Predictors of inpatient mortality among children hospitalized for severe acute malnutrition: a systematic review and meta-analysis
| Autor: | Andrew J. Prendergast, Rajvi Patel, Jonathan P Sturgeon, Radhini Karunaratne |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty 030231 tropical medicine Severe Acute Malnutrition Medicine (miscellaneous) malnutrition Standard score Cochrane Library inpatient Protein-Energy Malnutrition AcademicSubjects/MED00160 03 medical and health sciences AcademicSubjects/MED00060 0302 clinical medicine Internal medicine medicine Humans 030212 general & internal medicine Hospital Mortality Wasting child Inpatients Nutrition and Dietetics business.industry Infant Newborn Infant medicine.disease mortality Hospitalization Malnutrition Diarrhea Pneumonia Original Research Communications Editor's Choice SAM predictors Meta-analysis Child Preschool Female medicine.symptom business |
| Zdroj: | The American Journal of Clinical Nutrition |
| ISSN: | 1938-3207 0002-9165 |
| Popis: | Background Malnutrition underlies 45% of under-5 deaths globally. Severe acute malnutrition (SAM) is the most serious form of undernutrition, characterized by wasting with or without edema. Mortality remains high (10%–40%) among children requiring hospitalization for complicated SAM. Objectives We aimed to systematically document the factors independently associated with inpatient mortality in children with SAM. Methods Embase, Ovid MEDINE, the Cochrane Library, and clinicaltrials.gov were searched for articles published between January 2000 and January 2020, using a prespecified protocol. Eligible studies included children aged ≤59 mo hospitalized with SAM and used multivariable analysis to assess the baseline factors independently associated with inpatient mortality. Random-effects meta-analysis, stratified by the stated measure of effect, was used where >20% of studies included the same factor in analyses. Results Twenty-eight of 1432 studies fulfilled inclusion criteria: 19 studies included all children with SAM and 9 included specific subgroups of children with SAM. All 19 main studies were from 8 countries across Africa, with a median of 400 children/study. The mean inpatient mortality was 15.7% (95% CI: 10.4%, 21.0%) and HIV prevalence ranged from 2.1% to 51%. Nine factors were included in the meta-analysis, stratified by HR and OR. HIV infection (HR: 4.32; 95% CI: 2.31, 8.08), weight-for-height z score (WHZ) (OR: 0.44; 95% CI: 0.24, 0.80), diarrhea (HR: 2.84; 95% CI: 1.40, 5.75), pneumonia (HR: 1.89; 95% CI: 1.19, 3.02), presence of shock (HR: 3.67; 95% CI: 2.24, 6.03), and lack of appetite (HR: 2.16; 95% CI: 1.48, 3.16) were associated with increased mortality, whereas child age and sex were not. The association between edema and mortality was difficult to ascertain from the available studies. Conclusions HIV infection, diarrhea, pneumonia, shock, lack of appetite, and lower WHZ are independent predictors of inpatient mortality in children with SAM. These factors may help to risk-stratify children being hospitalized with complicated SAM. This systematic review/meta-analysis protocol was registered at www.crd.york.ac.uk/prospero as CRD42019152267. |
| Databáze: | OpenAIRE |
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