Related Experiment Video
Updated: Aug 23, 2025
A Controlled Mouse Model for Neonatal Polymicrobial Sepsis
Published on: January 27, 2019
Children with malignancies and septic shock - an attempt to understand the risk factors
Rafael T Azevedo1, Orlei R Araujo1, Antonio S Petrilli1
1Universidade Federal de São Paulo (UNIFESP), Instituto de Oncologia Pediátrica (IOP), Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), São Paulo, SP, Brazil.
Insights
Cancer recurrence increases sepsis death risk in children. Early fluid resuscitation (2-6% body weight) may reduce mortality. This study highlights key factors in pediatric septic shock outcomes.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Critical Care Medicine
Background:
- Septic shock poses a significant threat to children with cancer, often leading to high mortality rates.
- Understanding risk factors and protective measures is crucial for improving outcomes in this vulnerable population.
Purpose of the Study:
- To elucidate the factors contributing to the high mortality rate of septic shock in pediatric cancer patients.
- To identify predictors of early and in-hospital death in this cohort.
Main Methods:
- Retrospective cohort study of 139 children (0-18 years) with septic shock from 2016-2020.
- Analysis included patient demographics, diagnoses, blood culture results, clinical variables, and outcomes.
- A LASSO regression model was used to predict early death, and survival analyses were performed.
Main Results:
- Acute lymphocytic leukemia was the most common diagnosis; Gram-negative bacteria were frequent isolates.
- Overall ICU mortality was 41%, with 10 early deaths within 24 hours.
- Cancer recurrence independently predicted in-hospital death. A fluid balance of 2-6% body weight in the first 24 hours was associated with reduced mortality (HR 0.47).
Conclusions:
- Recurrence of cancer is a critical risk factor for sepsis-related mortality in children.
- Early administration of fluids (2-6% body weight) within 24 hours of sepsis onset is linked to improved survival outcomes.
Objectives:
To explain the high mortality of septic shock in children with cancer.
Methods:
A retrospective cohort from 2016 to 2020, of children aged 0 to 18 years, and septic shock.
Results:
The authors included 139 patients. Acute lymphocytic leukemia was the most frequent diagnosis (16.5%), and Gram-negative bacteria were the most frequent blood culture isolates (22.3%). There were 57 deaths in ICU (41%), 10 in the first 24 hours of shock (early death). A LASSO model with variables: neutropenia (coefficient 0.215), respiratory (0.81), hematological (1.41), and neurological (0.72) dysfunctions, age (-0.002) and solid tumor recurrence (0.34) generated AUC = 0.79 for the early death outcome. Survivors had significant differences in the PRISM-IV score (mean ± SD 10.9 ± 6.2 in the survivors, 14.1 ± 6.5 in the deceased, p = 0.004), and in the mean number of organ dysfunctions (3.2 ± 1.1 in the survivors, 3.8 ± 6.5 in the deceased, p < 0.001). A positive fluid balance in the first 24 hours of sepsis between 2% and 6% of body weight showed a reduction effect on the probability of death in ICU (hazard ratio 0.47, 95% CI 0.24-0.92, p = 0.027). The recurrence of any cancer was a predictor of in-hospital death, regardless of severity.
Conclusions:
Recurrence of any cancer is an important risk of sepsis-related death. A positive fluid balance between 20 and 60 mL/kg or 2% and 6% of body weight in the first 24 hours after the onset of sepsis is related to lower mortality.
Related Concept Videos
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:30Pneumonia III: Complications and Assessment
01:29Psychological and Sociocultural Causes of Schizophrenia
01:29Acute Kidney Injury II: Pathophysiology
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...