Pediatrics & Therapeutics
Open Access

Abstract

Characteristics and Predictors of Mortality after Intensive Care Admission of Children with Cancer

Mafalda Castelão*, Teresa Martins, Pierre Gonçalves and Ana Lacerda

Background: Pediatric oncology patients are a high-risk population for clinical deterioration that might require Pediatric Intensive Care Unit (PICU) admission. This study aims to assess the clinical characteristics of pediatric oncology patients admitted to PICU with acute events, and to identify prognostic factors related to mortality.

Materials and Methods: All PICU admissions for cancer-related acute complications in oncology patients’ ≤ 18 years followed at a Pediatric Oncology Unit (POU) of a general oncology hospital, from 2017 to 2021, were retrospectively evaluated. We assessed the relation between clinical characteristics and PICU interventions, and the in-hospital mortality during PICU admission and at 30-day after PICU discharge.

Results: Of 4225 admissions to the POU ward, 63 patients (1.6%) were admitted to PICU. Most had hematologic malignancies (83%) and were under induction/neoadjuvant chemotherapy (54%). The main reasons for PICU admission were cardiovascular collapse (53%), respiratory failure (30%), and neurologic deterioration (14%). There were no significant differences between survivors and non-survivors in relation to underlying cancer disease, disease status (including relapse or HSCT recipient status), or cause of PICU admission. The mean PICU stay was 6 ± 0.9 days. The PICU mortality rate was 19% and the cumulative in-hospital mortality at 30 days after PICU discharge was 29%. In the multivariate analysis, mechanical ventilation (OR 17.6; 95% CI: 3.8–80.1; p<0.001), confirmed infection (OR 3.6; 95% CI: 1.1–13.5; p=0.042), and younger age (OR 0.9; 95% CI: 0.7-0.9; p=0.045) were significant predictors of mortality. Mechanically-ventilated patients who were under vasoactive support had lower mortality risk when compared to those under mechanical ventilation only (OR 6.0; 95% CI: 1.9-18.2; p=0.001).

Conclusions: Although a small percentage of pediatric oncology patients required PICU admission for cancer-related acute complications, the mortality rate was still high. Mechanical ventilation was the strongest predictor of mortality. The use of vasopressors may be associated with a significant decrease in the mortality of mechanically ventilated children with cancer.

Published Date: 2023-02-06; Received Date: 2023-01-05