Assessing Predictors of Mortality Among Children admitted with Sepsis at a Referral Tertiary Health Center, Northwestern Nigeria

Abstract

Background Sepsis is a life-threatening infection that can lead to organ failure and death. We aim to assess predictors of mortality among children admitted with Septicemia at a referral health facility in Northwestern Nigeria. Methods We conducted a prospective cross-sectional study of children aged 0-14 years admitted to various units of the pediatrics department of the health facilities. Children were recruited between September 2018 and November 2019. All recruited children were followed up on clinical progress until either discharge, abscondment, or death. We assessed the children clinically daily and collected whole-blood samples for laboratory tests. We conducted a univariate and multivariable analysis using STATA-16 to assess identified predictive factors with our outcome variable. Results A total of 326 children were recruited, median age: 2-years. About 54.0% of the children were boys, and 53.1% were within 1-5 years age-group. Predominant organisms cultured from the blood of the children were Salmonella typhi (5.7%), Klebsiella pneumoniae (2.3%), and Staphylococcus aureus (2.0%). A total of 35 deaths were recorded with a case fatality rate (CFR) of 10.7%. CFR is highest in children <1years (13.6%). Child’s vaccination status, mother’s education level as well as blood lactate levels, GCS, qSOFA score and positive blood culture were significantly associated with child’s mortality. Factors associated with increase mortality include; children with incomplete vaccination history [OR=1.72, 95%CI: 2.74–15.53] versus those with full vaccination; children whose mothers had no formal education [OR=14.39, 95%CI: 3.24–63.99] when compared to those children whose mothers have tertiary level of education. Furthermore, children with whole blood lactate level between 4-8mmol/l [OR=3.23, 95%CI: 1.15–9.07], or greater than 8mmol/l [OR=10.54, 95%CI: 3.68–30.14] versus children with whole blood lactate level less than 4mmol/l; children with qSOFA score of 3 [OR=15.62, 95%CI: 3.31–73.60] versus children with qSOFA score of 1; and children who had a positive blood culture [OR=6.90, 95%CI: 3.04–15.64]. Conclusion We found a high prevalence of severe sepsis at pediatrics department of AKTH. Serum lactate levels, GCS, and qSOFA scores were predictive of mortality. Routine measurement and monitoring of these parameters will improve case management and reduce sepsis related mortality in the hospital.