Lethality by pneumonia and factors associated to death

• Published in: Jornal de pediatria 2014-01, Vol.90 (1), p.92-97
• Main Authors: Ferreira, Sidnei, Sant’Anna, Clemax C., March, Maria de Fátima B.P., Santos, Marilene Augusta R.C., Cunha, Antonio Jose Ledo A.
• Format: Article
• Language: English
• Subjects: Brazil - epidemiology; Case-fatality rate; Child; Child, Preschool; Community-Acquired Infections - drug therapy; Community-Acquired Infections - epidemiology; Community-Acquired Infections - mortality; Female; Hospitais pediatricos; Hospitais pediátricos; Hospital Mortality; Hospitalization - statistics & numerical data; Humans; Infant; Inpatients; Letalidade; Logistic Models; Longitudinal Studies; Male; Multivariate Analysis; Pacientes internados; Pediatric hospitals; PEDIATRICS; Penicilina G; Penicillin G; Penicillin G - therapeutic use; Pneumococcal pneumonia; Pneumonia - drug therapy; Pneumonia - epidemiology; Pneumonia - mortality; Pneumonia pneumococica; Pneumonia pneumocócica; Prospective Studies; Risk Factors
• ISSN: 0021-7557; 1678-4782; 1678-4782
• DOI: 10.1016/j.jped.2013.05.008

to describe the case-fatality rate (CFR) and risk factors of death in children with community-acquired acute pneumonia (CAP) in a pediatric university hospital. a longitudinal study was developed with prospective data collected from 1996 to 2011. Patients aged 1 month to 12 years were included in the study. Those who left the hospital against medical orders and those transferred to ICU or other units were excluded. Demographic and clinical-etiological characteristics and the initial treatment were studied. Variables associated to death were determined by bivariate and multivariate analysis using logistic regression. a total of 871 patients were selected, of whom 11 were excluded; thus 860 children were included in the study. There were 26 deaths, with a CFR of 3%; in 58.7% of these, penicillin G was the initial treatment. Pneumococcus was the most common pathogen (50.4%). From 1996 to 2000, there were 24 deaths (93%), with a CFR of 5.8% (24/413). From 2001 to 2011, the age group of hospitalized patients was older (p = 0.03), and the number of deaths (p = 0.02) and the percentage of disease severity were lower (p = 0.06). Only disease severity remained associated to death in the multivariate analysis (OR = 3.2; 95%CI: 1.2-8.9; p = 0.02). when the 1996-2000 and 2001-2011 periods were compared, a significant reduction in CFR was observed in the latter, as well as a change in the clinical profile of the pediatric inpatients at the institute. These findings may be related to the improvement in the socio-economical status of the population. Penicillin use did not influence CFR. descrever a taxa de letalidade (TL) e os fatores de risco de óbito em crianças com pneumonia grave adquirida na comunidade (CAP) em um hospital universitário pediátrico. foi desenvolvido um estudo longitudinal com dados prospectivos coletados de 1996 a 2011. Foram incluídos no estudo pacientes com idade entre 1 mês e 12 anos de idade. Foram excluídos aqueles que deixaram o hospital desconsiderando as recomendações médicas e aqueles transferidos para UTI ou outras unidades. Foram estudadas as características demográficas, clínicas e etiológicas e o tratamento inicial. As variáveis associadas a óbito foram determinadas por análise bivariada e multivariada utilizando regressão logística. foi selecionado um total de 871 pacientes, dos quais 11 foram excluídos; assim, foram incluídas no estudo 860 crianças. Houve 26 óbitos, com uma TL de 3%; em 58,7% desses, penicilina G foi o tratamento inici