Identifying Risk Factors for PICU Mortality in Pediatric Cancer Patients: A 10-Year Retrospective Study.

Abstract

This 10-year retrospective study of pediatric cancer patients requiring intensive care evaluates mortality risk factors. The data included patients' demographics, cancer types, admission reasons, treatment modalities, and laboratory results. Standardized mortality ratio (SMR), mortality at different intervals, length of stay, and risk factors for death were analyzed. The most common malignancy was leukemia (n=116, 37.0%), followed by noncentral nervous system solid tumors (n=71, 22.6%). The acute kidney injury (AKI) rate was 23.7% (n=74), with 55.4% requiring renal replacement therapy (RRT). RRT indications included tumor lysis syndrome, AKI, fluid overload, and treatment toxicity. 66.7% of leukemia patients and 64.7% of lymphoma patients needed RRT (P=0.012). Three patients underwent extracorporeal membrane oxygenation, one of them was successfully weaned; however, died later due to sepsis. The crude mortality rate was 17.6% (n=47). SMR was 0.51. The highest PICU mortality rate occurred among leukemia patients (19.1%). Multivariate analysis showed that age and invasive mechanical ventilation (IMV) were significantly associated with PICU mortality. NIV was used in 25 patients, and only one patient required intubation. IMV was independently associated with increased mortality (OR: 9.029, 95% CI: 2.921-27.914, P<0.001).