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Mortality of Hemato-Oncologic Patients Admitted to a Pediatric Intensive Care Unit: A Single-Center Experience

Agnes Pechlaner¹, Gabriele Kropshofer¹, Roman Crazzolara¹

¹Department of Paediatrics, Medical University of Innsbruck, Innsbruck, Austria.

Frontiers in Pediatrics

|July 29, 2022

Insights

Pediatric intensive care unit (PICU) admissions for children with hemato-oncologic disease are increasing. While emergency admissions show high mortality risks, overall outcomes appear better than previously reported.

Area of Science:

Pediatric critical care medicine
Pediatric hematology-oncology
Clinical outcomes research

Background:

Children with hemato-oncologic diseases face higher mortality in the pediatric intensive care unit (PICU).
Reasons for increased mortality in this vulnerable population remain underexplored.
Understanding trends and outcomes is crucial for improving care.

Purpose of the Study:

To assess outcomes and trends of hemato-oncologic patients admitted to the PICU.
To specifically analyze emergency admissions within this cohort.
To identify risk factors associated with mortality in PICU admissions.

Main Methods:

Retrospective analysis of 701 PICU admissions (2009-2019) in children with hemato-oncologic diagnoses.
Inclusion of 6-month and follow-up mortality data until December 2020.
Multivariable analysis to identify independent risk factors for PICU death.

Main Results:

A total of 701 PICU admissions were analyzed; 28.5% were emergency admissions.
Emergency admissions had a patient mortality of 18.0% and an admission mortality of 11.0%.
Severe neutropenia and invasive mechanical ventilation (IMV) were independent risk factors for PICU death (p=0.029 and p=0.002).
Total PICU admissions for these patients significantly increased from 44 (2009) to 125 (2019).

Conclusions:

Despite a high need for intensive organ support in emergency PICU admissions, mortality rates appear lower than previously reported.
The overall number of PICU admissions for hemato-oncologic patients has notably increased over the study period.
Further research into risk factors like severe neutropenia and IMV is warranted.

Read full analysis

Abstract

Introduction:

Mortality in children with hemato-oncologic disease admitted to a pediatric intensive care unit (PICU) is higher compared to the general population. The reasons for this fact remain unexplored. The aim of this study was to assess outcomes and trends in hemato-oncologic patients admitted to a PICU, with analytical emphasis on emergency admissions.

Methods:

Patients with a hemato-oncologic diagnosis admitted to a tertiary care university hospital PICU between 1 January 2009 and 31 December 2019 were retrospectively analyzed. Additionally, patient mortality 6 months after PICU admission and follow-up mortality until 31 December 2020 were recorded.

Measurements And Main Results:

We reviewed a total of 701 PICU admissions of 338 children with hemato-oncologic disease, of which 28.5% were emergency admissions with 200 admissions of 122 patients. Of these, 22 patients died, representing a patient mortality of 18.0% and an admission mortality of 11.0% in this group. Follow-up patient mortality was 25.4% in emergency-admitted children. Multivariable analysis revealed severe neutropenia at admission and invasive mechanical ventilation (IMV) as independent risk factors for PICU death (p = 0.029 and p = 0.002). The total number of PICU admissions of hemato-oncologic patients rose notably over time, from 44 in 2009 to 125 in 2019.

Conclusion:

Although a high proportion of emergency PICU admissions of hemato-oncologic patients required intensive organ support, mortality seemed to be lower than previously reported. Moreover, in this study, total PICU admissions of the respective children rose notably over time.

Keywords:

critically ill children hemato-oncology outcome pediatric intensive care unit (PICU)trends

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