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Prognostic factors for multi-organ dysfunction in pediatric oncology patients admitted to the pediatric intensive

Marijn Soeteman1, Marta F Fiocco1,2, Joppe Nijman3

  • 1Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.

Frontiers in Oncology
|July 28, 2023
PubMed

Insights

Pediatric oncology patients admitted to the pediatric intensive care unit (PICU) with new or progressive multi-organ dysfunction (NPMOD) face higher mortality. Key risk factors for NPMOD include hemato-oncological diagnosis, organ failure number, and unplanned admission.

Area of Science:

  • Pediatric Intensive Care
  • Oncology
  • Critical Care Medicine

Background:

  • Pediatric oncology patients admitted to the PICU have poorer outcomes than non-cancer patients.
  • Multi-organ dysfunction (MOD) significantly impacts mortality and morbidity in the PICU.
  • Risk factors for MOD in this vulnerable population remain largely unidentified.

Purpose of the Study:

  • To identify risk factors present at PICU admission that predict new or progressive multi-organ dysfunction (NPMOD) within the first week of PICU stay.
  • To analyze associations between baseline covariates and NPMOD in pediatric oncology patients.
  • To inform early interventions and closer monitoring strategies for high-risk patients.

Main Methods:

  • Retrospective cohort study of pediatric oncology patients (0-18 years) admitted to the PICU from June 2018 to June 2021.
  • Utilized the PODIUM criteria for defining multi-organ dysfunction.
  • Employed multivariable logistic regression to identify risk factors for NPMOD, with internal validation via bootstrap.

Main Results:

  • Included 761 PICU admissions; 20% (154 admissions) developed NPMOD.
  • Patients with NPMOD had a significantly higher mortality rate (14%) compared to those without (1.0%).
  • Independent risk factors for NPMOD included hemato-oncological diagnosis, number of failing organs, and unplanned PICU admission.

Conclusions:

  • Identified key risk factors at PICU admission for NPMOD, aiding in early detection and intervention for pediatric oncology patients.
  • The PODIUM criteria showed potential for refinement in this specific patient group, warranting further validation.
  • Findings support enhanced monitoring and timely interventions for pediatric oncology patients at risk of NPMOD.
Abstract

Keywords:
critical careintensive care unitmulti-organ dysfunctionpediatric oncologyprognosis

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