Soeteman Marijn, Fiocco Marta F, Nijman Joppe, Bollen Casper W, Marcelis Maartje M, Kilsdonk Ellen, Nieuwenhuis Edward E S, Kappen Teus H, Tissing Wim J E, Wösten-van Asperen Roelie M
Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.
Mathematical Institute, Leiden University, Leiden, Netherlands.
Front Oncol. 2023 Jul 12;13:1192806. doi: 10.3389/fonc.2023.1192806. eCollection 2023.
Pediatric oncology patients who require admission to the pediatric intensive care unit (PICU) have worse outcomes compared to their non-cancer peers. Although multi-organ dysfunction (MOD) plays a pivotal role in PICU mortality and morbidity, risk factors for MOD have not yet been identified. We aimed to identify risk factors at PICU admission for new or progressive MOD (NPMOD) during the first week of PICU stay.
This retrospective cohort study included all pediatric oncology patients aged 0 to 18 years admitted to the PICU between June 2018 and June 2021. We used the recently published PODIUM criteria for defining multi-organ dysfunction and estimated the association between covariates at PICU baseline and the outcome NPMOD using a multivariable logistic regression model, with PICU admission as unit of study. To study the predictive performance, the model was internally validated by using bootstrap.
A total of 761 PICU admissions of 571 patients were included. NPMOD was present in 154 PICU admissions (20%). Patients with NPMOD had a high mortality compared to patients without NPMOD, 14% and 1.0% respectively. Hemato-oncological diagnosis, number of failing organs and unplanned admission were independent risk factors for NPMOD. The prognostic model had an overall good discrimination and calibration.
The risk factors at PICU admission for NPMOD may help to identify patients who may benefit from closer monitoring and early interventions. When applying the PODIUM criteria, we found some opportunities for fine-tuning these criteria for pediatric oncology patients, that need to be validated in future studies.
与非癌症患儿相比，需要入住儿科重症监护病房（PICU）的儿科肿瘤患者预后更差。尽管多器官功能障碍（MOD）在PICU的死亡率和发病率中起关键作用，但MOD的风险因素尚未明确。我们旨在确定PICU入院时与PICU住院第一周内新发或进展性MOD（NPMOD）相关的风险因素。
这项回顾性队列研究纳入了2018年6月至2021年6月期间入住PICU的所有0至18岁儿科肿瘤患者。我们使用最近发布的PODIUM标准来定义多器官功能障碍，并使用多变量逻辑回归模型估计PICU基线时协变量与NPMOD结局之间的关联，以PICU入院作为研究单位。为了研究预测性能，该模型通过自助法进行内部验证。
共纳入571例患者的761次PICU入院病例。154次PICU入院（20%）出现NPMOD。与未出现NPMOD的患者相比，出现NPMOD的患者死亡率较高，分别为14%和1.0%。血液肿瘤诊断、功能衰竭器官数量和非计划入院是NPMOD的独立危险因素。该预后模型具有总体良好的区分度和校准度。
PICU入院时NPMOD的风险因素可能有助于识别那些可能从密切监测和早期干预中获益的患者。在应用PODIUM标准时，我们发现了一些针对儿科肿瘤患者对这些标准进行微调的机会，这些机会需要在未来的研究中进行验证。
