Complex Chronic Conditions in the PICU: Single-Center Retrospective Study in Central-Southern China, 2020–2025

OBJECTIVES: Complex chronic conditions (CCCs) are increasingly prevalent in the PICU. Identifying high-risk patterns of CCC and comorbidities is essential for patient risk stratification and targeted management. In this study, we aimed to describe the distribution and patterns of CCCs among children admitted to our tertiary PICU in China and to identify the types and combinations of conditions associated with a higher risk of adverse outcomes. DESIGN: Retrospective cohort study, January 2020 to February 2025. SETTING: Single center, at a tertiary referral PICU in Central-Southern China. PATIENTS: Children older than 28 days, up to 18 years old. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: CCCs were defined according to the Pediatric Complex Chronic Conditions Classification System Version 2. Of 9589 PICU admissions, 49% had one or more CCCs. Admissions with CCCs accounted for 69.8% of the adverse outcomes, 70.8% of in-hospital deaths, 58% of multiple organ dysfunction cases, and 57.6% of total patient days. Admissions with multiple CCC diagnoses were associated with higher odds of adverse outcomes compared with admissions with a single CCC diagnosis (p < 0.0001). Transplantation and metabolic CCCs were associated with greater odds of adverse outcomes (odds ratios [OR], 6.06 and 5.27, respectively; p < 0.05). The most common co-occurring CCC categories were malignancy and hematologic/immunologic disorders. Among the most frequent combinations, the co-occurrence of metabolic and malignancy CCC was associated with greater odds of adverse outcomes (OR, 8.54 [95% CI, 4.48-16.29]). Admission with CCC was associated with pneumonia and sepsis (p < 0.05). CONCLUSIONS: In our 2020-2025 experience, admission of patients with CCCs accounted for most of the adverse PICU outcomes. The odds of adverse outcomes varied across CCC types and combinations. Hence, incorporating CCCs into a stratified management approach across our healthcare system may support more effective planning and delivery of care.