Contributions
Abstract: PB1894
Type: Publication Only
Background
Recent advances in supportive care have considerably improved the prognosis of pediatric cancer patients. However, the use of aggressive cancer treatment is also associated with complications and life-threatening events that result in admissions to the intensive care unit (ICU).
Aims
This study aimed to analyze the outcome of pediatric cancer patients admitted to the ICU.
Methods
A retrospective analysis of 84 ICU admissions of cancer patients <21 years old between May, 2004 and Aug, 2016 at Chonnam National University Hwasun Hospital (CNUHH) was undertaken. The risk factors for short-term outcome (survival at the time of discharge from the ICU) were analyzed. After excluding scheduled perioperative admissions, the records of 81 admissions (75 patients) were reviewed.
Results
Hematologic cancer patients represented 71.6% of admissions. The mean duration of ICU stay was 10.7 days. Respiratory failure (39.5%) and septic shock (17.8%) were the most frequent indications for ICU admissions. Overall mortality rate was 46.9%. The mortality for hematologic cancer was 51.7% as compared to 34.8% for solid cancer (P >0.05). Mortality for individual indication was as follows: bleeding, 66.7%; respiratory failure, 59.4%; systemic infection 57.5%, anterior mediastinal syndrome, 50%, neurologic disorders, 37.5%, renal disorder, 37.5%, and so on. ICU mortality after hematopoietic stem cell transplantation was 66.7%, mostly within 100 days post-transplant. The median Pediatric Risk of Mortality Score (PRISM) III score of survivors was lower than that of non-survivors (11.3 ± 5.1 vs. 19.9 ± 10.9, P<0.001). The mortality rates were 70.3% and 27.3 % in patients with high (>15 points) and low (≤15 points) PRISM III score, respectively (P<0.001). Mortality rate was significantly related to the presence and number of organ system dysfunction (P<0.01 and P<0.001, respectively), positive inotropic support (P<0.01), and mechanical ventilation (P<0.001). By using multivariate logistic regressions, the independent risk factors were mechanical ventilation (OR, 6.0; 95% CI, 1.7-21.3; P<0.01), and ≥3 organ system dysfunction (OR, 18.5; 95% CI, 4.4-77.0; P<0.001). Hematologic cancer patients had higher mean PRISM3 score (16.5 ± 9.4 vs. 12.2 ± 8.6; P=0.51) and higher risk of sepsis (39.3% vs. 13.0%; P<0.05) compared to solid cancer patients.
Conclusion
These results revealed the current status of ICU care for pediatric cancer patients in a tertiary hospital in Korea. Further improvement of supportive care and earlier effective intervention should be translated in gradual reduction in mortality rate in these population.
Session topic: 29. Infectious diseases, supportive care
Keyword(s): Supportive care, Mortality
Abstract: PB1894
Type: Publication Only
Background
Recent advances in supportive care have considerably improved the prognosis of pediatric cancer patients. However, the use of aggressive cancer treatment is also associated with complications and life-threatening events that result in admissions to the intensive care unit (ICU).
Aims
This study aimed to analyze the outcome of pediatric cancer patients admitted to the ICU.
Methods
A retrospective analysis of 84 ICU admissions of cancer patients <21 years old between May, 2004 and Aug, 2016 at Chonnam National University Hwasun Hospital (CNUHH) was undertaken. The risk factors for short-term outcome (survival at the time of discharge from the ICU) were analyzed. After excluding scheduled perioperative admissions, the records of 81 admissions (75 patients) were reviewed.
Results
Hematologic cancer patients represented 71.6% of admissions. The mean duration of ICU stay was 10.7 days. Respiratory failure (39.5%) and septic shock (17.8%) were the most frequent indications for ICU admissions. Overall mortality rate was 46.9%. The mortality for hematologic cancer was 51.7% as compared to 34.8% for solid cancer (P >0.05). Mortality for individual indication was as follows: bleeding, 66.7%; respiratory failure, 59.4%; systemic infection 57.5%, anterior mediastinal syndrome, 50%, neurologic disorders, 37.5%, renal disorder, 37.5%, and so on. ICU mortality after hematopoietic stem cell transplantation was 66.7%, mostly within 100 days post-transplant. The median Pediatric Risk of Mortality Score (PRISM) III score of survivors was lower than that of non-survivors (11.3 ± 5.1 vs. 19.9 ± 10.9, P<0.001). The mortality rates were 70.3% and 27.3 % in patients with high (>15 points) and low (≤15 points) PRISM III score, respectively (P<0.001). Mortality rate was significantly related to the presence and number of organ system dysfunction (P<0.01 and P<0.001, respectively), positive inotropic support (P<0.01), and mechanical ventilation (P<0.001). By using multivariate logistic regressions, the independent risk factors were mechanical ventilation (OR, 6.0; 95% CI, 1.7-21.3; P<0.01), and ≥3 organ system dysfunction (OR, 18.5; 95% CI, 4.4-77.0; P<0.001). Hematologic cancer patients had higher mean PRISM3 score (16.5 ± 9.4 vs. 12.2 ± 8.6; P=0.51) and higher risk of sepsis (39.3% vs. 13.0%; P<0.05) compared to solid cancer patients.
Conclusion
These results revealed the current status of ICU care for pediatric cancer patients in a tertiary hospital in Korea. Further improvement of supportive care and earlier effective intervention should be translated in gradual reduction in mortality rate in these population.
Session topic: 29. Infectious diseases, supportive care
Keyword(s): Supportive care, Mortality