Predicting the risk of mortality during hospitalization in sick severely malnourished children using daily evaluation of key clinical warning signs

Table 3 Predictive models based on identified clinical warning signs (CWS)

	Predictive Model 1: Admission Score		Predictive Model 2: Daily Score		Predictive Model 3: Daily Count (among all 8 identified CWS)		Predictive Model 4: Daily Count among Top 5 CWS
	HR (95% CI)	P	HR (95% CI)	P	HR (95% CI)	P	HR (95% CI)	P
*CWS (in order of importance, as determined by decreasing HR in Predictive Model 2)*
1 Reduced conciousness	3.6 (1.87–6.95)	<0.001	7.04 (4.25–11.67)	<0.001
2 Symptomatic hypoglycemia	3.65 (1.66–8.06)	0.001	4.74 (2.47–9.11)	<0.001
3 Chest indrawing	1.93 (1.26–2.96)	0.002	3.33 (2.18–5.09)	<0.001
4 Not able to complete feeds	0.71 (0.49–1.05)	0.09	2.42 (1.58–3.7)	<0.001
5 MUAC <10.5cm^a	1.7 (1.18–2.45)	0.005	1.82 (1.25–2.66)	0.002
6 Diarrhea	1.46 (1.03–2.08)	0.04	1.8 (1.23–2.62)	0.002
7 Nutritional edema	1.59 (1.06–2.38)	0.02	1.62 (1.01–2.59)	0.047
8 Fever	0.89 (0.57–1.4)	0.62	1.37 (0.88–2.15)	0.16
*Counted number of CWS*^b
0					1.00 (ref)		1.00 (ref)
1					4.67 (1.8–12.15)	0.002	3.44 (1.92–6.18)	<0.001
2					7.06 (2.67–18.68)	<0.001	10.68 (5.83–19.56)	<0.001
3					28.02 (10.84–72.46)	<0.001	46.51 (24.83–87.13)	<0.001
>3					100.38 (39.13–257.51)	<0.001	177.29 (81.27–386.79)	<0.001
Observations (n)	770		6852		6852		6852
Events (n)	126		124		124		124
C-index (95% CI)^c	0.69 (0.63–0.74 )		0.81 (0.77–0.86)		0.79 (0.75–0.84)		0.79 (0.74–0.84)

Notes: Data are estimation results from extended Cox proportional hazard models with (counted) CWS, event death and censored at discharge. HR cause-specific hazard ratio. ^aAs MUAC was only measured at admission, the counted number of the other CWS was increased by 1 on each hospitalization day if the child had a MUAC<10.5cm at admission. ^bCounted from: 1 reduced consciousness, 2 symptomatic hypoglycemia, 3 chest indrawing, 4 not able to complete feeds, 5 MUAC<10.5cm, 6 diarrhea, 7 nutritional edema, and 8 fever. ^cBootstrapped with 1000 replications

ISSN: 1741-7015