Mortality after inpatient treatment for diarrhea in children: a cohort study
Mortality after inpatient treatment for diarrhea in children: a cohort study
复制标题
DOI：
10.1186/s12916-019-1258-0
复制
发表时间：
2019-01-28
期刊：
影响因子：
9.3
通讯作者：
Berkley, James A.
中科院分区：
文献类型：
--
作者：
Talbert, Alison;Ngari, Moses;Berkley, James A.
背景人们越来越认识到，资源匮乏地区的儿童从卫生机构出院后死亡的风险仍然较高。腹泻以前被强调为出院后死亡的危险因素。方法进行了一项回顾性队列研究，以评估 2007 年至 2015 年基利菲县医院因腹泻入院且为基利菲健康中心居民的 2-59 个月儿童的发病率以及与住院患者和出院 1 年死亡率相关的人口统计学、临床和生化特征。 和人口统计监测系统（KHDSS）。对数二项式回归用于确定住院患者死亡的危险因素。面临风险的时间是从出院之日到死亡、迁出之日或 365 天后。按每 1000 个观察儿童年计算出院后死亡率，并使用 Cox 比例回归来确定死亡的危险因素。 结果 KHDSS 居民中有 2626 名儿童因腹泻入院，中位年龄 13（IQR 8-21）个月，其中 415 名（16%）严重营养不良，130 名（5.0%）HIV 检测呈阳性。 121 人 (4.6%) 在医院死亡，2505 名活着出院的儿童中，49 人 (2.1%) 出院后死亡：每 1000 名儿童年有 21.4 人死亡 (95% CI 16.1-28.3)。入院时同时出现腹泻和严重肺炎症状或仅出现严重肺炎症状的住院患者和出院后死亡率均高于仅因腹泻入院的风险。仅因腹泻入院的儿童与除严重肺炎外其他诊断的儿童之间，住院死亡率和出院后死亡率没有显着差异。 HIV、低中上臂围 (MUAC) 和菌血症与住院患者和出院后死亡率相关。循环障碍、败血症和电解质异常的症状与住院患者死亡率相关，但与出院后死亡率无关。既往入院和下胸壁内缩与出院后死亡率相关，但与住院死亡率无关。年龄、发育迟缓和持续性或血性腹泻与出院前后的死亡率无关。结论我们的结果强调需要进行研究来改善营养不良和艾滋病毒服务的采用和结果，并阐明因果途径和测试干预措施以减轻这些风险。
BackgroundThere is an increasing recognition that children remain at elevated risk of death following discharge from health facilities in resource-poor settings. Diarrhea has previously been highlighted as a risk factor for post-discharge mortality.MethodsA retrospective cohort study was conducted to estimate the incidence and demographic, clinical, and biochemical features associated with inpatient and 1-year post-discharge mortality amongst children aged 2-59months admitted with diarrhea from 2007 to 2015 at Kilifi County Hospital and who were residents of Kilifi Health and Demographic Surveillance System (KHDSS). Log-binomial regression was used to identify risk factors for inpatient mortality. Time at risk was from the date of discharge to the date of death, out-migration, or 365days later. Post-discharge mortality rate was computed per 1000 child-years of observation, and Cox proportion regression used to identify risk factors for mortality.ResultsTwo thousand six hundred twenty-six child KHDSS residents were admitted with diarrhea, median age 13 (IQR 8-21) months, of which 415 (16%) were severely malnourished and 130 (5.0%) had a positive HIV test. One hundred twenty-one (4.6%) died in the hospital, and of 2505 children discharged alive, 49 (2.1%) died after discharge: 21.4 (95% CI 16.1-28.3) deaths per 1000 child-years. Admission with signs of both diarrhea and severe pneumonia or severe pneumonia alone had a higher risk of both inpatient and post-discharge mortality than admission for diarrhea alone. There was no significant difference in inpatient and post-discharge mortality between children admitted with diarrhea alone and those with other diagnoses excluding severe pneumonia. HIV, low mid-upper arm circumference (MUAC), and bacteremia were associated with both inpatient and post-discharge mortality. Signs of circulatory impairment, sepsis, and abnormal electrolytes were associated with inpatient but not post-discharge mortality. Prior admission and lower chest wall indrawing were associated with post-discharge mortality but not inpatient mortality. Age, stuntedness, and persistent or bloody diarrhea were not associated with mortality before or after discharge.ConclusionsOur results accentuate the need for research to improve the uptake and outcomes of services for malnutrition and HIV as well as to elucidate causal pathways and test interventions to mitigate these risks.