Survival in children with malignancies in the PICU: Data from a retrospective chart analysis (2001–2003)

Background and study purpose: Current treatment protocols for pediatric oncologic patients have improved prognosis with a long-term survival rate of about 60–70%. The purpose of this study is to present our data concerning the short-term outcome of children with cancer who were admitted to our PICU.

Patients and methods: Between 2001–2003, 32 patients were enrolled for retrospective chart analysis (age: range: 1 month-17 years; female 14). The underlying diseases were: leukemia (10), NHL (5), brain tumor (6), solid non-cerebral tumor (6), and post BMT (5). The reasons for PICU admission were: 6 sepsis (4 septic shock), 2 localized infections, 6 neurological complications, 7 directly therapy-associated complications, 5 post BMT complications, 6 miscellaneous causes. Patients admitted to the PICU for routine post-operative treatment were excluded. The overall survival at discharge from the PICU was 81.2%. Mortality rate in patients who required mechanical ventilation was 46.1%, in patients with mechanical ventilation and additional inotropic support 54,5% and in those patients with septic shock 75%. Non-infectious complications leading to PICU admission were heterogeneous and were associated with a better outcome (survival: 87.5%). Mortality rate in children requiring PICU treatment after BMT was high (60%). 9 patients developed ≥ 3 organ system failure with 3 survivors (33.3%). Survival in patients that were admitted when the initial diagnosis of cancer was made was excellent (5 of 5 patients).

Conclusions: There was a substantial mortality rate among those patients with sepsis and septic shock. Recognition of early sepsis in the ward and in outpatients is fundamental, and may contribute to a better outcome in these high-risk patients. In order to further optimize the management of these patients, close cooperation between pediatric oncologists and pediatric intensive care physicians is necessary. For comparison of different therapeutic strategies and outcome in pediatric cancer patients admitted to the PICU, prospective studies with equal inclusion criteria are warranted.