Outcome and Predictors of Mortality in Pediatric Oncology Patients Requiring Intensive Care

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Children with malignancies admitted to pediatric intensive care units (PICUs) for complications of their treatment regimes have a high mortality. There are seven previous publications addressing the outcome of this group of patients. We retrospectively analyzed data from 171 admissions (134 patients) to the PICU for predictors of outcome. The most frequent underlying diagnosis was acute lymphoblastic leukemia (ALL) (n = 23, 17%) followed by post-bone marrow transplant (BMT) (n = 12, 9%), but a wide variety of tumors were represented. Sixty-three children were admitted with suspected sepsis, 58 with positive cultures. This represents the largest series published. Mortality for sepsis was 53% and for systemic inflammatory response syndrome (SIRS) (negative cultures), 80%. Logistic regression analysis revealed the number of organs failed, day 1 PRISM score, and the dose and type of inotropes required to be independent predictors of mortality. The need for ventilation alone was not an independent predictor of death. Twenty-six percent of all ventilated children with sepsis survived, with a mean number of failed organs in the survivors of 1.8. Children with respiratory failure without multiple organ dysfunction syndrome (MODS) have a significant chance of survival. Mortality was 100% for four or more failed organs and was 92% for children in renal failure. Survival if ventilation and inotropes were required was 9.4%, higher than expected.

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