# Predictors of mortality of pediatric cancer patients admitted to the intensive care unit in a low-middle-income country

## TL;DR

This study identifies factors that increase the risk of death for children with cancer in intensive care units in low-middle-income countries.

## Contribution

The study provides insights into mortality predictors for pediatric cancer ICU patients in a low-middle-income country context.

## Key findings

- The most common causes of ICU admission were sepsis and respiratory failure.
- Septic shock and respiratory failure were the strongest predictors of mortality.
- Early diagnosis and infection control are critical to improving outcomes.

## Abstract

Advancements in cancer therapies have markedly increased survival rates among patients. However, this progress has also led to a growing number of pediatric cancer patients requiring admission to intensive care units due to the severity of their disease and complications arising from treatment. It is essential to identify the predictors of mortality within this population to enhance clinical outcomes effectively.

A retrospective study included patients younger than or aged 18 years old at diagnosis of malignancy who were admitted to the medical ICU in The Children Cancer Hospital, Egypt, from January 1, 2019, to August 1, 2021. The primary objectives were to determine the mortality rate, identify the common causes of ICU admissions, and analyze the predictors of mortality among the pediatric cancer patients admitted to the ICU.

A total of 1,501 ICU admissions were included. The most common causes of admission were sepsis (39%) and respiratory failure (31%). The mortality rate for the whole cohort was 32%. The most common causes of death were sepsis (46%) and disease progression/relapse (28.6%). Multivariable analysis identified higher mortality for patients admitted with septic shock (OR =  6.01, 95%CI 3.97–9.23, P < 0.001) and respiratory failure (OR =  6.35, 95%CI 4.13–9.97, P < 0.001), patients with progressive disease (OR =  1.86, 95%CI 1.38–2.50, P < 0.001), those transferred from inpatient wards (OR =  1.63, 95%CI 1.20–2.22, P = 0.002) and patients with longer ICU stay (OR =  1.04, 95%CI 1.04–1.06, P < 0.001).

Pediatric cancer patients admitted to the ICU in LMICs have a high mortality rate, which confirms the need for targeted strategies to improve outcomes in this vulnerable population. Key approaches suggested by our research include early cancer diagnosis, optimized identification of early warning signs of critical illness, and decreasing sepsis-related mortalities by strict infection control, early diagnosis, and antimicrobial stewardship programs.