The death risk of pediatric patients with cancer-related sepsis requiring continuous renal replacement therapy: a retrospective cohort study

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria Pub Date : 2024-05-24 DOI:10.1016/j.jped.2024.04.004

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引用次数: 0

Abstract

Objective

To assess the outcome of patients with cancer-related sepsis requiring continuous renal replacement therapy (CRRT) in a single-center pediatric intensive care unit (PICU).

Method

Children with sepsis who necessitate CRRT from January 2017 to December 2021 were enrolled. The patients with leukemia/lymphoma or solid tumors were defined as underlying cancer. Multivariate logistic regression analysis was performed to identify the death risk factors in patients with cancer-related sepsis.

Results

A total of 146 patients were qualified for inclusion. Forty-six (31.5%) patients with cancer-related sepsis and 100 (68.5%) non-cancer-related sepsis. The overall PICU mortality was 28.1% (41/146), and mortality was significantly higher in cancer-related sepsis patients compared with non-cancer patients (41.3% vs. 22.0%, p = 0.016). Need mechanical ventilation, p-SOFA, acute liver failure, higher fluid overload at CRRT initiation, hypoalbuminemia, and high inotropic support were associated with PICU mortality in cancer-related sepsis patients. Moreover, levels of IL-6, total bilirubin, creatinine, blood urea nitrogen, and international normalized ratio were significantly higher in non-survivors than survivors. In multivariate logistic regression analysis, pediatric sequential organ failure assessment (p-SOFA) score (OR:1.805 [95%CI: 1.047–3.113]) and serum albumin level (OR: 0.758 [95%CI: 0.581 -0.988]) were death risk factors in cancer-related sepsis receiving CRRT, and the AUC of combined index of p-SOFA and albumin was 0.852 (95% CI: 0.730–0.974).

Conclusion

The overall PICU mortality is high in cancer-related sepsis necessitating CRRT. Higher p-SOFA and lower albumin were independent risk factors for PICU mortality.

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需要持续肾脏替代治疗的癌症相关败血症儿科患者的死亡风险：一项回顾性队列研究

目的评估单中心儿科重症监护病房（PICU）中需要进行持续肾脏替代治疗（CRRT）的癌症相关脓毒症患者的预后。方法纳入 2017 年 1 月至 2021 年 12 月期间需要进行 CRRT 的脓毒症患儿。白血病/淋巴瘤或实体瘤患者被定义为基础癌症。为确定癌症相关脓毒症患者的死亡风险因素，进行了多变量逻辑回归分析。其中46例（31.5%）为癌症相关脓毒症患者，100例（68.5%）为非癌症相关脓毒症患者。PICU 的总死亡率为 28.1%（41/146），与非癌症患者相比，癌症相关脓毒症患者的死亡率明显更高（41.3% 对 22.0%，P = 0.016）。癌症相关脓毒症患者需要机械通气、p-SOFA、急性肝功能衰竭、CRRT 开始时液体超负荷较高、低白蛋白血症和高肌力支持与 PICU 死亡率相关。此外，未存活患者的 IL-6、总胆红素、肌酐、血尿素氮和国际标准化比率水平明显高于存活者。在多变量逻辑回归分析中，儿科序贯器官衰竭评估（p-SOFA）评分（OR：1.805 [95%CI：1.047-3.113]）和血清白蛋白水平（OR：0.758 [95%CI：0.581 -0.结论需要接受CRRT的癌症相关脓毒症患者的PICU总死亡率较高。高 p-SOFA 和低白蛋白是 PICU 死亡率的独立风险因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Jornal de pediatria 医学-小儿科

CiteScore

5.60

自引率

3.00%

发文量

审稿时长

43 days

期刊介绍： Jornal de Pediatria is a bimonthly publication of the Brazilian Society of Pediatrics (Sociedade Brasileira de Pediatria, SBP). It has been published without interruption since 1934. Jornal de Pediatria publishes original articles and review articles covering various areas in the field of pediatrics. By publishing relevant scientific contributions, Jornal de Pediatria aims at improving the standards of pediatrics and of the healthcare provided for children and adolescents in general, as well to foster debate about health.