Pravin Rr1,2, Enrica Ee Kar Tan2,3,4, Rehena Sultana5, Koh Cheng Thoon2,4,6,7, Mei-Yoke Chan2,3,4,7, Jan Hau Lee2,4,8, Judith Ju-Ming Wong2,4,8. 1. Department of Pediatrics, KK Women's & Children's Hospital, Singapore. 2. Yong Loo Lin School of Medicine, National University of Singapore, Singapore. 3. Department of Pediatric Subspecialties, Pediatric Hematology/Oncology Service, KK Women's & Children's Hospital, Singapore. 4. Duke-NUS Medical School, Singapore. 5. Center for Quantitative Medicine, Duke-NUS Medical School, The Academia, Singapore. 6. Infectious Disease Service, Department of Pediatrics, KK Women's & Children's Hospital, Singapore. 7. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore. 8. Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's & Children's Hospital, Singapore.
Abstract
OBJECTIVE: Pediatric oncology patients admitted to the pediatric intensive care unit (PICU) are at high risk of mortality. This study aims to describe the epidemiology of and the risk factors for mortality in these patients. STUDY DESIGN: This is a retrospective cohort study including all consecutive PICU oncology admissions from 2011 to 2017. Demographic and clinical risk factors between survivors and nonsurvivors were compared. Both univariate and multivariate Cox proportional hazard regression models were used to quantify the association between 60-day mortality and admission categories, accounting for other covariates (Pediatric Risk Of Mortality [PRISM] III score and previous bacteremia). MAIN OUTCOME MEASURES: The primary outcome was 60-day mortality. RESULTS: The median (interquartile range) age and PRISM III scores of pediatric oncology patients admitted to the PICU were 7 (3, 12) years and 3 (0, 5), respectively. The most common underlying oncological diagnoses were brain tumors (73/200 [36.5%]) and acute lymphoblastic leukemia (36/200 [18.0%]). Emergency admissions accounted for approximately half of all admissions (108/200 [54.0%]), including cardiovascular (24/108 [22.2%]), neurology (24/108 [22.2%]), respiratory (22/108 [20.4%]), and "other" indications (38/108 [35.2%]). The overall 60-day mortality was 35 of 200 (17.5%). Independent risk factors for mortality were emergency respiratory and neurology categories of admission (adjusted hazard ratio[aHR]: 5.62, 95% confidence interval [95% CI]: 1.57, 20.19; P = .008 and aHR: 6.96, 95% CI: 2.04, 23.75; P = .002, respectively) and previous bacteremia (aHR: 3.37, 95% CI: 1.57, 7.20; P = .002). CONCLUSION: Emergency respiratory and neurology admissions and previous bacteremia were independent risk factors for 60-day mortality for pediatric oncological patients admitted to the PICU.
OBJECTIVE: Pediatric oncology patients admitted to the pediatric intensive care unit (PICU) are at high risk of mortality. This study aims to describe the epidemiology of and the risk factors for mortality in these patients. STUDY DESIGN: This is a retrospective cohort study including all consecutive PICU oncology admissions from 2011 to 2017. Demographic and clinical risk factors between survivors and nonsurvivors were compared. Both univariate and multivariate Cox proportional hazard regression models were used to quantify the association between 60-day mortality and admission categories, accounting for other covariates (Pediatric Risk Of Mortality [PRISM] III score and previous bacteremia). MAIN OUTCOME MEASURES: The primary outcome was 60-day mortality. RESULTS: The median (interquartile range) age and PRISM III scores of pediatric oncology patients admitted to the PICU were 7 (3, 12) years and 3 (0, 5), respectively. The most common underlying oncological diagnoses were brain tumors (73/200 [36.5%]) and acute lymphoblastic leukemia (36/200 [18.0%]). Emergency admissions accounted for approximately half of all admissions (108/200 [54.0%]), including cardiovascular (24/108 [22.2%]), neurology (24/108 [22.2%]), respiratory (22/108 [20.4%]), and "other" indications (38/108 [35.2%]). The overall 60-day mortality was 35 of 200 (17.5%). Independent risk factors for mortality were emergency respiratory and neurology categories of admission (adjusted hazard ratio[aHR]: 5.62, 95% confidence interval [95% CI]: 1.57, 20.19; P = .008 and aHR: 6.96, 95% CI: 2.04, 23.75; P = .002, respectively) and previous bacteremia (aHR: 3.37, 95% CI: 1.57, 7.20; P = .002). CONCLUSION: Emergency respiratory and neurology admissions and previous bacteremia were independent risk factors for 60-day mortality for pediatric oncological patients admitted to the PICU.
Authors: Saad Ghafoor; Kimberly Fan; Sarah Williams; Amanda Brown; Sarah Bowman; Kenneth L Pettit; Shilpa Gorantla; Rebecca Quillivan; Sarah Schwartzberg; Amanda Curry; Lucy Parkhurst; Marshay James; Jennifer Smith; Kristin Canavera; Andrew Elliott; Michael Frett; Deni Trone; Jacqueline Butrum-Sullivan; Cynthia Barger; Mary Lorino; Jennifer Mazur; Mandi Dodson; Morgan Melancon; Leigh Anne Hall; Jason Rains; Yvonne Avent; Jonathan Burlison; Fang Wang; Haitao Pan; Mary Anne Lenk; R Ray Morrison; Sapna R Kudchadkar Journal: Front Oncol Date: 2021-03-08 Impact factor: 6.244
Authors: Shilpushp J Bhosale; Malini Joshi; Vijaya P Patil; Amol T Kothekar; Sheila Nainan Myatra; Jigeeshu V Divatia; Atul P Kulkarni Journal: Indian J Crit Care Med Date: 2021-10