Authors: Nicholas J Prince Katherine L Brown Teumzghi F Mebrahtu Roger C Parslow Mark J Peters
Publish Date: 2014/07/18
Volume: 40, Issue: 8, Pages: 1132-1139
Abstract
Admission weightforage standard deviation scores SDS were calculated for all PIC admissions March 2003–December 2011 to Great Ormond Street Hospital this is the number of standard deviations SD between a child’s weight and the UK mean weightforage Categorised into nine SDS groups standardised mortality ratios SMR and logistic regression were used to assess the relationship between weightforage at admission and riskadjusted mortalityOut of 12458 admissions mean weightforage was 104 SD below the UK reference population mean p 00001 Based on 942 deaths riskadjusted mortality was lowest in those with mildtomoderately raised weightforage SDS 05–25 and highest in children with extreme under or overweight SDS −35 and SDS +35 Logistic regression indicated that age gender ethnicity and weightforage are independent risk factors for mortality South Asian and ‘other’ ethnicities had significantly increased risk of death compared to children of white and black ethnic originThe PIC population mean weightforage is significantly lower than the UK reference mean The extremes of weightforage are overrepresented especially underweight Weightforage at admission is an independent risk factor for mortality A Ushaped association between weight and riskadjusted mortality exists with the lowest risk of death in children who are mildtomoderately overweight Future studies should determine the impact of malnutrition on riskadjusted mortality and investigate the aetiology of risk disparities with ethnicityTake home message Children admitted to PICU are underweight compared to the UK reference population and weightforage at admission is an independent risk factor for mortality Weightforage has a Ushaped relationship with mortality with the lowest risk in mildtomoderately overweight childrenPart of this data was presented at the 24th Annual Meeting of the European Society of Paediatric and Neonatal Intensive Care 12–15th June 2013 Rotterdam the Netherlands see Prince NJ Brown K Parslow RC and Peters MJ Intensive Care Med 39Suppl 1S20 2013Extremes of weightforage are common in children requiring intensive care and are likely to impact upon morbidity and mortality 1 2 Being underweight may indicate malnutrition be associated with genetic syndromes chronic conditions or represent increased energy consumption 3 4 Proteinenergy malnutrition is associated with increased mortality 5 can be complex to diagnose and is often under recognised and underestimated 6 7 Being overweight may reflect underlying disease or syndromes limited mobility or may simply represent increasing prevalence of obesity in the general population 8
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