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.

Abstract

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.