Epidemiology and Predictors of Hospital Outcomes of Critically Ill Pediatric Oncology Patients: A Retrospective Study
Shilpushp J Bhosale, Malini Joshi, Vijaya P Patil
Critical care oncology, Hematooncology, Hospital mortality, ICU mortality, ICU outcomes, Intensive care in pediatric cancer, Pediatric cancers, Solid tumors
Citation Information :
Bhosale SJ, Joshi M, Patil VP. Epidemiology and Predictors of Hospital Outcomes of Critically Ill Pediatric Oncology Patients: A Retrospective Study. Indian J Crit Care Med 2021; 25 (10):1183-1188.
Background: The number of pediatric oncology patients admitted to the intensive care unit (ICU) has increased, and their hospital outcomes are improving. Since scarce data are available about this patient population, we conducted this retrospective study to evaluate the epidemiology and predictors of hospital outcomes.
Materials and methods: We included all children with cancers who were admitted to our ICU over 1 year. We excluded children admitted after elective surgery and those following bone marrow transplant. We collected data about demographics, admission diagnosis, type of malignancies, and ICU interventions. The primary outcome was the hospital outcome. The secondary outcomes were ICU length of stay (LOS), and ICU and hospital mortality. We analyzed the predictors of hospital outcome.
Results: Two hundred pediatric oncology patients were admitted from November 1, 2014 to October 30, 2015. Seventy-eight children had solid organ malignancies, and the rest had hematological malignancies. Hematooncology malignancy patients had significantly higher hospital mortality than those with solid organ malignancies. (61.5 vs 34.6%, p = 0.015). On multivariate regression analysis, mechanical ventilation [odds ratio (OR), 14.64; 95% confidence interval (CI): 1.23–165.05; p <0.030], inotropes (OR, 9.81; 95% CI: 1.222–78.66; p <0.032), and the presence of coagulopathy (OR, 3.86; 95% CI: 1.568–9.514; p <0.003) were independent predictors of hospital mortality.
Conclusion: In this retrospective cohort of 200 children with malignancies, we found that children with hematologic cancer had significantly higher hospital mortality as compared to those with solid tumors. The need for mechanical ventilation, use of inotrope infusion, and coagulopathy were independent predictors of mortality.
Van Veen A, Karstens A, van der Hoek AC, Tibboel D, Hählen K, van der Voort E, et al. The prognosis of oncologic patients in the pediatric intensive care unit. Intensive Care Med 1996;22(3):41. DOI: 10.1007/BF01712243.
Hallahan AR, Shaw PJ, Rowell G, O'Connell A, Schell D, Gillis J. Improved outcomes of children with malignancy admitted to a pediatric intensive care unit. Crit Care Med 2000;28(11):3718–3722. DOI: 10.1097/00003246-200011000-00030.
Rr P, Tan EEK, Sultana R, Thoon KC, Chan MY, Lee JH, et al. Critical illness epidemiology and mortality risk in pediatric oncology. Pediatr Blood Cancer 2020;67(6):e28242. DOI: 10.1002/pbc.28242.
Tilford JM, Roberson PK, Lensing S, Fiser DH. Differences in pediatric ICU mortality risk over time. Crit Care Med 1998;26(10):1737–1743. DOI: 10.1097/00003246-199810000-00032.
Wösten-van Asperen RM, van GestelJPJ, van Grotel M, Tschiedel E, Dohna-Schwake C, Valla FV, et al. POKER (PICU Oncology Kids in Europe Research group) research consortium. PICU mortality of children with cancer admitted to pediatric intensive care unit a systematic review and meta-analysis. Crit Rev Oncol Hematol 2019;142:153–163. DOI: 10.1016/j.critrevonc.2019.07.014.
Butt W. What is the outcome of children admitted to intensive care? This is the most important question we need to answer! Pediatr Crit Care Med 2017;18(3):292–293. DOI: 10.1097/PCC.0000000000001080.
Butt W, Barker G, Walker C, Gillis J, Kilham H, Stevens M. Outcome of children with hematologic malignancy who are admitted to an intensive care unit. Crit Care Med 1988;16(8):761–764. DOI: 10.1097/00003246-198808000-00005.
Verlaat CW, Wubben N, Visser IH, Hazelzet JA, van der Hoeven J, Lemson J, et al. SKIC (Dutch collaborative PICU research network). Retrospective cohort study on factors associated with mortality in high-risk pediatric critical care patients in the Netherlands. BMC Pediatr 2019;19(1):274. DOI: 10.1186/s12887-019-1646-9.
Ali AM, Sayed HA, Mohammed MM. The outcome of critically ill pediatric cancer patients admitted to the pediatric intensive care unit in a tertiary university oncology center in a developing country: a 5-year experience. J Pediatr Hematol Oncol 2016;38(5):355–359. DOI: 10.1097/MPH.0000000000000523.
Zinter MS, DuBois SG, Spicer A, Matthay K, Sapru A. Pediatric cancer type predicts infection rate, need for critical care intervention, and mortality in the pediatric intensive care unit. Intensive Care Med 2014;40(10):1536–1544. DOI: 10.1007/s00134-014-3389-2.
López-Herce J, Sancho L, Martinón JM. Study of paediatric intensive care units in Spain. Spanish Society of Paediatric Intensive Care. Intensive Care Med 2000;26(1):62–68. DOI: 10.1007/s001340050013.
Garrido MM, Garrido RQ, Cunha TN, Ehrlich S, Martins IS. Comparison of epidemiological, clinical and microbiological characteristics of bloodstream infection in children with solid tumours and haematological malignancies. Epidemiol Infect 2019;147:e298. DOI: 10.1017/S0950268819001845.
Akhtar N, Fadoo Z, Panju S, Haque A. Outcome and prognostic factors seen in pediatric oncology patients admitted in PICU of a developing country. Indian J Pediatr 2011;78(8):969–972. DOI: 10.1007/s12098-011-0391-3.
Ben Abraham R, Toren A, Ono N, Weinbroum AA, Vardi A, Barzilay Z, et al. Predictors of outcome in the pediatric intensive care units of children with malignancies. J Pediatr Hematol Oncol 2002;24(1): 23–26. DOI: 10.1097/00043426-200201000-00007.
Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, et al. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 2001;344(7):481–487. DOI: 10.1056/NEJM200102153440703.
Pancera CF, Hayashi M, Fregnani JH, Negri EM, Deheinzelin D, de Camargo B. Noninvasive ventilation in immunocompromised pediatric patients: eight years of experience in a pediatric oncology intensive care unit. J Pediatr Hematol Oncol 2008;30(7):533–538. DOI: 10.1097/MPH.0b013e3181754198.
Piastra M, De Luca D, Marzano L, Stival E, Genovese O, Pietrini D, Conti G. The number of failing organs predicts non-invasive ventilation failure in children with ALI/ARDS. Intensive Care Med 2011;37(9):1510–1516. DOI: 10.1007/s00134-011-2308-z.
García-Salido A, Mastro-Martínez I, Cabeza-Martín B, Oñoro G, Nieto-Moro M, Iglesias-Bouzas MI, et al. Respiratory failure in children with hemato-oncological diseases admitted to the PICU: a single-center experience. J Pediatr Hematol Oncol 2015;37(6):449–454. DOI: 10.1097/MPH.0000000000000377.
Tamburro RF, Barfield RC, Shaffer ML, Rajasekaran S, Woodard P, Morrison RR, et al. Changes in outcomes (1996–2004) for pediatric oncology and hematopoietic stem cell transplant patients requiring invasive mechanical ventilation. Pediatr Crit Care Med 2008;9(3): 270–277. DOI: 10.1097/PCC.0b013e31816c7260.
Dursun O, Hazar V, Karasu GT, Uygun V, Tosun O, Yesilipek A. Prognostic factors in pediatric cancer patients admitted to the pediatric intensive care unit. J Pediatr Hematol Oncol 2009;31(7):481–484. DOI: 10.1097/MPH.0b013e3181a330ef.
Ghimire S, Ravi S, Budhathoki R, Arjyal L, Hamal S, Bista A, et al. Current understanding and future implications of sepsis induced thrombocytopenia. Eur J Haematol 2021;106(3):301–305. DOI: 10.1111/ejh.13549.
Yang R, Moosavi L. Prothrombin time [updated July 10, 2020]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544269/.
Parker RI. Coagulopathies in the PICU: DIC and liver disease. Crit Care Clin 2013;29(2):319–333. DOI: 10.1016/j.ccc.2012.12.003.