Mortality in children and adolescents with autoimmune inflammatory rheumatic diseases admitted to the pediatric intensive care unit
Authors' conclusion
SLE was the main AIIRD that required admission to the PICU. Mechanical ventilation, pneumothorax and thrombocytopenia were associated with mortality in pediatric patients with AIIRD. The PRISM III and PIM 3 scores demonstrated good calibration, while the PIM 3 score provided better discrimination ability in the prediction of mortality for pediatric AIIRD.
Study context
- Population
- Children and adolescents aged ≤ 18 years with AIIRD admitted to the pediatric intensive care unit (PICU) at the largest university-based referral center in Thailand, July 2011 to June 2021
- Participants
- 74 children122 PICU admissions
- Exposure
- Pediatric Risk of Mortality (PRISM) III vs Pediatric Index of Mortality (PIM) 3
- Outcome
- Mortality of PICU admissions; accuracy of PRISM III and PIM 3 scores to predict mortality
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
Mortality of PICU admissions
Mortality rate of PICU admissions (18 deaths; 17 systemic lupus erythematosus (SLE), 1 juvenile dermatomyositis (JDM))
14.8%
Observational data: associations, not effects.
Further findings
Factors associated with mortality
| aOR (95% CI) | P value | ||
|---|---|---|---|
| Mechanical ventilation | 24.07 (1.33–434.91) | P = 0.031 | |
| Pneumothorax | 24.08 (1.76–328.86) | P = 0.017 | |
| Thrombocytopenia | 8.34 (1.31–53.73) | P = 0.025 | |
| 0.050.21520Adjusted odds ratio (log scale) |
| Outcome | PRISM III | PIM 3 |
|---|---|---|
| Mortality prediction by PRISM III and PIM 3 scores | ||
| AUC | 0.741 (95%CI: 0.633-0.849), P = 0.001 | 0.804 (95%CI: 0.685-0.924), P < 0.001 |
| Hosmer-Lemeshow chi-square | 4.335, P = 0.826 | 7.987, P = 0.435 |
| Mortality risk increased with score | ≥ 9 | ≥ 3 |
Macrophage activation syndrome
- Admissions with MAS
- 8 (6.5%)
Main cause of admission
- Combined infection and disease flare
- 29.5%
Original publication
Mortality in children and adolescents with autoimmune inflammatory rheumatic diseases admitted to the pediatric intensive care unit. Pediatr Rheumatol Online J. Published 20 February 2025. doi:10.
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