Mostly death in PEM is due to all except –
Hepatomegaly is one of the essential diagnostic feature of kwashiorkor, it does not indicate poor prognosis.
Poor prognostic factors in PEM, which can lead to early death -


Hypothermia                                                                                                                    
Hypoglycemia    
Systemic infections                                                                                                             
Diarrhea
Severe anemia    
Liver failure  
Cardiac failure  
Dehydration or over hydration
Fluid & electrolyte imbalance
Hypothermia
CCF
Worm infestation
Electrolyte imbalance