Predictors of mortality in subjects hospitalized with acute lower respiratory tract infections.
OBJECTIVE
To identify the predictors of mortality due to acute lower respiratory tract infection (ALRI).


METHODS
Prospective cohort study.


METHODS
Urban tertiary care teaching hospital.


METHODS
201 cases with ALRI between 2 weeks to 5 years of age were prospectively enrolled and followed up to determine outcome. Detailed history and clinical evaluation were recorded on a pretested proforma. Significant independent predictors of mortality were determined by comparison of dead subjects (n = 21) with surviving children (n = 180) in a multiple logistic analytic framework.


RESULTS
The case fatality rate (CFR) was 10.45%. Significant independent predictors of mortality were (OR, 95% CI) age less than 1 year (23.1, 2.7-197.5), inability to feed (6.2, 1.3-30.7), associated loose stools (5.1,1.2-27.3), weight for age Z score < -3 (3.9,1.01-9.7), short duration of fever (1.2,1.0-1.5) and bandemia (1.1,1.05-1.2). The WHO guidelines identified 91% of children diagnosed as ALRI by clinical and investigative criteria. The CFR was related to severity of WHO classification ("pneumonia"-0%, "severe pneumonia"-8.7% and "very severe pneumonia"-47.0%). However, 2 of the 18 subjects with a diagnosis of "no pneumonia" expired (CFR 11.1% and 10% of total mortality).


CONCLUSIONS
Even in settings of high case fatality, predictors of mortality can be identified in under five children suffering from ALRI. In this context, age below 1 year, inability to feed, presence of loose stools and severe malnutrition merit attention for interventional purposes.
Sehgal
V
V
Department of Pediatrics, Maulana Azad Medical College, New Delhi.
Sethi
G R
GR
Sachdev
H P
HP
Satyanarayana
L
L
D017677:Age Distribution; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D003906:Developing Countries; D005069:Evaluation Studies as Topic; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016017:Odds Ratio; D011014:Pneumonia / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors; D015996:Survival Rate