Department of Pediatrics, KK Women's & Children's Hospital, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Pediatr Blood Cancer. 2020 Jun;67(6):e28242. doi: 10.1002/pbc.28242. Epub 2020 Mar 18.
Pediatric oncology patients admitted to the pediatric intensive care unit (PICU) are at high risk of mortality. This study aims to describe the epidemiology of and the risk factors for mortality in these patients.
This is a retrospective cohort study including all consecutive PICU oncology admissions from 2011 to 2017. Demographic and clinical risk factors between survivors and nonsurvivors were compared. Both univariate and multivariate Cox proportional hazard regression models were used to quantify the association between 60-day mortality and admission categories, accounting for other covariates (Pediatric Risk Of Mortality [PRISM] III score and previous bacteremia).
The primary outcome was 60-day mortality.
The median (interquartile range) age and PRISM III scores of pediatric oncology patients admitted to the PICU were 7 (3, 12) years and 3 (0, 5), respectively. The most common underlying oncological diagnoses were brain tumors (73/200 [36.5%]) and acute lymphoblastic leukemia (36/200 [18.0%]). Emergency admissions accounted for approximately half of all admissions (108/200 [54.0%]), including cardiovascular (24/108 [22.2%]), neurology (24/108 [22.2%]), respiratory (22/108 [20.4%]), and "other" indications (38/108 [35.2%]). The overall 60-day mortality was 35 of 200 (17.5%). Independent risk factors for mortality were emergency respiratory and neurology categories of admission (adjusted hazard ratio[aHR]: 5.62, 95% confidence interval [95% CI]: 1.57, 20.19; P = .008 and aHR: 6.96, 95% CI: 2.04, 23.75; P = .002, respectively) and previous bacteremia (aHR: 3.37, 95% CI: 1.57, 7.20; P = .002).
Emergency respiratory and neurology admissions and previous bacteremia were independent risk factors for 60-day mortality for pediatric oncological patients admitted to the PICU.
入住儿科重症监护病房（PICU）的儿科肿瘤患者死亡率较高。本研究旨在描述这些患者的死亡率流行病学和危险因素。
这是一项回顾性队列研究，包括 2011 年至 2017 年所有连续的 PICU 肿瘤住院患者。比较了幸存者和非幸存者之间的人口统计学和临床危险因素。使用单变量和多变量 Cox 比例风险回归模型来量化 60 天死亡率与入院类别之间的关联，同时考虑其他协变量（儿科死亡率风险[PRISM] III 评分和先前菌血症）。
主要结局是 60 天死亡率。
入住 PICU 的儿科肿瘤患者的中位（四分位间距）年龄和 PRISM III 评分为 7（3，12）岁和 3（0，5），最常见的基础肿瘤诊断为脑肿瘤（73/200 [36.5%]）和急性淋巴细胞白血病（36/200 [18.0%]）。急诊入院约占所有入院人数的一半（108/200 [54.0%]），包括心血管（24/108 [22.2%]）、神经科（24/108 [22.2%]）、呼吸科（22/108 [20.4%]）和“其他”指征（38/108 [35.2%]）。总的 60 天死亡率为 200 例中的 35 例（17.5%）。死亡率的独立危险因素为急诊呼吸和神经科入院类别（校正后的危险比[aHR]：5.62，95%置信区间[95%CI]：1.57，20.19；P=0.008 和 aHR：6.96，95%CI：2.04，23.75；P=0.002）和先前菌血症（aHR：3.37，95%CI：1.57，7.20；P=0.002）。
入住 PICU 的儿科肿瘤患者中，急诊呼吸和神经科入院以及先前菌血症是 60 天死亡率的独立危险因素。
