# A Retrospective Epidemiological Study of Mortality in a Pediatric Intensive Care Unit: Trends, Causes, and Risk Factors (2014–2023)

## TL;DR

This study analyzed mortality trends and risk factors in a pediatric ICU from 2014 to 2023, finding that early deaths were linked to severe conditions like shock and the need for mechanical ventilation.

## Contribution

The study identifies specific risk factors for early mortality in PICUs and highlights a decline in overall mortality since 2019.

## Key findings

- The overall mortality rate was 2.3%, with a notable decline after 2019.
- Early mortality was associated with invasive mechanical ventilation, elevated lactate levels, and postoperative status.
- Procalcitonin and lactate levels were higher in early mortality cases compared to later deaths.

## Abstract

Background: Continuous monitoring of mortality trends and a thorough understanding of death epidemiology in Pediatric Intensive Care Units (PICUs) are critical for healthcare quality assessment, rational resource allocation, and quality improvement initiatives. This study aimed to analyze a decade-long mortality rate, its temporal trends, and the primary causes of death and to elucidate the independent risk factors for early death within a PICU cohort. Methods: This retrospective cohort study included all PICU admissions at the Children’s Hospital of Chongqing Medical University from 1 January 2014, to 31 December 2023. Data collection covered demographic characteristics, primary diagnoses, comorbidities, requirements for mechanical ventilation or vasoactive drugs, lengths of stay, and patient outcomes. The multivariate logistic regression analysis was used to determine independent risk factors associated with early death. Results: Among 21,910 ICU admissions, the overall mortality rate was 2.3% (n = 512), with a historical range of 0.41% to 5.71%, indicating a gradual decline after 2019. Early mortality (death within 24 h of admission) accounted for 13.9% (71/512) of all deaths. Patients in the early mortality group presented with more severe disease conditions, including shock, sepsis, and postoperative status (p < 0.05). Laboratory findings at admission revealed significantly higher procalcitonin and lactate levels, along with lower albumin levels, in this group than in children who died >24 h after admission (p < 0.05). Multivariate analysis revealed that a need for invasive mechanical ventilation (OR = 3.03; 95% CI: 1.68–5.58; p < 0.001), elevated lactate levels (OR = 1.10; 95% CI: 1.02–1.17; p = 0.009), and postoperative status (OR = 0.29; 95% CI: 0.09–0.73; p = 0.017) were independent risk factors for early mortality. Conclusions: Despite an overall decline in mortality since 2019, early mortality among high-risk patients—such as those requiring invasive mechanical ventilation or those presenting with elevated lactate levels—requires attention. Prompt recognition of these risk profiles and timely intervention are crucial for improving outcomes in children.