In-hospital mortality and associated factors among pediatric patients with heart failure at selected public hospitals of eastern Ethiopia

Background

The treatment of pediatric heart failure continues to have a poor outcome, such as significant mortality, morbidity, and hospitalization. Irrespective of the poor outcomes of children admitted with heart failure (HF) all over the globe, there is limited data on the status of children with HF in low-income settings, including Ethiopia.

Objectives

This study aimed to assess the magnitude of and factors associated with in-hospital mortality among admitted children at selected public hospitals in Eastern Ethiopia.

Methods

A retrospective cohort study design was conducted. A simple random sampling method was used to select medical records of 671 pediatric patients with HF admitted between June 01, 2017, and May 31, 2022, and data was collected from the medical records. Descriptive statistics were used to analyze information about patient's characteristics. A survival analysis by Cox regression was used to analyze the collected data. Hazard ratios with 95 % confidence interval and p-values were used to examine factors associated with in-hospital mortality of children with heart failure. A p-value of <0.05 was used to declare a significant association.

Results

The study analyzed 671 pediatric patients hospitalized with HF. Regarding the in-hospital outcomes, 386 (57.5 %) patients were discharged with improvement, 132 (19.7 %) patients were self-discharged or left against medical advice, 49 (7.3 %) patients were referred, and 104 (15.5 %) patients died while they were at the hospital. In a multivariate Cox regression analysis, participants with female gender (adjusted hazard ratio: 1.665, 95 % confidence interval: 1.111–2.494, p = 0.013), under-nutrition (adjusted hazard ratio: 1.517, 95 % confidence interval: 1.018–2.259, p = 0.04), age between one year to <5 years (adjusted hazard ratio: 1.834, 95 % confidence interval: 1.177–2.858, p = 0.007), and congenital heart disease (adjusted hazard ratio: 0.357, 95 % confidence interval: 0.151–0.654, p = 0.002) were significantly associated with in-hospital mortality of children with HF.

Conclusion

The overall in-hospital mortality rate was 15.5 %. Malnutrition, age group of one year to <5 years, and female gender were associated with pediatric mortality. These findings highlight the need for screening for malnutrition at each follow-up for under-five children.