Unraveling mortality risks in pediatric oncology: Exploring bloodstream coinfections and inflammatory biomarkers in COVID-19

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy Pub Date : 2025-05-30 DOI:10.1016/j.jiac.2025.102741

Rasha M. Abdel-Hamid , Rasha M. Allam , Lobna Refaat , Hend A. Nooh , Farida M. Mahmoud , Ahmed Bayoumi , Safaa S. Hassan

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Abstract

Background

Pediatric oncology patients face heightened mortality rates, primarily due to bacteremia exacerbated by the ongoing COVID-19 pandemic. Given hyperinflammation's role in coronavirus pathogenesis and the importance of inflammatory biomarkers in adults, we aim to explore 60-day mortality predictors in children with cancer, where research remains limited. This study aimed to investigate predictors of mortality in pediatric oncology patients with COVID-19, focusing on bacteremia and inflammatory biomarkers.

Methods

Sixty pediatric cancer patients with COVID-19 and 60 with bacteremia (no COVID-19) were included. Bloodstream coinfections were identified, and causative species with antimicrobial sensitivities were characterized. Various inflammatory indices were calculated. Survival analyses identified risk factors for COVID-19 patients’ mortality. Mortality factors in bacteremia patients were examined.

Results

The 60-day OS rate of COVID-19 pediatrics was 81.7 %. Worse outcomes were associated with solid tumors, ICU admission, moderate/severe COVID-19, lymphopenia, high NLR, high CLR, and Gram-negative bacteremia (p-values = 0.002, 0.025, 0.042, 0.013, 0.047, 0.052, and 0.025). Multivariate analysis identified solid tumors, high NLR, and high CLR as independent factors for lower OS (p-values = 0.003, 0.046, and 0.046). Bacteremia was revealed in 24 COVID-19 patients (40 %). In patients with bacteremia (n = 84), non-survivors exhibited higher rates of ICU admission, fever, Gram-negative bacteria (GNB), and elevated CRP (p-values = 0.007, 0.038, <0.001, and 0.006), with multivariate analysis identifying GNB and ICU as independent mortality risk factors (p-values = 0.002 and 0.031). Conclusions: NLR and CLR predict mortality in pediatric oncology patients with COVID-19, with solid tumors heightening risk. Infection severity, GNB, and patient condition significantly influence outcomes of bacteremia cancer patients.

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揭示儿科肿瘤学的死亡风险：探索COVID-19的血液共感染和炎症生物标志物。

背景：儿科肿瘤患者面临着更高的死亡率，主要是由于持续的COVID-19大流行加剧了菌血症。鉴于过度炎症在冠状病毒发病机制中的作用以及炎症生物标志物在成人中的重要性，我们的目标是探索儿童癌症患者60天死亡率预测因子，这方面的研究仍然有限。本研究旨在探讨COVID-19儿童肿瘤患者的死亡率预测因素，重点关注菌血症和炎症生物标志物。方法：选取60例小儿肿瘤合并COVID-19患者和60例合并菌血症（未合并COVID-19）患者。血流共感染鉴定，病原物种与抗菌药物敏感性表征。计算各种炎症指数。生存分析确定了COVID-19患者死亡的危险因素。检查菌血症患者的死亡因素。结果：新冠肺炎患儿患儿60天生存率为81.7%。较差的预后与实体肿瘤、ICU住院、中/重度COVID-19、淋巴细胞减少、高NLR、高CLR和革兰氏阴性菌血症相关（p值=0.002、0.025、0.042、0.013、0.047、0.052和0.025）。多因素分析发现，实体肿瘤、高NLR和高CLR是降低OS的独立因素（p值分别为0.003、0.046和0.046）。24例（40%）出现菌血症。在菌血症患者（n=84）中，非幸存者表现出更高的ICU入院率、发热率、革兰氏阴性菌（GNB）率和CRP升高率（p值分别为0.007、0.038）。结论：NLR和CLR可预测儿童肿瘤学COVID-19患者的死亡率，实体瘤增加了风险。感染严重程度、GNB和患者状况显著影响菌血症癌症患者的预后。

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来源期刊

Journal of Infection and Chemotherapy INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY

CiteScore

4.10

自引率

4.50%

发文量

303

审稿时长

47 days

期刊介绍： The Journal of Infection and Chemotherapy (JIC) — official journal of the Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases — welcomes original papers, laboratory or clinical, as well as case reports, notes, committee reports, surveillance and guidelines from all parts of the world on all aspects of chemotherapy, covering the pathogenesis, diagnosis, treatment, and control of infection, including treatment with anticancer drugs. Experimental studies on animal models and pharmacokinetics, and reports on epidemiology and clinical trials are particularly welcome.