study in respiratory ICUs of three university hospitals in China during a 7-year period. We compared clinical data and outcomes between patients with IPF and those with CTD-ILD and performed logistic regression analyses to identify risk factors for ICU death. Of the 94 patients in the analyses, 63 were diagnosed with IPF and 31 were diagnosed with CTD-ILD. ICU mortality was significantly higher in the IPF group than in the CTD-ILD group (86% vs 68%; P=0.041) and was significantly lower in patients receiving noninvasive ventilation than in those receiving IMV (62% vs 88%; P=0.004). Risk factors for ICU death were disease progression as the principal cause of acute respiratory failure and IMV. Based on current clinical practice in three ICUs, the mortality rate in IPF patients receiving MV might reach 86% and is higher than in CTD-ILD patients. IMV might be initiated cautiously, especially in patients with disease progression as the principal cause of acute respiratory failure.

Hip fracture is common in older patients and is associated with high mortality and functional impairment. The Geriatric Nutritional Risk Index (GNRI) evaluates the risk of malnutrition-related complications, and the Barthel Index (BI) evaluates older patients' functional status. The study aim was to determine the risk factors for both death and decreased BI within 1year after hip fracture. We retrospectively reviewed the records of 108 patients who were treated for hip fractures in 10 public or private hospitals from February to July 2007. Participating facilities comprised eight public or private hospitals with 200-499 beds, and two private or orthopedic hospitals with 20-199 beds. We evaluated several risk factors for death and lower BI within 1year after hip fracture. The mortality rate within 1year postoperatively for patients who survived inpatient stay was 6.5% (7/108). The proportion of patients with decreased postoperative BI was 43.6% (44/101). Binomial logistic regression analysis showed that several factors, including low GNRI (odds ratio [OR]: 0.80; 95% confidence interval [CI: 0.68-0.93]), were risk factors for death within 1year. Postoperative delirium (OR: 8.84 [1.52-51.6]), postinjury dementia (OR: 34.8 [3.01-402]), preinjury BI (OR: 1.05 [1.02-1.08]), and preinjury dementia (OR: 6.22 [1.73-22.4]) were risk factors for decreased postoperative BI. Our findings indicated that lower GNRI was a risk factor for death within 1 year of hip surgery and that delirium and dementia were among the risk factors for decreased BI 1year after hip fracture.