Treatment Outcome of Bacteremia Due to KPC-Producing Klebsiella pneumoniae: Superiority of Combination Antimicrobial Regimens

Predicting Surgical Risk in Patients With Cirrhosis: From Art to Science

To evaluate outcomes after major surgery in children and adolescents with intellectual disability. We used 2004 to 2013 claims data from Taiwan's National Health Insurance programme to conduct a nested cohort study, which included 220292 surgical patients aged 6 to 17years. A propensity score matching procedure was used to select 2173 children with intellectual disability and 21730 children without intellectual disability for comparison. Logistic regression was used to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of the postoperative complications and 30-day mortality associated with intellectual disability. Children with intellectual disability had a higher risk of postoperative pneumonia (OR 2.16, 95% CI 1.48-3.15; p<0.001), sepsis (OR 1.67, 95% CI 1.28-2.18; p<0.001), and 30-day mortality (OR 2.04, 95% CI 1.05-3.93; p=0.013) compared with children without intellectual disability. Children with intellectual disability also had longer lengths of hospital stay (p<0.001) and higher medical expenditure (p<0.001) when compared with children with no intellectual disability. Children with intellectual disability experienced more complications and higher 30-day mortality after surgery when compared with children without intellectual disability. There is an urgent need to revise the protocols for the perioperative care of this specific population. Surgical patients with intellectual disability are at increased risk of postoperative pneumonia, sepsis, and 30-day mortality. Intellectual disability is associated with higher medical expenditure and increased length of stay in hospital after surgical procedures. The influence of intellectual disability on postoperative outcomes is consistent in both sexes and those aged 10 to 17 years. Low income and a history of fractures significantly impacts postoperative adverse events for patients with intellectual disability.

Background Persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with high mortality. Ceftaroline monotherapy is a promising treatment, and combining ceftaroline with daptomycin or vancomycin has shown in vitro synergistic effects that may enhance clinical outcomes. This real-world study compares the effectiveness of ceftaroline monotherapy versus combination therapy in treating persistent MRSA bacteremia. Methods This multicenter, retrospective cohort study included patients with persistent MRSA bacteremia (i.e., positive blood cultures after 48 hours of anti-MRSA therapy) from five hospitals across the Memorial Health Care System between January 2019 and September 2023. Included patients received ≥48 hours of ceftaroline monotherapy or combination therapy with ceftaroline plus either daptomycin or vancomycin. Exclusions were lack of repeat blood cultures, polymicrobial bacteremia, pregnancy, or incarceration. The primary outcome was 30-day all-cause mortality; secondary outcomes included in-hospital mortality, 30-day infection-related mortality, time to bacteremia clearance, 30-day readmission, 30-day recurrence, and adverse events. Logistic regression identified predictors of 30-day mortality. Results Among 46 adults (23 per arm), baseline demographics and severity scores were similar except for higher rates of myocardial infarction (17% vs 0%, p=0.036) and CKD (39% vs 13%, p=0.044) in the monotherapy group; appropriate dosing was more frequent with monotherapy (100% vs 78%, p=0.018). 30-day all-cause mortality was lower with combination therapy (17% vs 30%) but not statistically significant (p=0.299), whereas infection-related mortality was significantly reduced (9% vs 30%, p=0.039). For all other secondary outcomes, no differences were observed. In multivariable analysis, higher APACHE II score (aOR 1.53, 95% CI 1.12–2.56; p=0.039) and discharge on antibiotics (aOR 0.004, 95% CI &amp;lt; 0.001–0.097; p=0.012) predicted 30-day mortality. Conclusion Combination therapy with ceftaroline plus daptomycin or vancomycin may reduce infection-related mortality, with a trend toward lower 30-day mortality. These findings suggest potential clinical benefit and warrant further study in a larger sample. Disclosures All Authors: No reported disclosures

Division of Infectious Diseases, Keck School of Medicine at USC and the Los Angeles County-USC Medical Center, Los Angeles, CA Department of Medicine, Department of Pharmacology, Department of Molecular Biology and Microbiology, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, OH * See also p. 1194. Dr. Spellberg has received support for article research from the National Institutes of Health (NIH). His institution received grant support from the NIH (Dr. Spellberg is a funded investigator who does research on Acinetobacter). Dr. Bonomo has received support for article research from the NIH.

ObjectivesThe ratio of ferritin to albumin (FAR) has been proposed as a novel prognostic indicator for COVID-19. However, the role of FAR in predicting the all-cause mortality rate in patients with sepsis has not been evaluated. Therefore, the aim of this study is to elucidate the correlation between FAR and the 28-day all-cause mortality rate in patients with sepsis.MethodsThis study used data from the Medical Information Mart for Intensive Care IV database (v2.0) for a retrospective cohort analysis. The study focused on adult patients with sepsis who were admitted to the intensive care unit. The primary objective was to assess the predictive capability of FAR in determining the 28-day all-cause mortality rate among patients with sepsis.ResultsThe study involved 1553 sepsis patients in total. Based on the survival status of sepsis patients within 28 days, they were divided into two groups: a survival group consisting of 973 patients, and a death group consisting of 580 patients. The results revealed a 28-day mortality rate of 37.35% among sepsis patients. The multivariable Cox regression analysis revealed that FAR was an independent predictor of the 28-day all-cause mortality rate in patients with sepsis (hazard ratio [HR]: 1.17–1.19; 95% confidence interval 1.11–1.26; P < 0.001). The FAR demonstrated a higher area under the curve (AUC) of 61.01% (95% confidence interval 58.07–63.96%), compared to serum ferritin (60.48%), serum albumin (55.56%), and SOFA score (56.97%). Receiver operating characteristic curve (ROC) analysis determined the optimal cutoff value for FAR as 364.2215. Kaplan–Meier analysis revealed a significant difference in the 28-day all-cause mortality rate between patients with FAR ≥ 364.2215 and those with FAR < 364.2215 (P < 0.001). Furthermore, subgroup analysis showed no significant interaction between FAR and each subgroup.ConclusionsThis study revealed a significant correlation between FAR and the 28-day mortality rate in patients with sepsis. Higher FAR values were strongly associated with increased mortality rates within 28 days.

The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) and the Society of Thoracic Surgeons (STS) score are currently used to estimate periprocedural risk of death in patients undergoing transcatheter aortic valve implantation (TAVI). However, data regarding the predictive ability and usefulness of these scores for TAVI are controversial, especially for different access sites. Between 2008 and 2016, 1192 consecutive patients undergoing TAVI [transfemoral (TF): n = 607 (51%); transapical (TA): n = 585 (49%)] at 2 centres were included. All-cause mortality was assessed at a median of 533 days (interquartile range 153-1036). The value of the EuroSCORE II and the STS score in terms of predicting 30-day and cumulative mortality according to access site was investigated. The mean age was 83 (interquartile range 79-86) years. Overall, the 30-day mortality rate was 7.6% (n = 90), and the cumulative all-cause mortality rate was 35.1% (n = 418). The EuroSCORE II and the STS score were significantly increased in non-survivors compared with survivors (P < 0.001). The EuroSCORE II and the STS score emerged as independent predictors of 30-day mortality [EuroSCORE II: odds ratio (OR) 1.039, 95% confidence interval (CI) 1.013-1.065; P = 0.003; STS score: OR 1.055, 95% CI 1.023-1.088; P = 0.001] and cumulative all-cause mortality [EuroSCORE II: hazard ratio (HR) 1.026, 95% CI 1.013-1.038; P < 0.001; STS score: HR 1.05, 95% CI 1.03-1.06; P < 0.001]. In contrast to TF TAVI, the EuroSCORE II (OR 1.038, 95% CI 1.009-1.068; P = 0.010) and the STS score (OR: 1.063, 95% CI 1.025-1.102; P = 0.001) were independent predictors of 30-day mortality and cumulative mortality (EuroSCORE II: HR 1.023, 95% CI 1.009-1.037; P = 0.001; STS score: HR 1.055, 95% CI 1.037-1.073; P < 0.001) in patients undergoing TA TAVI. The EuroSCORE II and the STS score were independent predictors of 30-day and cumulative mortality rates in patients undergoing TAVI. The EuroSCORE II and the STS score were associated with 30-day mortality and mortality during follow-up period only in TA TAVI.

BackgroundSurgery remains the most effective treatment for patients with non-small cell lung cancer (NSCLC). However, pneumonectomy is usually associated with high mortality and morbidity rates. Defining post-operative death after such extensive procedures remains controversial. This study aimed to assess the 30- and 90-day post-pneumonectomy mortality rates. The secondary aim was to identify the most critical factors determining early post-pneumonectomy mortality.MethodsThis retrospective, single-institution cohort study was conducted at a high-volume center and included a large group of 514 patients who underwent pneumonectomy for NSCLC from 2006 to 2020. Our analysis considered patient comorbidities, staging, surgical techniques, neoadjuvant chemotherapy, and major complications, and examined their associations with 30- and 90-day mortality rates. We initially performed a univariable Cox regression analysis, followed by multivariable analyses, including variables with P<0.1.ResultsThe 30- and 90-day mortality was equal to 4.3% and 9.1%, respectively. For 30-day mortality, statistically significant factors included the occurrence of a bronchopleural fistula (BPF) [hazard ratio (HR) =5.128; 95% confidence interval (CI): 2.009–13.087; P<0.001], positive bronchial resection margin (HR =7.917; 95% CI: 2.61–24.01; P<0.001) and the prolonged intubation (>48 hours) (HR =3.822; 95% CI: 1.06–13.785; P=0.041). For the 90-day mortality, the presence of the BPF (HR =5.284; 95% CI: 2.706–10.318; P<0.001), positive bronchial resection margin (HR =3.528; 95% CI: 1.370–9.083; P=0.009), chest wall infiltration (HR =3.770; 95% CI: 1.121–12.676; P=0.03), and prolonged intubation (>48 hours) (HR =2.912; 95% CI: 1.102–7.649; P=0.03) were the statistically significant risk factors.ConclusionsA 90-day follow-up period should be considered when assessing short-term mortality rates after major pulmonary resections. Monitoring long-term mortality is important, as the mortality rate in our group doubled after 3 months. BPF, prolonged intubation, chest wall infiltration, and positive bronchial resection margin significantly increase the risk of 30- and 90-day mortality rates.

The Japanese Board of General Thoracic Surgery and the annual survey by the Japanese Association for Thoracic Surgery (JATS) of certified hospitals began in 2005; since then, over 1300 specialists and 650 hospitals have been certified by this system. To evaluate how this system contributes to improving the outcomes of general thoracic surgery, the effects of the number of certified general thoracic surgeons (GTSs) and hospital volume on 30-day mortality or hospital mortality were evaluated. Using data from the annual survey of JATS from 2005 to 2012, the outcomes of 211 619 patients who underwent lung resection for lung cancer were evaluated. The patients were divided into four groups by the level of surgery: first level, partial resection; second level, segmentectomy and lobectomy; third level, sleeve segmentectomy and lobectomy; and fourth level, pneumonectomy, sleeve pneumonectomy and pleuro-pneumonectomy. Multiple logistic regression analysis was used to examine the associations between operative mortality and the number of GTSs, hospital volume and level of surgical procedure. Overall 30-day and hospital mortality rates were 0.40 and 0.77%, respectively. The 30-day and hospital mortality rates for each surgical level were 0.20 and 0.35% for the first level, 0.36 and 0.73% for the second level, 1.02 and 1.81% for the third level and 2.42 and 4.26% for the fourth level, respectively. The number of GTSs was associated with lower 30-day and hospital mortality rates (P < 0.0001). On logistic analysis, number of GTSs (<3 vs ≥3), hospital volume (<50 vs ≥50) and level of procedure (1 vs 2, 3 vs 2, 4 vs 2) were significantly associated with 30-day and hospital mortality rates. For 30-day mortality, the odds ratios were 0.688 (P < 0.0001) for higher number of GTSs and 0.856 (P = 0.0510) for higher volume hospitals. In the subgroup analysis by surgical level, low 30-day and hospital mortality rates in the second and fourth surgical levels were correlated with a higher number of GTSs. The current decrease in overall 30-day mortality rates from the JATS data showed greater dependence on the number of GTSs than on the hospital volume. We believe that the certification system in Japan is useful for the establishment of GTS status.

Famotidine Use Is Not Associated With 30-day Mortality: A Coarsened Exact Match Study in 7158 Hospitalized Patients With Coronavirus Disease 2019 From a Large Healthcare System

Clinical characteristics and outcomes of 56 patients with pneumonia caused by carbapenem-resistant Klebsiella pneumoniae

Whether appropriate monotherapy or combination therapy is more effective for carbapenem-resistant gram-negative bacilli bloodstream infections (CRGNB-BSI) is still a matter of debate. This multicenter retrospective study included CRGNB-BSI patients who received either appropriate monotherapy (only one active agent) or combination therapy (at least two active agents). The primary outcome was 28-day all-cause mortality, while the secondary outcome was 14-day clinical cure. Inverse probability of treatment weighting (IPTW) was used to adjust confounding factors for the choice of therapeutic strategies. Multivariable regression analysis was performed in the IPTW cohort. Of 237 patients included, 155 received appropriate monotherapy and 82 received combination therapy. The overall 28-day mortality was 40% (94/237), with no significant difference between the combination group (37%, 30/82) and the monotherapy group (41%, 64/155; P = 0.479). In multivariable analysis of the IPTW cohort, combination therapy was not associated with reduced 28-day mortality (aHR 0.65; 95% CI, 0.40-1.07; P = 0.088) or increased 14-day clinical cure rate (aOR 1.04; 95% CI, 0.71-1.51; P = 0.855). Subgroup analyses demonstrated significant 28-day survival benefits of combination therapy among patients who received early appropriate treatment (started within 48 hours after infection), those with septic shock, and those treated with regimens including tetracycline or polymyxin B (P < 0.01). In patients with CRGNB-BSI, appropriate combination therapy was not associated with improved overall survival compared to monotherapy. However, it may offer survival benefits when initiated early, in patients with septic shock, and when regimens include tetracyclines or polymyxin B.IMPORTANCECarbapenem-resistant gram-negative bacilli bloodstream infections remain a critical therapeutic challenge with high mortality and few effective options. In a real-world, multicenter cohort using inverse probability weighting to control for confounding, we found no overall benefit of appropriate combination therapy versus monotherapy in survival or early clinical cure. However, combination therapy was associated with improved 28-day survival in specific contexts: when initiated within 48 hours, in patients with septic shock, and when regimens included tetracyclines or polymyxin B. These findings highlight the importance of timely, targeted combination therapy for selected high-risk patients, while supporting judicious monotherapy use otherwise.

中文摘要 目的： 評估不同抗生素對於超廣效乙內醯胺酶克雷白氏肺炎桿菌所引起之菌血症的治療結果，並辨別導致病人死亡的危險因子以供臨床治療參考。 設計： 單中心、回溯性病歷回顧分析研究 地點： 國立台灣大學醫學院附設醫院─台灣北部ㄧ家醫學中心 對象： 於西元2002年4月1日至2006年12月31日期間，感染超廣效乙內醯胺酶克雷白氏肺炎桿菌菌血症之成年病患 方法： 藉由病歷回顧的方式收集病人的基本資料與臨床相關數據。臨床資料以時間作為區分，記錄菌血症發作前、中、後病人所有的合併症、移生菌種或相關感染症、醫療處置、臨床表徵、併發症以及抗生素治療 (包含經驗療法與確切治療)等等資料，並以菌血症發作後30天的死亡率作為觀察終點，進行資料統計分析比較。統計分析包括單變數分析及多變數羅吉斯迴歸分析，尋找可能導致死亡的危險因子以及不同抗生素治療是否影響病人的預後情形。 結果： 研究期間共收入104名病人，其中99人為院內感染菌血症 (95.2%)，感染單菌種菌血症的病患有67人 (64.4%)。整體死亡率為28.8%，單菌種菌血症病患之死亡率為29.9%。分析抗生素治療的結果則發現經驗療法使用適當的抗生素治療對於死亡率具有趨於顯著的差異 (P值 0.055)，而確切治療的適當與否對於病人死亡率的影響並沒有差異 (P值0.342)。而以carbapenem與非carbapenem治療組相比較，則發現30天死亡率不具有顯著差異 (P值0.668)。然而，死亡病人與存活病人之間的比較發現其疾病嚴重程度具有顯著差異 ( APACHEⅡscore 26.6±8.3 vs. 19.8±8.5，P值0.001；Pitt bacteremia score 4.8±2.8 vs. 2.9±2.6，P值0.001)。單變數分析的結果顯示與死亡有關的因子包括有嗜中性白血球減少症 (勝算比4.73，P值0.043)、先前接受免疫抑制治療 (特別是類固醇的使用，勝算比9.20，P值0.001)、APACHEⅡscore≧17 (勝算比4.19，P值0.010)、Pitt bacteremia score≧4 (勝算比3.01，P值0.013)、可能感染來源為呼吸道 (勝算比11.38，P值0.002)、敗血性休克 (勝算比6.79，P值0.001) 以及在菌血症發作前有較長的住院時間 (P=0.024)。而多變數羅吉斯迴歸分析的結果則顯示，與病人在ESBL-KP菌血症發作後30天內死亡有關的獨立因子為敗血性休克 (勝算比11.89，P值<0.001)、可能的感染來源為呼吸道 (勝算比9.96，P值0.035)、先前使用免疫抑制治療 (勝算比9.65，P值<0.001)以及經驗療法的適當抗生素使用 (勝算比0.20，P值0.014)。單菌種菌血症病人經單變數分析所得到的結果與全部病人的分析結果相似，由多變數羅吉斯迴歸分析也顯示敗血性休克 (勝算比20.14，P值<0.001)、先前使用免疫抑制治療 (勝算比24.77，P值0.001) 以及經驗療法的適當抗生素使用 (勝算比0.09，P值0.012)等是單菌種菌血症病人死亡的獨立因子。 結論： 經驗療法使用適當抗生素治療的ESBL-KP菌血症病患有較低的死亡率，而確切治療使用的抗生素療法對於病人30天的死亡率並無顯著影響。除了治療之外，病人本身的狀況如疾病嚴重程度 (如敗血性休克) 與先前接受免疫抑制治療對病人於ESBL-KP菌血症發作後30天的死亡率也具有顯著影響。

Extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae isolates are important clinical pathogens. In addition, the efficacy of cefepime for such infections is controversial. We performed a retrospective study of monomicrobial bacteremia caused by ESBL producers at 2 medical centers between May 2002 and August 2007. The patients definitively treated with in vitro active cefepime (cases) were compared with those treated with a carbapenem (controls) in a propensity score-matched analysis to assess therapeutic effectiveness. The 30-day crude mortality is the primary endpoint. A total of 178 patients were eligible for the study. Patients who received cefepime (n = 17) as definitive therapy were more likely to have a clinical failure (odds ratio [OR] 6.2; 95% confidence interval [CI], 1.7-22.5; P = .002), microbiological failure (OR 5.5; 95% CI, 1.3-25.6; P = .04), and 30-day mortality (OR 7.1; 95% CI, 2.5-20.3; P < .001) than those who received carbapenem therapy (n = 161). Multivariate regression revealed that a critical illness with a Pitt bacteremia score ≥ 4 points (OR 5.4; 95% CI, 1.4-20.9; P = .016), a rapidly fatal underlying disease (OR 4.4; 95% CI, 1.5-12.6; P = .006), and definitive cefepime therapy (OR 9.9; 95% CI, 2.8-31.9; P < .001) were independently associated with 30-day crude mortality. There were 17 case-control pairs in the propensity scores matched analysis. The survival analysis consistently found that individuals who received cefepime therapy had a lower survival rate (log-rank test, P = .016). Based on the current Clinical and Laboratory Standards Institute susceptible breakpoint of cefepime (minimum inhibitory concentration ≤ 8 μg/mL), cefepime definitive therapy is inferior to carbapenem therapy in treating patients with so-called cefepime-susceptible ESBL-producer bacteremia.

研究背景： 萬古黴素抗藥性Enterococcus faecium（vancomycin-resistant Enterococcus faecium，VREfm）菌血症之感染在近年來有上升的趨勢，而且臨床上能夠治療VREfm菌血症的藥物相當有限，因此在治療上格外地困難，然而目前對於VREfm菌血症之藥物治療結果以及病人預後相關之研究卻不多。 研究目的： 評估抗vancomycin-resistant enterococci（VRE）藥物之使用對於VREfm菌血症病人預後之影響，並進一步分析不同的抗生素對於VREfm菌血症之治療結果；另外也會分析VREfm菌血症發作後第30天之死亡危險因子。 研究設計、地點、對象： 本研究為單醫學中心之回溯性病歷分析，於國立臺灣大學醫學院附設醫院進行研究。研究對象為西元2009年1月1日至2010年12月31日感染VREfm菌血症之病人，只納入第一次感染事件，並排除年齡小於18歲及病歷資料不全者。 研究方法： 以紙本與電子病歷收集相關資料，包含病人基本資料、潛在疾病與造成菌血症感染之潛在因子、臨床表徵與相關檢驗數值、細菌培養結果、菌血症發作後之抗生素治療、後續追蹤與治療結果。本研究之主要觀察終點為菌血症發作後第30天之死亡率，並且利用單變項分析與多變項羅吉斯迴歸分析死亡危險因子以及抗生素治療對於病人預後之影響。 研究結果： 本研究共收入94位感染VREfm菌血症之成年病人，有93位（98.9%）病人為院內感染，有43位（45.7%）為單一菌種感染。全體病人之平均年齡為60.9±17.1歲，有57.4%為男性。在潛在疾病方面，以惡性腫瘤（62.8%）比例最高，其次為心血管疾病（55.3%）。在菌血症發作時，40.4%有敗血性休克，平均APACHE II score為 22.9±8.9。菌血症發作後第30天之死亡率在全體病人為55.3%，在單一菌種感染者則為48.8%。 在單一菌種感染方面，抗VRE藥物之使用對於其第30天之死亡率無顯著影響（P值0.67），而進一步分析不同抗生素之治療結果發現，linezolid組和daptomycin組在第30 天之死亡率也沒有達統計上顯著之差異（57.1% vs. 35.7%，P值0.26）。 在多變項羅吉斯迴歸分析中，全體病人於菌血症發作後第30天死亡之危險因子包含Charlson’s comorbidity index（勝算比1.47；95%信賴區間為1.12-1.93；P值0.006）、敗血性休克（勝算比3.13；95%信賴區間為1.08-9.05；P值0.0035）、APACHE II score≧23分（勝算比6.52；95%信賴區間為2.35-18.12；P值0.0003），而使用抗VRE藥物對於第30天之死亡率沒有影響（勝算比1.09；95%信賴區間為0.37-3.24；P值0.88）；單一菌種感染者於菌血症發作後第30天死亡之危險因子只有APACHE II score≧23分（勝算比14.15；95%信賴區間為2.63-75.98；P值0.002），但是Charlson’s comorbidity index較高者有較高之趨勢會死亡，雖然未達統計上之顯著差異（勝算比1.53；95%信賴區間為0.96-2.44；P值0.07），而抗VRE藥物之使用對於第30天之死亡也沒有顯著之影響（勝算比1.19；95%信賴區間為0.21-6.92；P值0.84）。 結論： 從全體病人或是單一菌種感染者的多變項分析結果顯示，病人於VREfm菌血症發作時之合併症以及疾病嚴重程度才是影響病人於菌血症發作後第30天死亡之危險因子，而使用抗VRE藥物治療VREfm菌血症並無法改善病人之預後。

To determine the predictors of mortality within 30days of hospital admission in a diarrhoeal disease hospital in Bangladesh. Cohort study of hospitalised children aged 0-59months with severe acute malnutrition (SAM) and severe pneumonia in Dhaka Hospital, icddr,b, Bangladesh from April 2015 to March 2017. Those discharged were followed up, and survival status at 30days from admission was determined. Children who died were compared with the survivors in terms of clinical and laboratory biomarkers. Multivariable logistic regression analysis was used for calculating adjusted odds ratio for death within 30days of hospital admission. We enrolled 191 children. Mortality within 30days of admission was 6% (14/191). After adjusting for potential confounders (hypoxia, CRP and haematocrit) in logistic regression analysis, independent factors associated with death were female sex (aOR=5.80, 95% CI: 1.34-25.19), LAZ <-4 (aOR=6.51, 95% CI: 1.49-28.44) and Polymorphonuclear Leucocytes (PMNL) (>6.0×109 /L) (aOR=1.06, 95% CI: 1.01-1.11). Using sex, Z-score for length for age (LAZ), and PMNL percentage, we used random forest and linear regression models to achieve a cross-validated AUC of 0.83 (95% CI: 0.82, 0.84) for prediction of 30-day mortality. The results of our data suggest that female sex, severe malnutrition (<-4 LAZ) and higher PMNL percentage were prone to be associated with 30-day mortality in children with severe pneumonia. Association of these factors may be used in clinical decision support for prompt identification and appropriate management for prevention of mortality in this population.