Prognostic factors of sepsis in children with acute leukemia admitted to the pediatric intensive care unit

Abstract

Objective:To analyze the prognostic factors of sepsis in children with acute leukemia admitted to the pediatric intensive care unit (PICU) and to compare the efficacy of different scoring systems for predicting the outcome of children. Methods:Patients with an acute leukemia diagnosis admitted to a tertiary care university hospital PICU due to sepsis during chemotherapy between May 2015 and August 2022 were retrospectively analyzed through an electronic medical record system.Results: During this period, 693 children with acute leukemia initially diagnosed were admitted to the center, and 155 (22.3%) of them were transferred to PICU due to deterioration of the disease during treatment. Total 109 (70.3%) patients were transferred to PICU due to sepsis. Here, 17 patients was excluded (prior treatment from another hospital; referring from other hospitals; discontinued treatment; incomplete medical record). Of the 92 patients studied, the mortality rate was 35.9%. Multivariate analysis revealed that remission status, lactate level, invasive mechanical ventilation (IMV), and inotropic support within 48 hours after PICU transfer were independent risk factors for PICU mortality. The pediatric sequential organ failure assessment (PSOFA) score had the greatest predictive validity for hospital mortality (area under the receiver operating characteristic curve [AUROC]: 0.83, 95% confidence intervals [CI]: 0.74-0.92), followed by the pediatric early warning score (PEWS) (0.82, 0.73-0.91) and pediatric critical illness score (PCIS) (0.79, 0.69-0.88). Conclusion:The mortality rate among children with acute leukemia complicated with sepsis is high after being transferred to the PICU. Various scoring systems can be used to monitor the clinical status of patients, identify sepsis early, detect critical illness, and determine the optimal time for transfer to the PICU for supportive treatment, thereby improving the prognosis of these patients.

Development and validation of a nomogram to predict the risk of sepsis-associated encephalopathy for septic patients in PICU: a multicenter retrospective cohort study

“…Consistent with previous studies, the present study found that PCIS was a vital risk factor for SAE development in children with sepsis. Moreover, the PCIS showed good accuracy and discriminatory ability in the prognostic prediction of many other critical diseases, such as pneumonia-related bacteremia, hand-foot-and-mouth disease, acute paraquat poisoning, and acute leukemia [ 36 – 39 ]. However, data on the correlation between PCIS and SAE are limited, and future high-quality studies are needed for further exploration.…”

Critical Care Utilization in Children With Cancer: U.S. Pediatric Health Information System Database Cohort 2012–2021

“…In fact, some studies in this population suggest delays in more definitive critical care interventions, such as intubation, are associated with worse outcomes (12, 14, 17). Earlier identification and aggressive intervention might be beneficial in this population (18). ECMO is a great example of improving PICU outcomes.…”

Prediction of attributable mortality in pediatric patients with cancer admitted to the intensive care unit for suspected infection: A comprehensive evaluation of risk scores

“…In our study, mortality in many cases was likely caused by secondary infections or other complications related to ICU care without recovery from the original insult. Therefore, these scores may perform better in in children with cancer in low‐ or middle‐income countries, where the primary mode of death is acute non‐survivable organ failure 7,24,25 . Inclusion in this study cohort did not require a clinical diagnosis of severe sepsis or septic shock, just ICU admission with suspected infection, so the scores might perform better in patients with clearly established sepsis.…”

“…Therefore, these scores may perform better in in children with cancer in low-or middle-income countries, where the primary mode of death is acute non-survivable organ failure. 7,24,25 Inclusion in this study cohort did not require a clinical diagnosis of severe sepsis or septic shock, just ICU admission with suspected infection, so the scores might perform better in patients with clearly established sepsis. This suggests that speed of recovery from organ damage might be a F I G U R E 1 Performance of four pediatric sepsis risk prediction scores for prediction of attributable mortality in children with cancer.…”

“…Infection and associated sepsis are important causes of morbidity and death in children with cancer. [1][2][3][4][5][6][7] The high risk of sepsis is related to infections associated with immunocompromise, mucosal barrier damage from chemotherapy, central venous catheters and other interventions, and with immune dysregulation from chemotherapy or cancer itself. 8 Consequently, around 10%-15% of all pediatric patients with sepsis have an underlying neoplastic condition.…”