Characteristics and Outcomes of Pediatric Septic Patients With Cancer: A Retrospective Cohort Study
Gilbert Abou Dagher1, Rawan Safa1, Karim Hajjar1
1Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Insights
Pediatric sepsis patients with cancer had higher bacteremia rates and received more aggressive treatment, though mortality did not significantly differ from non-cancer patients. This study highlights key differences in sepsis presentation and management for pediatric oncology patients.
Area of Science:
- Pediatric Sepsis Research
- Oncology Patient Care
- Infectious Disease Epidemiology
Background:
- Pediatric oncology patients face elevated risks for sepsis complications and mortality compared to non-oncology counterparts.
- Understanding these disparities is crucial for improving outcomes in vulnerable pediatric populations.
Purpose of the Study:
- To compare the characteristics, treatment strategies, and sepsis-related mortality between pediatric oncology and non-oncology patients presenting to the emergency department.
- To identify specific differences in clinical presentation, management, and outcomes.
Main Methods:
- A retrospective, single-center cohort study included 158 pediatric patients (<18 years) diagnosed with sepsis, severe sepsis, septic shock, or bacteremia between 2009 and 2015.
- Data collected included demographics, clinical presentation, vital signs, laboratory results, infection site, treatment parameters (fluids, vasopressors, antibiotics), and length of stay.
- In-hospital mortality was the primary outcome, with secondary outcomes focusing on resuscitation and management variables.
Main Results:
- While oncology patients exhibited higher in-hospital mortality (5.9% vs. 2.7%), this difference was not statistically significant (p=0.45).
- Oncology patients presented with lower respiratory rates (p=0.04) but higher white blood cell counts (p<0.001).
- They received more aggressive treatment, including increased intravenous fluids (p=0.029), vasopressor administration (p=0.002), and earlier antibiotic initiation (p<0.0001).
- Cancer patients had a higher incidence of bacteremia (27.1% vs. 4.1%, p<0.001), whereas cancer-free patients had more lung infections (68.5% vs. 32.9%, p<0.0001).
Conclusions:
- No statistically significant difference in mortality was observed between pediatric oncology and non-oncology sepsis patients.
- Pediatric cancer patients demonstrated a higher incidence of bacteremia and were managed with more aggressive therapeutic interventions.
- Findings underscore the need for tailored sepsis management protocols for pediatric oncology patients.
Background:
Pediatric oncology patients may be at a higher risk of complications and mortality from sepsis compared with their nononcology counterpart.
Objectives:
The aim of this study is to compare characteristics, treatment, and sepsis-related mortality between oncology and nononcology patients presenting to the emergency department (ED).
Methods:
This is a retrospective single-center cohort study including patients <18 years old with a diagnosis of sepsis, severe sepsis, septic shock, or bacteremia presenting to an academic ED between January 2009 and January 2015. A total of 158 patients were included with 53.8% having an underlying malignancy. The primary outcome of the study was in-hospital mortality. Secondary outcomes included ED vital signs, resuscitation parameters, laboratory work, infection site, general practitioner unit, intensive care unit length of stay, and hospital length of stay.
Results:
Oncology patients had a higher in-hospital mortality (5.9% vs. 2.7%), however, it did not meet statistical significance (p = 0.45). On presentation, oncology patients had a lower respiratory rate (24.33 ± 9.48 vs. 27.45 ± 7.88; p = 0.04). There was a significant increase in the white blood count in oncology patients (4.011 ± 4.965 vs. 17.092 ± 12.806; p < 0.001) with this cohort receiving more intravenous fluids. In the first 6 hours (33.0 ± 27.7 mL/kg vs. 24.9 ± 16.1 mL/kg; p = 0.029) as well as having a higher percentage of vasopressor administration (15.3% vs. 1.4%; p = 0.002). Antibiotics were initiated at an earlier stage in the oncology cohort (1.25 ± 1.95 vs. 3.33 ± 1.97 hours; p < 0.0001). Cancer-free patients had a significantly higher rate of lung infections compared with cancer patients (68.5% vs. 32.9%; p < 0.0001). In terms of infection characteristics, cancer patients had a higher percentage of bacteremia (27.1% vs. 4.1%; p < 0.001).
Conclusion:
There was no statistical significance regarding mortality between the 2 cohorts. Pediatric cancer patients were found to have a higher incidence of bacteremia and received more aggressive treatment.
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