Very severe anemia and one year mortality outcome after hospitalization in Tanzanian children: A prospective cohort study
Very severe anemia and one year mortality outcome after hospitalization in Tanzanian children: A prospective cohort study
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DOI：
10.1371/journal.pone.0214563
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发表时间：
2019-06-20
期刊：
影响因子：
3.7
通讯作者：
Peck, Robert N.
中科院分区：
文献类型：
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作者：
Chami, Neema;Hauid, Duncan K.;Peck, Robert N.
背景非洲儿童死亡率最高。我们对患有严重贫血的儿童住院后的结果知之甚少。目的确定因严重贫血住院的坦桑尼亚儿童的一年死亡率和死亡率预测因素。方法我们开展了一项前瞻性队列研究，招募了2014年8月至2014年11月在坦桑尼亚西北部两家公立医院住院的2-12岁儿童。对儿童进行贫血筛查并随访至出院后 12 个月。测量的主要结果是死亡率。使用 Cox 回归分析确定死亡率的预测因子。结果 在 505 名儿童中，90 名 (17.8%) 患有非常严重的贫血，415 名 (82.1%) 没有。与入院后未超过一年的儿童相比，患有非常严重贫血的儿童死亡率较高，分别为 27/90 (30.0%) 和 59/415 (14.2%)（风险比 (HR) 2.42，95% Cl 1.53-3.83）。严重贫血儿童的院内死亡率为 11/90 (12.2%)，出院后死亡率为 16/79 (20.2%)。死亡率最强的预测因素是年龄（HR 1.01，95% Cl 1.00-1.03）和尿量减少（HR 4.30，95% Cl 1.04-17.7）。 结论 患有严重贫血的 12 岁以下儿童入院一年后死亡的可能性接近 30%，超过 50% 的死亡发生在出院后。迫切需要采取院后干预措施来降低患有严重贫血的儿童的死亡率，并且应将年龄较大的儿童包括在内。
BackgroundAfrica has the highest rates of child mortality. Little is known about outcomes after hospitalization for children with very severe anemia.ObjectiveTo determine one year mortality and predictors of mortality in Tanzanian children hospitalized with very severe anemia.MethodsWe conducted a prospective cohort study enrolling children 2-12 years hospitalized from August 2014 to November 2014 at two public hospitals in northwestern Tanzania. Children were screened for anemia and followed until 12 months after discharge. The primary outcome measured was mortality. Predictors of mortality were determined using Cox regression analysis.ResultsOf the 505 children, 90 (17.8%) had very severe anemia and 415 (82.1%) did not. Mortality was higher for children with very severe anemia compared to children without over a one year period from admission, 27/90 (30.0%) vs. 59/415 (14.2%) respectively (Hazard Ratio (HR) 2.42, 95% Cl 1.53-3.83). In-hospital mortality was 11/90 (12.2%) and post-hospital mortality was 16/79 (20.2%) for children with very severe anemia. The strongest predictors of mortality were age (HR 1.01, 95% Cl 1.00-1.03) and decreased urine output (HR 4.30, 95% Cl 1.04-17.7).ConclusionsChildren up to 12 years of age with very severe anemia have nearly a 30% chance of mortality following admission over a one year period, with over 50% of mortality occurring after discharge. Post-hospital interventions are urgently needed to reduce mortality in children with very severe anemia, and should include older children.