Multiple Organ Dysfunction and Critically Ill Children With Acute Myeloid Leukemia: Single-Center Retrospective
Mary Gaugler1, Nathan Swinger2, April L Rahrig3
1Department of Pediatrics, Division of General Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN.
Insights
Pediatric acute myeloid leukemia (AML) patients frequently need intensive care, with over half of pediatric intensive care unit (PICU) admissions experiencing multiple organ dysfunction syndrome (MODS). MODS is linked to longer PICU stays, and respiratory failure predicts worse outcomes.
Area of Science:
- Pediatric Hematology
- Critical Care Medicine
- Oncology
Background:
- Acute myeloid leukemia (AML) is a significant pediatric cancer requiring intensive care.
- Multiple organ dysfunction syndrome (MODS) is a serious complication in critically ill children.
- Understanding MODS prevalence and critical care needs in pediatric AML patients is crucial for improving outcomes.
Purpose of the Study:
- To determine the incidence of MODS in pediatric and young adult AML patients not undergoing hematopoietic cell transplantation (HCT).
- To describe critical care utilization patterns in this patient population.
- To identify factors associated with adverse outcomes in AML patients admitted to the PICU.
Main Methods:
- Retrospective cohort study design.
- Inclusion of patients aged 1 month to 26 years treated for AML between 2011 and 2019.
- Definition of MODS as dysfunction in two or more organ systems within 72 hours of PICU admission.
Main Results:
- Out of 80 AML patients, 71 PICU admissions were analyzed. MODS occurred in 75% of PICU admissions within 72 hours.
- Hematologic, respiratory, and cardiovascular systems were most commonly affected. Renal and respiratory failure rates increased during PICU stay.
- MODS on day 1 of PICU admission correlated with longer PICU length of stay (LOS) and increased risk of prolonged LOS. Respiratory failure on admission was also linked to increased LOS.
Conclusions:
- Pediatric AML patients frequently require intensive care, often complicated by MODS.
- MODS in the PICU is associated with significantly longer hospital stays.
- Respiratory failure is a key predictor of MODS development, progression, and prolonged PICU LOS in AML patients.
Objectives:
To describe the prevalence of multiple organ dysfunction syndrome (MODS) and critical care utilization in children and young adults with acute myeloid leukemia (AML) who have not undergone hematopoietic cell transplantation (HCT).
Design:
Retrospective cohort study of MODS (defined as dysfunction of two or more organ systems) occurring any day within the first 72 hours of PICU admission.
Setting:
Large, quaternary-care children's hospital.
Patients:
Patients 1 month through 26 years old who were treated for AML from 2011-2019.
Interventions:
None.
Measurements And Main Results:
Eighty patients with AML were included. These 80 patients had a total of 409 total non-HCT-related hospital and 71 PICU admissions. The majority 53 of 71 of PICU admissions (75%) were associated with MODS within the first 72 hours. MODS was present in 49 of 71 of PICU admissions (69%) on day 1, 29 of 52 (56%) on day 2, and 25 of 32 (78%) on day 3. The organ systems most often involved were hematologic, respiratory, and cardiovascular. There was an increasing proportion of renal failure (8/71 [11%] on day 1 to 8/32 [25%] on day 3; p = 0.02) and respiratory failure (33/71 [47%] to 24/32 [75%]; p = 0.001) as PICU stay progressed. The presence of MODS on day 1 was associated with a longer PICU length of stay (LOS) (β = 5.4 [95% CI, 0.7-10.2]; p = 0.024) and over a six-fold increased risk of an LOS over 2 days (odds ratio, 6.08 [95% CI, 1.59-23.23]; p = 0.008). Respiratory failure on admission was associated with higher risk of increased LOS.
Conclusions:
AML patients frequently require intensive care. In this cohort, MODS occurred in over half of PICU admissions and was associated with longer PICU LOS. Respiratory failure was associated with the development of MODS and progressive MODS, as well as prolonged LOS.
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