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Meta-Analysis
. 2020 Oct 1;112(4):1069-1079.
doi: 10.1093/ajcn/nqaa182.

Predictors of inpatient mortality among children hospitalized for severe acute malnutrition: a systematic review and meta-analysis

Radhini Karunaratne  1 , Jonathan P Sturgeon  1   2 , Rajvi Patel  3 , Andrew J Prendergast  1   2
Affiliations
Meta-Analysis

Predictors of inpatient mortality among children hospitalized for severe acute malnutrition: a systematic review and meta-analysis

Radhini Karunaratne et al. Am J Clin Nutr. .

Abstract

Background: Malnutrition underlies 45% of under-5 deaths globally. Severe acute malnutrition (SAM) is the most serious form of undernutrition, characterized by wasting with or without edema. Mortality remains high (10%-40%) among children requiring hospitalization for complicated SAM.

Objectives: We aimed to systematically document the factors independently associated with inpatient mortality in children with SAM.

Methods: Embase, Ovid MEDINE, the Cochrane Library, and clinicaltrials.gov were searched for articles published between January 2000 and January 2020, using a prespecified protocol. Eligible studies included children aged ≤59 mo hospitalized with SAM and used multivariable analysis to assess the baseline factors independently associated with inpatient mortality. Random-effects meta-analysis, stratified by the stated measure of effect, was used where >20% of studies included the same factor in analyses.

Results: Twenty-eight of 1432 studies fulfilled inclusion criteria: 19 studies included all children with SAM and 9 included specific subgroups of children with SAM. All 19 main studies were from 8 countries across Africa, with a median of 400 children/study. The mean inpatient mortality was 15.7% (95% CI: 10.4%, 21.0%) and HIV prevalence ranged from 2.1% to 51%. Nine factors were included in the meta-analysis, stratified by HR and OR. HIV infection (HR: 4.32; 95% CI: 2.31, 8.08), weight-for-height z score (WHZ) (OR: 0.44; 95% CI: 0.24, 0.80), diarrhea (HR: 2.84; 95% CI: 1.40, 5.75), pneumonia (HR: 1.89; 95% CI: 1.19, 3.02), presence of shock (HR: 3.67; 95% CI: 2.24, 6.03), and lack of appetite (HR: 2.16; 95% CI: 1.48, 3.16) were associated with increased mortality, whereas child age and sex were not. The association between edema and mortality was difficult to ascertain from the available studies.

Conclusions: HIV infection, diarrhea, pneumonia, shock, lack of appetite, and lower WHZ are independent predictors of inpatient mortality in children with SAM. These factors may help to risk-stratify children being hospitalized with complicated SAM.This systematic review/meta-analysis protocol was registered at www.crd.york.ac.uk/prospero as CRD42019152267.

Keywords: SAM; child; inpatient; malnutrition; mortality; predictors; severe acute malnutrition.

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Figures

FIGURE 1
FIGURE 1
Forest plots of the meta-analysis of sex (A), presence of edema (B), WHZ (C), HIV infection (D), and age <2 y (E), on mortality in children admitted with SAM. Results with HRs are shown in red and studies reporting results in ORs are shown in green. aThis result was reported as aHR: 0.679 (95% CI: 0.63, 0.99) among males. However, given the CI presented, it is likely there is a typographical error and the point estimate should be 0.79. We contacted the authors but did not receive a reply. We have therefore used the value as published. We found no change in inference from using the likely alternative value. WHZ, weight-for-height z score.
FIGURE 2
FIGURE 2
Forest plots of the meta-analysis of diarrhea (A), presence of shock (B), pneumonia (C), and lack of appetite/needing NG feeding (D), on mortality in children admitted with SAM. Results with HRs are shown in red and studies reporting results in ORs are shown in green. NG, nasogastric.
See this image and copyright information in PMC

Comment in

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