Clinical Predictors of Morbidity and Mortality in Hospitalized Pediatric Patients with Ascites.

OBJECTIVES Ascites is a pathologic buildup of fluid in the peritoneal cavity. Knowledge is lacking in clinical outcome in pediatric patients with ascites. We aim to identify and assess clinical variables to associated with morbidity and mortality in pediatric patients hospitalized with ascites. METHODS A retrospective cohort study was performed on patients aged 0-21 hospitalized at Johns Hopkins Hospital between 1983-2010 with an ICD-9 discharge diagnosis of ascites (789.5, 789.51, 789.59). A total of 518 pediatric patients were studied, all with a diagnosis of ascites during hospitalization. Study outcomes included hospital length of stay (LOS) as a proxy for morbidity and death at hospital discharge for mortality. Variables analyzed included demographic data, ascites etiology and grade, co-morbidities, and laboratory markers. Variables were analyzed by log-linear regression and competing risk model. RESULTS Among three age groups (0-5, 6-12, and 13-21), the 0-5 age group experienced significantly increased LOS (p < 0.001) and mortality (p = 0.027). Ascites etiology of veno-occlusive disease (VOD) and the presence of hydrothorax or thrombocytopenia was also significantly associated with increased LOS. Ascites with the etiology of congestive hepatopathy and the presence of grade 3 ascites, hepatic encephalopathy, hepatorenal syndrome, hydrothorax, hyponatremia, and thrombocytopenia were associated with increased mortality. Additionally, Black pediatric patients have an increased risk of mortality (p = 0.027). Other factors including sex, leukopenia, portal vein thrombosis, and splenomegaly were not associated with LOS or mortality. CONCLUSION Morbidity and mortality in pediatric patients hospitalized with ascites are associated with specific demographic and clinical factors. Further studies are required to apply this knowledge to predict the clinical outcomes.