Weight-for-age distribution and case-mix adjusted outcomes of 14,307 paediatric intensive care admissions

  • Prince N
  • Brown K
  • Mebrahtu T
 et al. 
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Abstract

AIMS: To determine whether the paediatric intensive care (PIC) population weight distribution differs from the UK reference population and whether weight-for-age at admission is an independent risk factor for mortality.

METHODS: Admission weight-for-age standard deviation scores (SDS) were calculated for all PIC admissions (March 2003-December 2011) to Great Ormond Street Hospital: this is the number of standard deviations (SD) between a child's weight and the UK mean weight-for-age. Categorised into nine SDS groups, standardised mortality ratios (SMR) and logistic regression were used to assess the relationship between weight-for-age at admission and risk-adjusted mortality.

RESULTS: Out of 12,458 admissions, mean weight-for-age was 1.04 SD below the UK reference population mean (p < 0.0001). Based on 942 deaths, risk-adjusted mortality was lowest in those with mild-to-moderately raised weight-for-age (SDS 0.5-2.5) and highest in children with extreme under- or overweight (SDS < -3.5 and SDS > +3.5). Logistic regression indicated that age, gender, ethnicity and weight-for-age are independent risk factors for mortality. South Asian and 'other' ethnicities had significantly increased risk of death compared to children of white and black ethnic origin.

CONCLUSION: The PIC population mean weight-for-age is significantly lower than the UK reference mean. The extremes of weight-for-age are over-represented, especially underweight. Weight-for-age at admission is an independent risk factor for mortality. A U-shaped association between weight and risk-adjusted mortality exists, with the lowest risk of death in children who are mild-to-moderately overweight. Future studies should determine the impact of malnutrition on risk-adjusted mortality and investigate the aetiology of risk disparities with ethnicity.

Author-supplied keywords

  • Malnutrition
  • Mortality
  • Obesity
  • PICU weight distribution
  • Underweight
  • Weight-for-age

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Authors

  • Nicholas J. Prince

  • Katherine L. Brown

  • Teumzghi F. Mebrahtu

  • Roger C. Parslow

  • Mark J. Peters

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