PROGNOSTIC INDEXES FOR MORTALITY OF HOSPITALIZED CHILDREN IN CENTRAL-AFRICA

A hospital-based follow-up study was conducted between 1986 and 1988 a t Lwiro (South Kivu Province, Zaire), Of 1,129 children in the study, three of four were severely malnourished, and 17.4% died, This study a nalyzes the mortality in hospital; its objectives are to evaluate the prognostic power of edema and anthropometric and biologic indicators a nd to seek indices that perform better. Receiver operating characteris tic curves were established for each parameter under study and for eac h index constructed. Areas under receiver operating characteristic cur ves were highest for biologic indicators, and simple indices, obtained by counting the number of risk factors present, performed best, In th e absence of biologic parameters, the authors suggest classifying chil dren as at risk of dying when they present with edema and/or with arm circumference of less than 115 mm. When biologic measurements are poss ible, in addition to edema and arm circumference, the authors suggest taking serum albumin and transthyretin into account. For serum albumin and transthyretin, mortality risk is defined in terms of values of le ss than 16 g/liter and 6.5 mg/dl, respectively. Children will be class ified as at risk of dying when they present with at least two of the f our risk factors, The resulting diagnostic test has a high sensitivity (91.2%) and positive and negative predictive values of 40.8% and 97.9 %, respectively.