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[Steroid pulse therapy and vital prognosis among pediatric cancer patients with sepsis]

K Oda1, Y Hirota, Y Sakata

  • 1Department of Pediatrics, and Child Health, Kurume University School of Medicine.

Kansenshogaku Zasshi. the Journal of the Japanese Association for Infectious Diseases
|February 3, 2000
PubMed

Insights

Steroid pulse therapy in pediatric sepsis patients was associated with increased mortality, even when conditions like interstitial pneumonia, infection-associated hemophagocytic syndrome, and graft-versus-host disease were present. This therapy may appear beneficial due to underlying conditions, but it independently elevates death risk.

Area of Science:

  • Pediatric critical care medicine
  • Pharmacology and therapeutics
  • Oncology

Context:

  • Sepsis management in pediatric cancer patients remains challenging.
  • The role of glucocorticosteroid therapy in sepsis is debated.
  • Previous studies have not clearly defined the impact of steroid pulse therapy on pediatric sepsis outcomes.

Purpose:

  • To investigate the effect of steroid pulse therapy on the vital prognosis of pediatric patients with sepsis.
  • To analyze mortality predictors in pediatric sepsis patients treated with steroid pulse therapy.
  • To determine the independent association of steroid pulse therapy with cumulative death risk.

Summary:

  • This study reviewed 89 pediatric cancer patients with sepsis, finding a 25% cumulative death rate.
  • Patients receiving steroid pulse therapy had a 100% mortality rate (12/12).
  • Conditions like interstitial pneumonia (IP), infection-associated hemophagocytic syndrome (IAHS), and graft-versus-host disease (GVHD) were associated with higher mortality, but this risk diminished when adjusted for steroid pulse therapy.
  • Steroid pulse therapy itself was independently linked to a significantly increased risk of cumulative death (adjusted RR = 10).

Impact:

  • The findings suggest that steroid pulse therapy may not improve, and could worsen, outcomes in pediatric sepsis patients.
  • The observed association between IP, IAHS, and GVHD with mortality appears to be confounded by the use of steroid pulse therapy.
  • This research highlights the need for careful consideration and further investigation into the use of glucocorticosteroids in pediatric sepsis, particularly in immunocompromised populations.

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