title: Mortality, length of stay, bloodstream and respiratory viral infections in a pediatric intensive care unit.
abstract: We investigated whether diagnostic categories and presence of infections were associated with increased mortality or length of stay (LOS) in patients admitted to a pediatric intensive care unit (PICU).
  
  
  
  A retrospective study of all PICU admissions between October 2002 and April 2016 was performed. Oncologic vs nononcologic, trauma/injuries vs nontraumatic, infectious (gram-positive, gram-negative, fungal bloodstream infections, common respiratory viruses) vs noninfectious diagnoses were evaluated for survival and LOS.
  
  
  
  Pediatric intensive care unit admissions (n = 2211) were associated with a mortality of 5.3%. Backward binary logistic regression showed that nonsurvival was associated with leukemia (odds ratio [OR], 4.81; 95% confidence interval [CI], 2.2-10.10; P < .0005), lymphoma (OR, 21.34; 95% CI, 3.89-117.16; P < .0005), carditis/myocarditis (OR, 7.91; 95% CI, 1.98-31.54; P = .003), encephalitis (OR, 6.93; 95% CI, 3.27-14.67; P < .0005), bloodstream infections with gram-positive organisms (OR, 5.32; 95% CI, 2.67-10.60; P < .0005), gram-negative organisms (OR, 8.23; 95% CI, 4.10-16.53; P < .0005), fungi (OR, 3.93; 95% CI, 1.07-14.42; P = .039), and pneumococcal disease (OR, 3.26; 95% CI, 1.21-8.75; P = .019). Stepwise linear regression revealed that LOS of survivors was associated with bloodstream gram-positive infection (B = 98.2; 95% CI, 75.7-120.7; P < .0005).
  
  
  
  Patients with diagnoses of leukemia, lymphoma, cardiomyopathy/myocarditits, encephalitis, and comorbidity of bloodstream infections and pneumococcal disease were significantly at risk of PICU mortality. Length of stay of survivors was associated with bloodstream gram-positive infection. The highest odds for death were among patients with leukemia/lymphoma and bloodstream coinfection. As early diagnosis of these childhood malignancies is desirable but not always possible, adequate and early antimicrobial coverage for gram-positive and gram-negative bacteria might be the only feasible option to reduce PICU mortality in these patients. In Hong Kong, a subtropical Asian city, none of the common respiratory viruses were associated with increased mortality or LOS in PICU.
authors.affiliation: Department of Paediatrics, The Chinese University of Hong Kong. Electronic address: ehon@hotmail.com.
authors.forename: Kam Lun
authors.initials: KL
authors.lastname: Hon
authors.affiliation: Medical students, Faculty of Medicine, The Chinese University of Hong Kong.
authors.forename: Man Ping
authors.initials: MP
authors.lastname: Luk
authors.affiliation: Medical students, Faculty of Medicine, The Chinese University of Hong Kong.
authors.forename: Wing Ming
authors.initials: WM
authors.lastname: Fung
authors.affiliation: Medical students, Faculty of Medicine, The Chinese University of Hong Kong.
authors.forename: Cho Ying
authors.initials: CY
authors.lastname: Li
authors.affiliation: Medical students, Faculty of Medicine, The Chinese University of Hong Kong.
authors.forename: Hiu Lee
authors.initials: HL
authors.lastname: Yeung
authors.affiliation: Medical students, Faculty of Medicine, The Chinese University of Hong Kong.
authors.forename: Pui Kwun
authors.initials: PK
authors.lastname: Liu
authors.affiliation: Medical students, Faculty of Medicine, The Chinese University of Hong Kong.
authors.forename: Shun
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Paediatrics, The Chinese University of Hong Kong.
authors.forename: Kathy Yin Ching
authors.initials: KY
authors.lastname: Tsang
authors.affiliation: Department of Paediatrics, The Chinese University of Hong Kong.
authors.forename: Chi Kong
authors.initials: CK
authors.lastname: Li
authors.affiliation: Department of Microbiology, Th Chinese University of Hong Kong.
authors.forename: Paul Kay Sheung
authors.initials: PK
authors.lastname: Chan
authors.affiliation: Department of Paediatrics, The Chinese University of Hong Kong.
authors.forename: Kam Lau
authors.initials: KL
authors.lastname: Cheung
authors.affiliation: Department of Paediatrics, The Chinese University of Hong Kong.
authors.forename: Ting Fan
authors.initials: TF
authors.lastname: Leung
authors.affiliation: Department of Paediatrics, National University Hospital, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.
authors.forename: Pei Lin
authors.initials: PL
authors.lastname: Koh
mesh_terms: D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D012141:Respiratory Tract Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D016019:Survival Analysis
keywords: Asthma; Bacterial coinfection; Leukemia; Lymphoma; Pediatric intensive care; Respiratory virus