title: Clinical risk factors of death from pneumonia in children with severe acute malnutrition in an urban critical care ward of Bangladesh.
abstract: BACKGROUND
  Risks of death are high when children with pneumonia also have severe acute malnutrition (SAM) as a co-morbidity. However, there is limited published information on risk factors of death from pneumonia in SAM children. We evaluated clinically identifiable factors associated with death in under-five children who were hospitalized for the management of pneumonia and SAM.
  
  
  METHODS
  For this unmatched case-control design, SAM children of either sex, aged 0-59 months, admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) during April 2011 to July 2012 with radiological pneumonia were studied. The SAM children with pneumonia who had fatal outcome constituted the cases (n = 35), and randomly selected SAM children with pneumonia who survived constituted controls (n = 105).
  
  
  RESULTS
  The median (inter-quartile range) age (months) was comparable among the cases and the controls [8.0 (4.9, 11.0) vs. 9.7 (5.0, 18.0); p = 0.210)]. In logistic regression analysis, after adjusting for potential confounders, such as vomiting, abnormal mental status, and systolic hypotension (<70 mm of Hg) in absence of dehydration, fatal cases of severely malnourished under-five children with pneumonia were more often hypoxemic (OR = 23.15, 95% CI = 4.38-122.42), had clinical dehydration (some/severe) (OR = 9.48, 95% CI = 2.42-37.19), abdominal distension at admission (OR = 4.41, 95% CI = 1.12-16.52), and received blood transfusion (OR = 5.50, 95% CI = 1.21-24.99) for the management of crystalloid resistant systolic hypotension.
  
  
  CONCLUSIONS
  We identified hypoxemia, clinical dehydration, and abdominal distension as the independent predictors of death in SAM children with pneumonia. SAM children with pneumonia who required blood transfusion for the management of crystalloid resistant systolic hypotension were also at risk for death. Thus, early identification and prompt management of these simple clinically recognizable predictors of death and discourage the use of blood transfusion for the management of crystalloid resistant systolic hypotension may help reduce deaths in such population.
authors.affiliation: Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh ; Dhaka Hospital, icddr,b, Dhaka, Bangladesh.
authors.forename: Mohammod Jobayer
authors.initials: MJ
authors.lastname: Chisti
authors.forename: Mohammed Abdus
authors.initials: MA
authors.lastname: Salam
authors.forename: Hasan
authors.initials: H
authors.lastname: Ashraf
authors.forename: Abu S G
authors.initials: AS
authors.lastname: Faruque
authors.forename: Pradip Kumar
authors.initials: PK
authors.lastname: Bardhan
authors.forename: Md Iqbal
authors.initials: MI
authors.lastname: Hossain
authors.forename: Abu S M S B
authors.initials: AS
authors.lastname: Shahid
authors.forename: K M
authors.initials: KM
authors.lastname: Shahunja
authors.forename: Sumon Kumar
authors.initials: SK
authors.lastname: Das
authors.forename: Gazi
authors.initials: G
authors.lastname: Imran
authors.forename: Tahmeed
authors.initials: T
authors.lastname: Ahmed
mesh_terms: D000208:Acute Disease; D001459:Bangladesh / Q000453:epidemiology; D016022:Case-Control Studies; D015362:Child Nutrition Disorders / Q000453:epidemiology*; D002675:Child, Preschool; D015897:Comorbidity; D003422:Critical Care / Q000706:statistics & numerical data*; D003967:Diarrhea / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D011014:Pneumonia / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
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