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Critical Illness and Cardiac Dysfunction in Anthracycline-Exposed Pediatric Oncology Patients
Katie K Wolfe1, Jennifer Reichek, Lauren E Marsillio
1All authors: Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
Insights
Pediatric cancer patients treated with anthracyclines who develop cardiac dysfunction face a higher risk of intensive care unit admission and mortality. Early identification of cardiac issues is crucial for managing critical illness in these young patients.
Area of Science:
- Pediatric Oncology
- Cardiology
- Critical Care Medicine
Background:
- Anthracyclines are crucial chemotherapy agents for pediatric cancers.
- Cardiac dysfunction is a known, serious side effect of anthracycline therapy.
- The impact of anthracycline-induced cardiac dysfunction on pediatric intensive care unit (PICU) admission and mortality requires further investigation.
Purpose of the Study:
- To determine if cardiac dysfunction in pediatric oncology patients exposed to anthracyclines is associated with increased PICU admission or mortality.
- To identify risk factors for critical illness and death in this patient population.
Main Methods:
- Retrospective parallel cohort study design.
- Inclusion of pediatric oncology patients who received anthracyclines between 2006 and 2014.
- Analysis of 545 patient charts to compare outcomes between those with and without cardiac dysfunction.
Main Results:
- Patients with cardiac dysfunction had significantly higher PICU admission rates (87% vs 37%).
- Cardiac dysfunction was linked to increased mortality (26% vs 6%), longer PICU stays, and higher rates of mechanical ventilation.
- Higher cumulative anthracycline dose correlated with death within one year of ICU admission.
Conclusions:
- Pediatric cancer patients receiving anthracyclines, particularly at higher doses, who develop cardiac dysfunction are at increased risk of critical illness and mortality.
- Cardiac dysfunction significantly elevates the risk of adverse outcomes, including multiple organ dysfunction and death.
- This highlights the importance of monitoring cardiac function in pediatric oncology patients undergoing anthracycline treatment.
Objectives:
To determine if the presence of cardiac dysfunction in anthracycline-exposed pediatric oncology patients is associated with an increased frequency of PICU admission or mortality.
Design:
Retrospective parallel cohort study.
Setting:
PICU at an academic freestanding children's hospital.
Subjects:
Children with oncologic diagnoses who received anthracyclines between January 2006 and December 2014 and were admitted to the hospital within 1 year of completion of therapy.
Interventions:
None.
Measurements And Main Results:
Charts of 734 patients were reviewed and 545 were included in analysis. Anthracycline-exposed pediatric oncology patients with cardiac dysfunction were more likely to be admitted to the PICU than those without cardiac dysfunction (87% vs 37% rate of PICU admission). PICU admission was also associated with identified infection and higher cumulative anthracycline dose. Once admitted to the PICU, those anthracycline-exposed patients with cardiac dysfunction had significantly higher mortality (26% vs 6%) and longer length of stay (7 vs 2 d) than children without cardiac dysfunction. Patients with cardiac dysfunction were more likely to require mechanical ventilation (59% vs 18%), required more vasoactive medications for longer, and were more likely to develop fluid overload. Death within 1 year of ICU admission was associated with higher cumulative anthracycline dose.
Conclusions:
Children with cancer who received anthracyclines, especially at higher doses, and who develop cardiac dysfunction are at higher risk of critical illness, have higher rates of multiple organ dysfunction and higher rates of mortality than anthracycline-exposed patients without cardiac dysfunction.
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