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Pediatric cancer type predicts infection rate, need for critical care intervention, and mortality in the pediatric intensive care unit

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Abstract

Purpose

Up to 38 % of children with cancer require pediatric intensive care unit (PICU) admission within 3 years of diagnosis, with reported PICU mortality of 13–27 % far exceeding that of the general PICU population. PICU outcomes data for individual cancer types are lacking and may help identify patients at risk for poor clinical outcomes.

Methods

We performed a retrospective multicenter analysis of 10,365 PICU admissions of cancer patients no greater than 21 years old among 112 PICUs between 1 January 2009 and 30 June 2012. We evaluated the effect of cancer type, age, gender, genetic syndrome, stem cell transplantation, PRISM3 score, infections, and critical care interventions on PICU mortality.

Results

After excluding scheduled perioperative admissions, cancer patients represented 4.2 % of all PICU admissions (10,365/246,346), had overall mortality of 6.8 % (708/10,365) vs. 2.4 % (5,485/230,548) in the general PICU population (RR = 2.9, 95 % CI 2.7–3.1, p < 0.001), and accounted for 11.4 % of all PICU deaths (708/6,215). Hematologic cancer patients had greater median PRISM3 score (8 vs 2, p < 0.001), rates of sepsis (27 vs 9 %, RR = 2.9, 95 % CI 2.6–3.1, p < 0.001), and mortality (9.6 vs 4.5 %, RR = 2.1, 95 % CI 1.8–2.5, p < 0.001) compared to solid cancer patients. Among hematologic cancer patients, stem cell transplantation, diagnosis of acute myeloid leukemia, PRISM3 score, and infection were all independently associated with PICU mortality.

Conclusions

Children with cancer account for 4.2 % of PICU admissions and 11.4 % of PICU deaths. Hematologic cancer patients have significantly higher admission illness severity, rates of infections, and PICU mortality than solid cancer patients. These data may be useful in risk stratification for closer monitoring and patient counseling.

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Acknowledgments

Statistical consultation was provided by John Kornak, PhD, UCSF Department of Biostatistics, and funded by the National Center for Advancing Translational Sciences, National Institutes of Health (NIH), through UCSF-CTSI Grant Number UL1 TR000004. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. VPS data were provided by the VPS, LLC. No endorsement or editorial restriction of the interpretation of these data or opinions of the authors has been implied or stated. Dr. Zinter had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Conflicts of interest

There are no disclosures or conflicts of interest to report.

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Authors and Affiliations

  1. Division of Critical Care Medicine, Department of Pediatrics, University of California, San Francisco–School of Medicine, 505 Parnassus Ave, M680, San Francisco, 94143-0106, CA, USA

    Matt S. Zinter, Aaron Spicer & Anil Sapru

  2. Division of Hematology/Oncology, Department of Pediatrics, University of California, San Francisco–School of Medicine, San Francisco, USA

    Steven G. DuBois & Katherine Matthay

  3. UCSF Benioff Children’s Hospital, San Francisco, CA, USA

    Matt S. Zinter, Steven G. DuBois, Aaron Spicer, Katherine Matthay & Anil Sapru

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  1. Matt S. Zinter
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Correspondence to Matt S. Zinter.

Additional information

Take home message: Children with cancer account for 4.2 % of admissions and 11.4 % of all deaths among children admitted to the PICU. Children with hematologic cancer have significantly higher admission illness severity, rates of infections, and PICU mortality than children with solid cancer.

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Zinter, M.S., DuBois, S.G., Spicer, A. et al. Pediatric cancer type predicts infection rate, need for critical care intervention, and mortality in the pediatric intensive care unit. Intensive Care Med 40, 1536–1544 (2014). https://doi.org/10.1007/s00134-014-3389-2

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  • DOI: https://doi.org/10.1007/s00134-014-3389-2

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