Factors Affecting Short-Term Outcome of Critically Ill Children with Malignancies Admitted in Pediatric Intensive Care Unit: A Retrospective Observational Study

Abstract

Introduction Pediatric cancer contributes <1% of all malignancies. Childhood cancer survival has improved dramatically with the use of more intensive chemotherapy regimens, better stratification, and improvement in supportive care with enhanced facilities in pediatric intensive care unit (PICU). Objective The aim of this study was to identify the risk factors responsible for poor outcome in critically ill children with malignancies admitted in PICU. Materials and Methods Sixty-four children with a primary diagnosis of malignancy admitted in PICU with disease or treatment related complications were enrolled retrospectively. The short-term outcome, that is, shifting from PICU to ward, was assessed in relation to the presence of febrile neutropenia, organ failure, hepatitis, acute renal failure as well as requirement of inotropes and mechanical ventilation. Death was considered as an adverse outcome in this study. Results The mean age of study population was 6.25 ± 3.91 and M:F ratio 2.4:1. The majority of children had hematological malignancies (81.25%), that is, pre-B acute lymphoblastic leukemia (ALL) (45.3%), non-Hodgkin lymphoma (21.3%), acute myeloid leukemia (12.5%), T ALL (10.9%), and Hodgkin lymphoma (3.1%). Few children also had retinoblastoma (4.7%) and Langerhans cell histiocytosis (1.6%). The mean duration of PICU stay was 3.16 ± 2.31 days. Sepsis (37.5%) was the most common indication for PICU admission, followed by metabolic disturbance (26.6%), respiratory failure (17.2%), neurological complaints (15.6%), and anaphylactic shock (3.1%). Children requiring mechanical ventilation (p < 0.001), inotrope support (p < 0.001), having acute renal failure (p = 0.001), and >1 organ failure (p < 0.001) were associated with adverse outcome. The overall survival at the time of discharge from PICU was 64%. Conclusion In the context of low- and middle-income countries, optimal resource utilization by early identification of risk factors for clinical deterioration is required to allow timely admission to PICU and delivery of life-saving therapy to salvageable patients.