Exploring risk factors for pediatric cancer patients admitted to the Pediatric Intensive Care Unit: insight from a multicenter observational study revealing no association with mechanical ventilation
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Angela Amigoni1, Sara Boscato2, Maria Cristina Mondardini3
1Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy.
Insights
Pediatric cancer patients undergoing stem cell transplantation (HSCT), those with non-solid tumors, and higher PIM-3 scores face increased mortality risk in the pediatric intensive care unit (PICU). Mechanical ventilation use was not linked to higher mortality.
Area of Science:
- Pediatric Oncology
- Critical Care Medicine
- Epidemiology
Background:
- Adverse outcomes in pediatric cancer patients admitted to the pediatric intensive care unit (PICU) require thorough risk factor analysis.
- Understanding these risk factors is crucial for improving patient management and outcomes in critical care settings.
Purpose of the Study:
- To identify and analyze risk factors associated with adverse outcomes in a national sample of pediatric cancer patients admitted to the PICU.
- To investigate factors influencing mortality and length of stay (LOS) in the PICU for this vulnerable population.
Main Methods:
- An observational study utilizing a 4-year (2-year retrospective, 2-year prospective) data collection period in Italian PICUs.
- Inclusion of 518 pediatric cancer patients, with data collected before and during PICU admission.
Main Results:
- In-PICU mortality was 15%, significantly higher in patients who underwent stem cell transplantation (HSCT) (41%) and those with non-solid tumors (25%).
- Pre-PICU mortality risk factors included HSCT, higher Pediatric Overall Performance Category (POPC), and Pediatric Index of Mortality 3 (PIM-3) score.
- In-PICU mortality was associated with multiple organ failure (MOF) and cardiac arrest. Longer PICU LOS correlated with pre-admission conditions like acute respiratory distress syndrome and renal failure, as well as PIM-3 score and duration of mechanical ventilation (MV).
Conclusions:
- Stem cell transplantation (HSCT), non-solid tumors, elevated PIM-3 scores, higher POPC on admission, MOF, and a history of cardiac arrest are linked to poorer outcomes in pediatric cancer patients in the PICU.
- The use of mechanical ventilation (MV) was not found to be associated with increased mortality in this patient group.
Background:
To analyze risk factors for adverse outcomes in a nationally representative sample of pediatric cancer patients admitted to the PICU.
Methods:
An observational study composed of a 2-year retrospective phase and a 2-year prospective phase was conducted before and during PICU admission in Italian PICUs.
Results:
We included 518 patients, median age 7.2 years (IQR 2.5-12.6). Main diagnosis: solid tumors (51%) and acute lymphoblastic leukemia (23%). Nineteen percent underwent stem cell transplantation (HSCT). Main causes of admission were respiratory failure (33%) and neurological impairment (24%). In-PICU mortality was 15%, higher in HSCT (41%) and non-solid cancer (25%). Pre-PICU mortality risk factors included HSCT (OR 3.48, 95%CI 1.5-8.11), higher Pediatric Overall Performance Category (POPC) (OR 1.72, 95%CI 1.23-2.42), and Pediatric Index of Mortality 3 (PIM-3) score (OR 1.03, 95%CI 1.01-1.06). In-PICU mortality risk factors included multiple organ failure (MOF) (OR 4.83, 95%CI 1.66-15.71), and cardiac arrest (OR 82.16, 95%CI 14.19-1594.61). The use of MV does not appear to be associated with increased mortality. Longer PICU LOS was associated with pre-admission acute respiratory distress syndrome (p < 0.001), renal failure (p = 0.024), POPC (p = 0.007) and PIM 3 (p < 0.001), and in-PICU use of total parenteral nutrition (p = 0.036), and duration of mechanical ventilation (MV) (p < 0.001).
Conclusions:
HSCT, non-solid tumor, higher PIM-3, and POPC on admission, MOF, and history of cardiac arrest were associated with poorer outcome. The use of MV does not appear to be associated with increased mortality.
Trial Registration:
ClinicalTrials.gov ID NCT04581655, October 7, 2020.
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