Friday March 6, 2009 (pediatric pearl)

Is the survival of pediatric oncology patients with severe sepsis any different from those without oncologic malignancies?

In a retrospective study patients (446 ICU admissions of 359 eligible patients) with cancer admitted to the ICU with severe sepsis overall ICU mortality was 17%. 30% in post-bone marrow transplant (BMT) admissions and 12% in non-BMT admissions. In the 106 admissions progressing to septic shock and requiring both mechanical ventilation and inotropic support, ICU mortality was 64% with BMT patients carrying a significantly lower survival rate than non-BMT patients (26% vs. 44%).

6-month survival was 69% among non-BMT patients vs. 39% for BMT patients. When the 38 patients who survived to ICU discharge after requiring both mechanical ventilation and inotropic/vasopressor support are considered 71% were alive at 6 months after ICU discharge (81% non-BMT vs. 19% for BMT patients.

Factors significantly associated with ICU mortality in admissions requiring both mechanical ventilation and inotropic support identified four variables:

• BMT,
• fungal sepsis,
• use of multiple inotropes, and
• Pediatric Risk of Mortality III score
  

The results regarding ICU survival are useful in that the overall mortality (83%) in these particular study subjects are in line with current estimates. This implies that they carry the same prognosis as any other pediatric patient with severe sepsis. However, when comparing those patients who underwent BMT versus those who did not, the BMT patients carried a significantly lower survival rate (70% vs. 88%). The number of patients alive at 6 months and the encouraging ICU survival rate further justifies the use of aggressive ICU interventions in this population. This is useful in that it may help provide patients/parents with realistic goals and expectations of outcome.

Reference: Click to get abstract

Outcome of severe sepsis in pediatric oncology patients - Pediatr Crit Care Med. 2005 Sep;6(5):531-536