Clinical Characteristics and Factors Associated with Mortality Among Children with Sepsis Admitted to Pediatric ICU at Muhimbili National Hospital in Dar es Salaam, Tanzania

Abstract

Background Sepsis is a global burden in the pediatric population with high morbidity and mortality. Clinical characteristics and factors associated with mortality at ICU in our settings are not well documented, hence posing more challenges in its management. This study aimed to assess the clinical characteristics and factors associated with mortality among children with sepsis admitted to the pediatric intensive care unit at Muhimbili National Hospital. Methodology: A cross-sectional study with longitudinal follow-up was conducted among children with suspected/proven sepsis admitted to the PICU at Muhimbili National Hospital, Tanzania from July 2022 to January 2023. The diagnosis of sepsis was made within 24 hours of admission after screening using SIRS criteria and thorough clinical examination. Clinical and laboratory characteristics were recorded from hospital software and patient clinical notes. Assessment of the outcome (survival or death) was done on day 10 post-admission. Data were analyzed using SPSS version 23. Chi-square or Fisher’s exact test was used to assess the association between categorical variables and mortality. Poisson regression was used for multivariate analysis of factors associated with mortality. A p-value of ≤ 0.05 was considered statistically significant. Results A total of 160 children with suspected or proven sepsis were included in the study, male to female ratio was 1:1. with a median age of 1 year (IQR = 1–14). The respiratory system was the most common focus of infection. The majority of children had sepsis with associated organ dysfunction with respiratory failure being the most common type. Of the study participants, 43.8% had positive culture growth, and the common isolate was Staphylococcus aureus. Death occurred in more than one–third of study participants within ten days of ICU admission. Septic shock and the need for inotropes were associated with an increase in mortality while positive culture growth was associated with a reduced mortality. Conclusion Sepsis is a major health challenge among children in the pediatric intensive care unit. Early recognition, prompt management, prevention of septic shock, and optimizing care are crucial in reducing mortality. Prompt identification and targeted treatment of the causative organism may improve outcomes for children with sepsis.