Predictors of mortality in children with community-acquired pneumonia admitted to paediatric intensive care units in Sri Lanka: a retrospective, multi-center cohort study

To describe the demographic, clinical, and laboratory characteristics as predictors of mortality of children with severe community-acquired pneumonia (CAP) admitted to paediatric intensive care units in Sri Lanka. We conducted a multi-center retrospective study among children with severe CAP admitted to all paediatric intensive care units (PICUs) from April 2018 to March 2020. The primary outcomes were mortality and length of PICU stay. Univariate and multivariate logistic regression analyses were used to identify the potential predictors of mortality. Records of 266 children with community-acquired pneumonia were studied. Mortality rate was 30.8%. 72% had at least one comorbidity. Mortality was higher among children < 1 year compared to children ≥ 5 years (aOR:5.69, CI:1.297,24.931, p = 0.02). Also, septic shock (aOR:12.04, CI:5.287,27.416, p < 0.001), invasive ventilation (aOR:4.92, CI: 2.34, 10.387, p < 0.001), comorbidities (aOR:7.75, CI:2.563,23.437, p < 0.001), leucopenia/leukocytosis (< 4 or > 15 × 109) (aOR:2.16, CI:1.030,4.531, p = 0.04) and multilobar involvement (aOR:3.44, CI:1.128,10.470, p = 0.03) increased the risk of mortality. The effect size was highest in cases involving septic shock unresponsive to fluid boluses and the presence of one or more comorbid conditions, as identified through regression analysis. The mortality rate among children with community-acquired pneumonia was high in this study population. Younger age, the need for invasive ventilation, septic shock, underlying comorbidities and multilobar involvement were identified as statistically significant independent predictors of mortality. However, the high mortality rate observed may also reflect other contributing factors not captured within the scope of this study, highlighting the need for further research to explore these influences.