Survival Status and Predictors of Mortality Among Pediatric Patients Admitted to Intensive Care Unit at a University Teaching Hospital in Southeastern Ethiopia: Insights from a Prospective Cohort Study

Background: Pediatric mortality rates in intensive care units (ICUs) are much higher in developing countries compared to high-income nations. Although advancements in pediatric intensive care have improved outcomes worldwide, resource-limited settings still face significant challenges. The high burden of disease and mortality from preventable illnesses further complicate patient outcomes in these under-resourced ICUs. In Ethiopia, there is limited published data on pediatric ICU outcomes and their influencing factors. This study aimed to assess survival status and identify predictors of mortality among pediatric patients admitted to the ICU at Asella Referral and Teaching Hospital. Methods: An Institutional-based prospective cohort study was conducted in the ICU, involving 305 pediatric patients admitted between September 2023 and November 2024. We consecutively recruited eligible patients and followed them until they were either censored or died. Kaplan Meier was used to compare patient survival experiences and Cox regression analyses were used to identify independent predictors of ICU mortality. The strength of associations was measured using hazard ratios, and statistical significance was determined at a P-value of <0.05. Results: In this cohort, A total of 129/305 patients died during the follow-up time, yielding an overall mortality of 42.3%. The mortality incidence was 7.1 deaths per 100 person-days of observation (95% CI: 5.86–8.32 deaths per 100 person-days), with a median survival time of 10 days. The independent predictors of ICU mortality include: Lack of health insurance (AHR: 2.03; 95% CI: 1.22–3.39; P = .007), Presence of multi-organ dysfunction (AHR: 1.73; 95% CI: 1.09–2.73; P = .019), Elevated creatinine levels (AHR: 1.82; 95% CI: 1.13–2.93; P = .013), Hemoglobin levels below 10 g/dL (AHR: 1.73; 95% CI: 1.15–2.60; P = .008), and Higher PIM 2 scores (AHR: 1.58; 95% CI: 1.03–2.43; P = .038). Conclusion: The study found a concerningly high mortality rate among pediatric patients in the ICU. Key predictors of ICU mortality included elevated creatinine levels, higher PIM 2 scores, hemoglobin levels below 10 g/dL, lack of health insurance, and the presence of multi-organ dysfunction. These findings underscore the urgent need for early intervention strategies targeting these risk factors, particularly in high-risk patients, to enhance outcomes in pediatric critical care and significantly reduce ICU mortality rates.