Andrea Marroquin, LEN
Research Scholar
Texas Children's Hospital and Baylor College of Medicine, Texas, United States
Disclosure information not submitted.
Ian Justement
Baylor College of Medicine Texas Children's Hospital
Houston, Texas
Disclosure information not submitted.
Yash Desai, NA
Student
Texas Children's Hospital and Baylor College of Medicine, Texas, United States
Disclosure information not submitted.
Jaime Silva-Gburek, MD
Instructor
Texas Children's Hospital and Baylor College of Medicine, Texas, United States
Disclosure information not submitted.
Thomas Fogarty, III, MD
Assistant Professor
Texas Children's Hospital and Baylor College of Medicine
Houston, Texas, United States
Disclosure information not submitted.
Lara Shekerdemian, FRACP, FCICM
Chief Pediatric Intensive Care
Baylor College of Medicine Texas Children's Hospital
Houston, Texas
Disclosure information not submitted.
Jorge Coss-Bu, MD
Professor of Pediatrics, Division of Pediatric Critical Care Medicine
Baylor College of Medicine/ Texas Children's Hospital, Texas, United States
Disclosure information not submitted.
Title: Organ dysfunction in stunted children admitted to PICU is a predictor of worse outcomes.
Introduction: Chronic malnutrition or stunting is common in critically ill children admitted to the pediatric intensive care unit (PICU). Additionally, the Pediatric Sequential Organ Failure Assessment (pSOFA) scoring system has been shown to be useful in predicting outcome in critically ill children. The aim was to assess nutritional status and organ dysfunction on children on admission to the PICU and their association with outcome.
Methods: Retrospective study of children admitted (index) to the PICU at Texas Children's Hospital (01/16-12/17) with a length of stay (LOS) in PICU ≥3 days. Malnutrition (MAL) was defined as height for age (HFA) z-scores < -2 by WHO and CDC. Duration of mechanical ventilation (MV), hospital and PICU LOS, risk of mortality (ROM) by PIM2, and mortality collected. Organ dysfunction (OD) was defined as a pSOFA score >5 and collected on days 1&3. Results &
Conclusions: 1283 children (729 M/554 F) were included; median age 2.83 yr. (0.62-10; 25-75th IQR). MV of 143 hr. (80-249); PIM2 ROM (%) 3.1 (0.87-4.5); PICU LOS, 6.7 (4.4-11); hospital LOS, 18 (10-33); pSOFA score on day 1&3 of 5 (4-7) and 5 (3-7) (p< 0.0001, Wilcoxon Ranked Test) for a prevalence of OD of 65.7% and 56.8% respectively. HFA z-score of -0.90±2.03, for a MAL prevalence of 25.4% and mortality was 6.9%. Patients with MAL (n=97) vs. patients with OD (n=614) vs. patients with MAL and OD (n=229) vs. patients without MAL or OD (n=343) had: MV hr. 161 (92-258) vs. 146 (80-250) vs. 147 (84-315) vs. 122 (72-208) (p=0.0375); PICU LOS, 7 days (5-11) vs. 7 (5-12) vs. 8 (5-13) vs. 6 (4-9) (p< 0.0001); hospital LOS, 21 days (12-47) vs. 18 (10-35) vs. 21 (12-43) vs. 15 (10-24) (p< 0.0001); and mortality was 4.1% vs. 10.6% vs. 7.4% vs. 0.88% (x2, p< 0.0001). On day 3, children with MAL had OD in 65% vs 35% without MAL. Stunting was associated with OD on day 1, odds ratios (OR) (95% CI) 1.32 (1.01-1.73) (p< 0.05). Mortality was associated with OD on day 1; OR 6.67 (3 -14) (p< 0.0001), but not with MAL; OR 0.890 (0.54-1.49) (p=0.6838). Organ dysfunction and stunting were common in children admitted to the PICU. Children with malnutrition and organ dysfunction had longer MV, PICU and hospital length of stay. Stunted children were more likely to have organ dysfunction. Mortality was associated with organ dysfunction but not with malnutrition