Original Research Article
Year: 2019 | Month: May | Volume: 9 | Issue: 5 | Pages: 87-92
Prognostic Factors and Clinical Outcome in Children Hospitalized with Severe Lower Respiratory Tract Infection: A Nested Case Control Study
Pallavi Agarwal1, A. K. Niswade2
1Junior Resident, 2Professor,
Department of Pediatrics, Government Medical College, Nagpur, India
Corresponding Author: Pallavi Agarwal
ABSTRACT
Introduction: Severe LRTI is one of the leading causes of death in children especially below the age of 5 years. Hyponatremia is the most common electrolyte disturbance occurring in such patients. This study aims to explain the impact of hyponatremia on the course of disease and explore other associated risk factors which may worsen the clinical outcome.
Materials and methods: A nested case control study was conducted at a tertiary care hospital for a period of 2 years. Study comprised of 150 children aged 1 month to 5 years. The subjects were divided into cases and controls based upon presence or absence of hyponatremia. Continuous variable (age) was presented as Mean± SD. Other variables (Gender, TLC, CRP, Hypoglycemia, Acidosis) were expressed in numbers and percentages. Categorical variables (duration of hospital stay, need for mechanical ventilation and mortality) were compared between cases and controls using Pearson’s Chi square test.
Results: Hyponatremia in severe LRTI was inversely proportional to the duration of hospital stay. There was a statistically significant increase in the rate of mechanical ventilation (odds ratio-3.03 with 95%CI of 1.44-6.42 and p value-0.0014) and mortality (odds ratio-3.03 with 95%CI of 1.44-6.42 and p value-0.001) in patients having hyponatremia. In univariate analysis, SAM, hypoglycemia and acidosis were found to be poor prognostic markers. However, in multivariate analysis, SAM and hypoglycemia emerged as independent risk factors. A change in microbiological profile was also reported.
Conclusion: Regular estimation of electrolytes is necessary to guide appropriate fluid and electrolyte management in severe LRTI. Presence of SAM and hypoglycemia in severe LRTI is predictor of worsened outcomes, hence needs to be addressed with caution. The changing trend of infectious organisms and increasing antibiotic resistance highlights the importance of judicious use of antibiotics.
Key words: LRTI (lower respiratory tract infection), TLC (total leukocyte count), CRP (C-reactive protein), SAM (severe acute malnutrition)