Prognostic Factors and Utility of the RISC Score Among Children with Community-Acquired Pneumonia Admitted to a Pediatric Intensive Care Unit at a Tertiary Care Hospital

Introduction: Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality among children. We aimed to evaluate the demographic, clinical, vaccination status, comorbidity profiles, and microbiological findings of children aged ۱ month to ۱۲ years with CAP admitted to a pediatric intensive care unit (PICU), and to assess the utility of the Respiratory Index of Severity in Children (RISC) score in predicting in-hospital mortality. Methods: This retrospective, observational study was conducted at SMS Medical College, Jaipur, India, from January ۲۰۱۹ to January ۲۰۲۱. Of ۳۵۲ screened children, ۳۲۲ meeting the WHO Integrated Management of Childhood Illness (IMCI) pneumonia definition were enrolled. Blood cultures were processed using the BD BACTEC FX system; isolates were identified by VITEK®۲. Antimicrobial susceptibility testing followed Clinical and Laboratory Standards Institute M۱۰۰-Ed۳۱ guidelines. The RISC score was calculated at PICU admission. The chi-square test, Fisher's exact test, and independent t-test were used; a P value < ۰.۰۵ was considered statistically significant. Results: Among ۳۲۲ children (۷۰.۲% male), in-hospital mortality was ۵.۹% (۱۹/۳۲۲). Age and sex were not significantly associated with mortality. Complete vaccination including pneumococcal conjugate vaccine (PCV) was protective (P < ۰.۰۰۱). Oxygen saturation (SpO₂) < ۹۰% was significantly associated with mortality (P = ۰.۰۰۲). Non-survivors had higher mean RISC scores (۲.۰۵ ± ۱.۵۸ vs. ۰.۸۶ ± ۱.۳۲; P < ۰.۰۰۱). At a RISC score cut-off of ≥ ۳, sensitivity was ۵۲.۶%, specificity ۸۱.۹%, and negative predictive value ۹۶.۵%. Blood culture positivity was ۳۵.۱% (۱۱۳/۳۲۲); ۷۹ isolates (۲۴.۵% of all enrolled children) were pathogenic. All ۱۹ deaths occurred in culture-positive children; no mortality was observed among those with sterile cultures. The highest mortality rates were observed with Escherichia coli (۶۶.۷%, ۲/۳), Klebsiella pneumoniae (۴۱.۲%, ۷/۱۷), and Streptococcus pneumoniae (۳۷.۵%, ۳/۸) bacteremia. Conclusion: Complete vaccination, SpO₂ < ۹۰%, and the RISC score were significant prognostic factors. The RISC score demonstrated high negative predictive value for identifying children at low risk of mortality. Early blood culture collection and expanded vaccination coverage may improve outcomes in resource-limited settings.

کلیدواژه ها:

Antimicrobial resistance ، Blood culture ، Children ، Community-acquired pneumonia ، Mortality ، Pediatric intensive care unit ، Prognostic factors ، RISC score