Pediatric cancer type predicts infection rate, need for critical care intervention, and mortality in the pediatric intensive care unit

Abstract

PURPOSE Up to 38% of children with cancer require PICU admission within three years of diagnosis, with reported PICU mortality of 13–27% far exceeding that of the general PICU population. PICU outcomes data for individual cancer types are lacking and may help identify patients at risk for poor clinical outcomes. METHODS We performed a retrospective multi-center analysis of 10,365 PICU admissions of cancer patients ≤ 21 years old among 112 PICUs between 1/1/2009 and 6/30/2012. We evaluated the effect of cancer type, age, gender, genetic syndrome, stem cell transplantation, PRISM3 score, infections, and critical care interventions on PICU mortality. RESULTS After excluding scheduled perioperative admissions, cancer patients represented 4.2% of all PICU admissions (10,365/246,346), had overall mortality of 6.8% (708/10,365) vs. 2.4% (5,485/230,548) in the general PICU population (RR=2.9, 95% CI 2.7–3.1, p<0.001), and accounted for 11.4% of all PICU deaths (708/6,215). Hematologic cancer patients had greater median PRISM3 score (8 vs 2, p<0.001), rates of sepsis (27% vs 9%, RR=2.9, 95% CI 2.6–3.1, p<0.001), and mortality (9.6% vs 4.5%, RR=2.1, 95% CI 1.8–2.5, p<0.001) compared to solid cancer patients. Among hematologic cancer patients, stem cell transplantation, diagnosis of acute myeloid leukemia, PRISM3 score, and infection were all independently associated with PICU mortality. CONCLUSIONS Children with cancer account for 4.2% of PICU admissions and 11.4% of PICU deaths. Hematologic cancer patients have significantly higher admission illness severity, rates of infections, and PICU mortality than solid cancer patients. These data may be useful in risk-stratification for closer monitoring and patient counseling.

Appropriateness of admissions of children with cancer to intensive care facilities in a resource-limited setting

“…Such systems were not developed for this specific cohort and often lead to incorrect predictions, either over-or under-predicting mortality. 5,10,11 These scores were not assessed in this study.…”

“…5,6 As both paediatric oncology and PICU are high cost units, it is apposite to analyse trends and decide whether changes should be implemented. The aim of this study was to determine if oncology admissions to a resource-constrained PICU were appropriate and to analyse short-and long-term survival rates.…”

Caracterización de los pacientes de una Unidad de Cuidado Intensivo Pediátrico exclusivamente oncológica

“…Estos datos son similares a los informados en países desarrollados que se encuentran con mortalidad del 15 al 20% 6,7 e incluso por debajo del 32 y 27% informado por Hallahan y Pollack 17,18 . Se ha descrito en otros estudios la disfunción multiorgá-nica asociada a choque séptico como la principal causa de muerte 19---22 en estos pacientes al igual que en nuestra cohorte, y aunque existen reportes acerca del comportamiento del choque séptico con pronóstico similar en niños con cáncer y sin él 22---24 , también hay informes de una mayor tasa de mortalidad por sepsis en los pacientes con leucemias agudas 21,25 , desenlaces que deberán ser estudiados posteriormente en nuestra población.…”

Focus on immunocompromised patients

“…In a large study (10,365 patients, 112 ICUs), Zinter et al reported that mortality was higher in children with cancer, and higher in hematologic cancer patients as compared to solid cancer patients [3]. Moreover, cancer type influenced infection rates.…”