Analysis of risk factors for lethal outcome in patients of pediatric intensive care units with immuno-inflammatory diseases

Introduction. Systemic immune-inflammatory diseases can affect many systems and organs and have an extremely severe course with complications, causing multiple organ failure and death. Often, children with such diseases require hospitalization in the intensive care unit (ICU). For example, approximately 50% of patients with multisystem inflammatory syndrome, associated with COVID-19 in children (MIS-C) and systemic lupus erythematosus require hospitalization in the ICU.

The objective was to determine risk factors for lethal outcome in children with immune-inflammatory diseases hospitalized in the ICU.

Materials and methods. The retrospective cohort study included 51 patients (23 boys, 28 girls) with immune-inflammatory diseases such as MIS-C (n = 18), systemic rheumatic diseases (n = 24), and sepsis (n = 9) aged 7 months to 17 years, hospitalized in the ICU of the Clinical Hospital of St. Petersburg State Pediatric Medical University in the period from 2007 to 2023.

Results. 13 patients (25.5%) died 39 (17; 62) days after admission to the ICU. Patients with a lethal outcome were significantly older and were admitted to the ICU later than surviving patients (30 vs. 7 days, p = 0.013), and also spent a longer time in the ICU (30 vs. 6 days, p = 0.003). Lethal outcome was more common in older children (> 162 months) who were admitted to the ICU later (> 26 days from the disease onset/diagnosis), who received previous immunosuppressive therapy, developed invasive mycosis during their stay in the ICU and were in the ICU for a long time (> 15 days). Multiple regression analysis revealed three significant predictors of lethal outcome: age > 162 months, time of admission to the ICU > 26 days from diagnosis, and ICU stay > 15 days (r2 = 0.458, p < 0.00001).

Conclusion. Early identification of patients at high risk of adverse outcome is a primary goal for optimization of therapy. Careful monitoring of immunosuppressive therapy and prevention of invasive mycosis can improve the outcome in children with systemic immune-mediated diseases.

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