Traditional Herbal Medicine Use Tripled the Risk of Multi-organ Dysfunction Syndrome in a Pediatric Intensive Care Unit in Ethiopia: A Prospective Cohort Study

AbstractObjectiveThis study aimed to investigate the incidence and predictors of MODS in a Pediatric Intensive Care Unit in Ethiopia, with a focus on the association between traditional herbal medicine (THM) use and the risk of MODS.MethodsThis was a single-center prospective cohort study conducted at a PICU in Ethiopia. The study enrolled eligible patients aged one month to 18 years admitted to the PICU during the study period. Recruitment was made at the time of admission to the PICU. Data on demographic characteristics, medical history, clinical and laboratory data, and outcome measures using standard case record forms, physical examination, and patient document reviews. The predictors of MODS were assessed using Cox proportional hazards models, with a focus on the association between traditional herbal medicine use and the risk of MODS.ResultsA total of 310 patients were included in the final analysis, with a median age of 48 months and a male-to-female ratio of 1.5:1. The proportion and incidence of MODS were 30.96% (95% CI:25.8, 36.6) and 7.71(95% CI: 6.10, 9.40) per 100-person-day observation respectively. Renal failure (17.74%), neurologic failure (15.16%), and heart failure (14.52%) were the leading organ failures identified. Nearly one-third of patients (32.9%) died in the PICU, of which 59.8% had MODS. The rate of mortality was higher in patients with MODS than in those without.The Cox proportional hazards model identified renal disease (AHR=6.32 (95%CI: 3.17,12.61)), intake of traditional herbal medication (AHR=2.45, 95% CI:1.29,4.65), modified Pediatric Index of Mortality 2 (mPIM 2) score (AHR=1.54 (95% CI: 1.38,1.71), and critical illness diagnoses (AHR=2.68 (95% CI: 1.77,4.07)) as predictors of MODS. Patients who used THM had a threefold increased risk of MODS (AHR) of 2.45 (95% CI: 1.29, 4.65).ConclusionThe incidence of MODS was high. Renal disease, THM use, mPIM 2 scores, and critical illness diagnoses were independent predictors of MODS. A threefold increase in the risk of MODS was seen in patients who used TMH. Healthcare providers should be aware of risks associated with THM, and educate caregivers about the potential harms of these products. Future studies with larger sample sizes and more comprehensive outcome measures are needed.