Related Experiment Video
Updated: Aug 16, 2026
Robot-Assisted Laparoscopic Splenectomy In Children: A Case Report with Literature Review
Published on: March 27, 2026
Outcome of severe sepsis in pediatric oncology patients
Richard T Fiser1, Nancy K West, Andrew J Bush
1Pediatric Critical Care and Cardiology, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR 72202-3591, USA.
Insights
Pediatric oncology patients with severe sepsis had a 17% intensive care unit (ICU) mortality rate overall. Higher acuity patients faced greater risks, with outcomes linked to bone marrow transplant status, fungal infections, and ventilation needs.
Area of Science:
- Pediatric critical care medicine
- Pediatric oncology
- Infectious diseases
Background:
- Severe sepsis poses a significant threat to pediatric oncology patients, a vulnerable population.
- Understanding survival outcomes in this group is crucial for optimizing treatment strategies.
Purpose of the Study:
- To determine intensive care unit (ICU) discharge and 6-month survival rates for pediatric oncology patients with severe sepsis.
- To identify factors associated with mortality in this high-risk cohort.
Main Methods:
- Retrospective analysis of pediatric oncology patients admitted to a single pediatric ICU between 1990 and 2002.
- Inclusion criteria included severe sepsis and specific fluid resuscitation or inotropic support.
- Data collected encompassed demographics, cancer details, ICU scores, interventions, and survival outcomes.
Main Results:
- Overall ICU mortality was 17% (76/446 admissions), with higher rates in post-bone marrow transplant (BMT) patients (30%) compared to non-BMT patients (12%).
- Patients requiring both mechanical ventilation and inotropic support had a 64% ICU mortality rate.
- Six-month survival was 69% for non-BMT patients versus 39% for BMT patients.
- Fungal sepsis, BMT status, use of multiple inotropes, and Pediatric Risk of Mortality III score were significant predictors of ICU mortality in high-acuity patients.
Conclusions:
- Despite a 17% overall ICU mortality, severe sepsis outcomes in pediatric oncology patients are variable.
- Aggressive ICU interventions are warranted, given the encouraging survival rates, particularly for those surviving ICU discharge.
- Identifying specific risk factors like fungal infections and BMT status can guide targeted management.
Objective:
To describe survival to intensive care unit (ICU) discharge and 6-month survival in a large cohort of pediatric oncology patients with severe sepsis.
Design:
Retrospective analysis.
Setting:
The ICU of a single pediatric oncology center.
Patients:
Patients with cancer admitted to the ICU of St. Jude Children's Research Hospital between January 1, 1990, and December 31, 2002, who met the following criteria: 1) severe sepsis by ACCP/SCCM (American College of Chest Physicians/Society of Critical Care Medicine) Consensus Conference criteria and 2) receipt of fluid boluses of > or =30 mL/kg to correct hypoperfusion or receipt of a dopamine infusion of >5 microg.kg.min for inotropic support.
Interventions:
None.
Measurements And Main Results:
Data evaluated were demographic variables, oncologic diagnosis and time from diagnosis to ICU admission, Pediatric Risk of Mortality III score and absolute neutrophil count at admission, use of inotropes or pressors, use of mechanical ventilation, maximum organ system failure score, blood culture results, survival to ICU discharge, and 6-month survival. We identified 446 ICU admissions of 359 eligible patients. Overall ICU mortality was 76 of 446 (17%): 40 of 132 (30%) in post-bone marrow transplant (BMT) admissions and 36 of 314 (12%) in non-BMT admissions (p < .0001). In the 106 admissions requiring both mechanical ventilation and inotropic support, ICU mortality was 68 of 106 (64%). Regarding individual patients, 6-month survival was 170 of 248 (69%) among non-BMT patients vs. 43 of 111 (39%) for BMT patients (p < .001). When the 38 patients who survived to ICU discharge after requiring both mechanical ventilation and inotropic/vasopressor support are considered, 27 (71%) were alive 6 months after ICU discharge (22 of 27 [81%] non-BMT vs. 5 of 27 BMT [19%; p < .001]). ICU mortality varied by causative pathogen, from 63% for fungal sepsis (12 of 19) to 9% (5 of 53) for Gram-negative sepsis. Logistic regression analysis of factors significantly associated with ICU mortality in admissions requiring both mechanical ventilation and inotropic support identified four variables: BMT (odds ratio, 2.9; 95% confidence interval, 1.1-7.4; p = .03); fungal sepsis (odds ratio, 10.7; 95% confidence interval, 1.2-94.4; p = .03); use of multiple inotropes (odds ratio, 4.1; 95% confidence interval, 1.4-11.8; p = .01); and Pediatric Risk of Mortality III score (odds ratio, 1.1; 95% confidence interval, 1.0-1.2; p = .04).
Conclusions:
In a large series of pediatric oncology patients with severe sepsis, ICU mortality was only 17% overall, although mortality remained quite high in the higher acuity patients. Mortality among the higher acuity patients was significantly associated with only a small number of variables. The number of patients alive at 6 months and the encouraging ICU survival rate further justifies the use of aggressive ICU interventions in this population.
