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Indian Pediatr. 1997 Mar;34(3):213-9.

Predictors of mortality in subjects hospitalized with acute lower respiratory tract infections.

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Department of Pediatrics, Maulana Azad Medical College, New Delhi.



To identify the predictors of mortality due to acute lower respiratory tract infection (ALRI).


Prospective cohort study.


Urban tertiary care teaching hospital.


201 cases with ALRI between 2 weeks to 5 years of age were prospectively enrolled and followed up to determine outcome. Detailed history and clinical evaluation were recorded on a pretested proforma. Significant independent predictors of mortality were determined by comparison of dead subjects (n = 21) with surviving children (n = 180) in a multiple logistic analytic framework.


The case fatality rate (CFR) was 10.45%. Significant independent predictors of mortality were (OR, 95% CI) age less than 1 year (23.1, 2.7-197.5), inability to feed (6.2, 1.3-30.7), associated loose stools (5.1,1.2-27.3), weight for age Z score < -3 (3.9,1.01-9.7), short duration of fever (1.2,1.0-1.5) and bandemia (1.1,1.05-1.2). The WHO guidelines identified 91% of children diagnosed as ALRI by clinical and investigative criteria. The CFR was related to severity of WHO classification ("pneumonia"-0%, "severe pneumonia"-8.7% and "very severe pneumonia"-47.0%). However, 2 of the 18 subjects with a diagnosis of "no pneumonia" expired (CFR 11.1% and 10% of total mortality).


Even in settings of high case fatality, predictors of mortality can be identified in under five children suffering from ALRI. In this context, age below 1 year, inability to feed, presence of loose stools and severe malnutrition merit attention for interventional purposes.


In a prospective cohort study (1993-94) conducted at a tertiary care teaching hospital in New Delhi, India, the predictors of mortality in 201 children 2 weeks to 5 years of age admitted with acute lower respiratory infection (ALRI) were investigated. There were 21 deaths in this series, for a case fatality rate of 10.45%. Mortality was inversely associated with age. Multivariate logistic regression identified the following significant predictors of mortality: age less than 12 months (odds ratio (OR), 23.1), inability to feed (OR, 6.2), associated loose stools (OR, 5.1), weight-for-age Z score under 3 (OR, 3.9), short duration of fever (OR, 1.2), and bandemia (OR, 1.1). The clinical and investigative criteria set forth in the World Health Organization (WHO) guidelines successfully identified 91% of children with ALRI. The case fatality rate was related to the severity of the WHO classification: pneumonia, 0%; severe pneumonia, 8.7%; and very severe pneumonia, 47.0%. However, 2 of the 18 children without any pneumonia died. At present, children under 2 months of age are designated as high-risk ALRI cases and targeted for close monitoring, referral, and therapy. The finding of this study of a 23-fold increased risk of mortality in children under 12 months of age suggests this cut-off should be expanded to 12 months.

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