Epidemiology and Mortality Predictors for Severe Childhood Community-acquired Pneumonia in ICUs: A Case-control Study

Abstract Background: To identify the epidemiology and mortality predictors for severe childhood community-acquired pneumonia (CAP) and evaluate the influence of medications on clinical outcome in the real world.Methods: We performed a retrospective case-control study among children with severe CAP aged ≤5 years of age, separately comparing the detailed information between the in-hospital death cases and the survival cases in two different age groups. Multivariate regression model was used to figure out mortality predictors.Results: 945 children were recruited, including 604 infants and 341 young children. Overall 88 deaths occurred (9.3%). There was low adherence to guidelines in antimicrobials and carbapenems were widely served as initial empiric regimens, but the efficacy was not superior to the guidelines recommended. In multivariate analyses, very severe pneumonia (OR: 3.55; 95% CI: 1.39-9.09), lower birth weight (OR: 3.92; 95% CI: 1.50-10.23), severe underweight (OR: 4.72; 95% CI: 1.92-11.62), mechanical ventilation (OR: 5.06; 95% CI: 1.97-12.95；OR：14.43; 95% CI 3.31-62.96)，comorbidity including anemia (OR: 5.61; 95% CI: 2.36-13.35), neonatal asphyxia (OR: 6.03; 95% CI: 1.57-23.12), gastrointestinal hemorrhage (OR: 3.73; 95% CI: 1.21-11.48) and sedative-hypnotics ( OR: 4.32; 95% CI: 1.76-10.61; OR: 4.13; 95% CI：1.50-11.38) were independent risk factors for death, whereas a lower mortality was present in infants with probiotics (OR: 0.24; 95% CI: 0.10-0.54).Conclusions: Severe pneumonia remains a primary cause of death in children under 5 years of age. Clinical characteristics, comorbidity and medications are evidently associated with death. Importantly, we should pay particular attention to the identification of the mortality predictors and establish prophylactic measures to reduce the mortality.