Risk factors for sepsis-related death in children and adolescents with hematologic and malignant diseases

Area of Science:

• Pediatric Hematology
• Oncology
• Infectious Diseases
• Critical Care Medicine

Background:

• Sepsis poses a significant mortality risk in pediatric patients with hematologic and malignant disorders.
• Identifying specific risk factors is crucial for improving outcomes in this vulnerable population.

Purpose of the Study:

• To elucidate the risk factors associated with mortality in pediatric patients diagnosed with sepsis and underlying hematologic or malignant conditions.
• To identify clinical and laboratory features that predict sepsis-related death in this patient cohort.

Main Methods:

• A retrospective analysis of 134 sepsis episodes in 90 pediatric patients (June 2006-March 2014) with hematologic/malignant diseases.
• Comparison of clinical and laboratory features between patients who died within 14 days of sepsis onset (sepsis-related death) and survivors.
• Univariate and multivariate analyses were employed to identify significant risk factors for mortality.

Main Results:

• Relapsed or refractory underlying disease and high C-reactive protein (CRP) levels (≥50 mg/L) at fever onset were significant predictors of sepsis-related death (p<0.01).
• Hematopoietic stem cell transplantation and changes in initial antibiotic therapy were also associated with increased mortality risk.
• Gram-positive cocci resistant to beta-lactam antibiotics, but sensitive to vancomycin, accounted for over half of sepsis-related deaths.

Conclusions:

• A history of relapse, refractory disease state, and elevated CRP levels at fever onset are key risk factors for sepsis mortality in pediatric cancer patients.
• Early administration of vancomycin may enhance survival rates for pediatric patients with hematologic malignancies who develop sepsis and present with identified risk factors.