Pseudomonas aeruginosa and other predictors of mortality and morbidity in young children with cystic fibrosis

Authors

  • Julia Emerson MD, MPH,

    Corresponding author
    1. Division of Pulmonary Medicine, Department of Pediatrics, University of Washington, Seattle, Washington
    2. Cystic Fibrosis Research Center, Children's Hospital and Regional Medical Center, Seattle, Washington
    • Cystic Fibrosis Research Center, Children's Hospital and Regional Medical Center, 4800 Sandpoint Way NE, Mail Stop CH-18, P.O. Box 5371, Seattle, WA 98105-0371.
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  • Margaret Rosenfeld MD, MPH,

    1. Division of Pulmonary Medicine, Department of Pediatrics, University of Washington, Seattle, Washington
    2. Cystic Fibrosis Research Center, Children's Hospital and Regional Medical Center, Seattle, Washington
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  • Sharon McNamara MN,

    1. Cystic Fibrosis Research Center, Children's Hospital and Regional Medical Center, Seattle, Washington
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  • Bonnie Ramsey MD,

    1. Division of Pulmonary Medicine, Department of Pediatrics, University of Washington, Seattle, Washington
    2. Cystic Fibrosis Research Center, Children's Hospital and Regional Medical Center, Seattle, Washington
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  • Ronald L. Gibson MD, PhD

    1. Division of Pulmonary Medicine, Department of Pediatrics, University of Washington, Seattle, Washington
    2. Cystic Fibrosis Research Center, Children's Hospital and Regional Medical Center, Seattle, Washington
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  • This work was presented in part at the 1998 North American Cystic Fibrosis Conference.

Abstract

We conducted a registry-based study to determine prognostic indicators of 8-year mortality and morbidity in young children with cystic fibrosis (CF). Patients ages 1–5 years from the 1990 U.S. Cystic Fibrosis Foundation (CFF) National Patient Registry served as the study cohort (N = 3,323). Registry data provided information on baseline characteristics in 1990, 8-year mortality, and clinical outcomes in 1998.

P. aeruginosa respiratory infection was found to be a major predictor of morbidity and mortality. The 8-year risk of death was 2.6 times higher in patients who had respiratory cultures positive for P. aeruginosa in 1990 (95% confidence interval 1.6, 4.1) than in children without P. aeruginosa in their respiratory cultures. Culture-positive patients in 1990 also had a significantly lower percent predicted forced expiratory volume in 1 sec (FEV1) and weight percentile at follow-up, and they had an increased risk of continued P. aeruginosa respiratory infection and hospitalization for acute respiratory exacerbation in 1998. Among the other predictors of increased morbidity and mortality were lower baseline weight percentiles and number of CF-related hospitalizations during the baseline year.

These findings confirm reports from previous smaller studies of outcomes among young children with CF, and highlight the potential to decrease the morbidity and mortality of young patients with CF through early intervention. Pediatr Pulmonol. 2002; 34:91–100. © 2002 Wiley-Liss, Inc.

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