Clinical Characteristics and Outcomes of Pediatric Oncology Patients Admitted to the Pediatric Intensive Care Unit: A Single Center Experience in Saudi Arabia

TL;DR

This study examines the clinical outcomes of pediatric cancer patients in Saudi Arabia's PICU, finding that sepsis and respiratory failure are common admission reasons and that mechanical ventilation and prior treatments strongly predict mortality.

Contribution

The study provides new insights into PICU outcomes for pediatric oncology patients in Saudi Arabia, identifying key predictors of mortality not captured by standard severity scores.

Findings

Sepsis and respiratory failure were the leading causes of PICU admission among pediatric oncology patients.

Mechanical ventilation and prior therapeutic interventions were the strongest independent predictors of mortality.

The PRISM-IV score was not significantly associated with mortality in adjusted analysis.

Abstract

What are the main findings?
Sepsis and respiratory failure were the leading reasons for PICU admission among pediatric oncology patients, with hematologic malignancies representing the majority of cases.Mechanical ventilation and prior therapeutic interventions were the strongest independent predictors of mortality, whereas PRISM-IV score was not associated with mortality in adjusted analysis.

Sepsis and respiratory failure were the leading reasons for PICU admission among pediatric oncology patients, with hematologic malignancies representing the majority of cases.

Mechanical ventilation and prior therapeutic interventions were the strongest independent predictors of mortality, whereas PRISM-IV score was not associated with mortality in adjusted analysis.

What are the implications of the main findings?
Early recognition of high-risk patients and rapid initiation of organ-supportive therapies are crucial to improving survival in pediatric oncology patients requiring intensive care.Reliance on general severity scoring tools may be insufficient; targeted risk-stratification strategies may be needed to better identify children at greatest risk of deterioration.

Early recognition of high-risk patients and rapid initiation of organ-supportive therapies are crucial to improving survival in pediatric oncology patients requiring intensive care.

Reliance on general severity scoring tools may be insufficient; targeted risk-stratification strategies may be needed to better identify children at greatest risk of deterioration.

Background/Objectives: Advances in pediatric oncology have improved survival; however, critically ill children with cancer remain at high risk for adverse outcomes and frequently require admission to the pediatric intensive care unit (PICU). Despite the rising burden of pediatric cancer in Saudi Arabia, data on PICU utilization and outcomes remain limited. This study aimed to describe the clinical characteristics, critical care interventions, and outcomes of pediatric oncology patients admitted to a tertiary PICU and to identify predictors of mortality. Methods: This is a retrospective cohort study was conducted including pediatric oncology patients (<14 years) admitted to the PICU at King Abdullah Specialized Children’s Hospital, Riyadh, between 2015 and 2021. Demographic, oncologic, and clinical variables; admission indications; PRISM-IV scores; and PICU interventions were collected. Predictors of mortality were evaluated using Cox proportional hazards modeling. Results: A total of 126 pediatric oncology patients were admitted to the PICU during the study period. The median age was 6 years (IQR 3–11), and 59% were female. Hematologic malignancies accounted for 63% of admissions. Sepsis (41%) and respiratory failure (21%) were the leading indications for PICU admission. Comorbidities were present in 33% of patients, and 70% had received prior therapeutic interventions, most commonly chemotherapy. Organ dysfunction occurred in 39% of patients, including 32% with multiorgan failure. Mechanical ventilation was required in 35% of patients, vasopressor support in 30%, and dialysis in a smaller proportion. The overall mortality rate was 19%, with more than half of deaths occurring during the PICU stay. Non-survivors had higher rates of comorbidities and invasive organ support, and higher PRISM scores. Mechanical ventilation (HR 3.02; 95% CI 1.16–7.60) and prior therapeutic interventions (HR 3.19; 95% CI 1.24–8.19) were independent predictors of mortality. Conclusions: Pediatric oncology patients admitted to the PICU experience substantial morbidity and mortality, underscoring the need for early risk identification and optimized supportive care.

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