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

TL;DR

This study identifies risk factors for mortality and longer stays in pediatric cancer patients admitted to intensive care units, finding that mechanical ventilation is not linked to higher mortality.

Contribution

The study reveals that mechanical ventilation is not associated with increased mortality in pediatric cancer ICU patients, challenging prior assumptions.

Findings

Higher mortality risk is linked to stem cell transplantation, non-solid tumors, and higher PIM-3 and POPC scores.

Mechanical ventilation does not increase mortality, but longer ICU stays are associated with pre-admission conditions and ventilation duration.

Multiple organ failure and cardiac arrest history are strong in-ICU mortality risk factors.

Abstract

To analyze risk factors for adverse outcomes in a nationally representative sample of pediatric cancer patients admitted to the PICU.

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.

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).

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.

ClinicalTrials.gov ID NCT04581655, October 7, 2020.