Agulnik Asya, Robles-Murguia Maricela, Chen Yichen, Muñiz-Talavera Hilmarie, Pham Linh, Carrillo Angela, Cardenas-Aguirre Adolfo, Costa Juliana, Mendez Aceituno Alejandra, Acuña Aguirre Carlos, Aguilar Roman Ana Berenice, Alvarez Arellano Shillel Yahamy, Andrade Sarmiento Leticia Aradi, Arce Cabrera Daniela, Blasco Arriaga Erika Esther, De León Gutiérrez Claudia María, Diaz-Coronado Rosdali, Diniz Borborema Maria do Céu, do Nascimento Othero Campacci Mariana, Drumond Alberto Leticia, Gonzalez Natalia Soledad, Herrera Almanza Martha, Jimenez Antolinez Valentine, Laffont Ortiz Merle Denisse, Lemos De Mendonça E Fontes Laura, López Facundo Norma Araceli, López Vázquez Claudia Beatriz, Lozano Lozano Idalia Margarita, Mijares Tobias Jose Miguel, Mora Robles Lupe Nataly, Noriega Acuña Berenice, Endo Marques Fernanda Paula, Pérez Fermín Clara Krystal, Quijano Lievano Monica Lorena, Ribeiro Pereira Aguiar De Paula Andreia, Rios Ligia, Rivera Jocelyn, Sahonero Marcela Alejandra, Salas Mendoza Beatriz, Sánchez-Martín María, Sepúlveda Ramírez Jennifer, Soto Chávez Verónica, Velásquez Cabrera Daniela María, Villanueva Hoyos Erika Elena, Zuñiga Quijano Luz Yadira, Devidas Meenakshi, Rodriguez-Galindo Carlos
St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
Hospital Dr Luis Calvo Mackenna, Santiago, Chile.
Cancer. 2025 Apr 15;131(8):e35818. doi: 10.1002/cncr.35818.
Hospitalized pediatric hematology-oncology patients have frequent clinical deterioration events (CDEs) requiring intensive care unit (ICU) interventions and resulting in high mortality, particularly in resource-limited settings. This study identifies independent risk factors for CDE mortality in hospitals providing childhood cancer care in Latin America and Spain.
Centers implemented a prospective CDE registry, defined as unplanned transfer to a higher level of care, use of ICU-level interventions on the ward, or nonpalliative ward death. The authors analyzed registry data from April 2017 to December 2022. The primary outcome was CDEs mortality, defined as death occurring during ICU admission, <24 hours of ICU discharge, or end of ward-based ICU interventions. Multilevel modeling identified event-, patient-, and hospital-level independent risk factors for CDE mortality.
Among 69 participating hospitals in 18 countries, 4134 CDEs were reported in 3319 pediatric hematology-oncology patients with an event mortality of 26.8% (1108 events). Of all CDEs, 33.7% used ICU interventions on the ward and 87.5% were transferred to a higher level of care. In multilevel modeling, significant independent risk factors for event mortality present at the start of deterioration included patient (disease relapse) and event (e.g., reason for hospital admission, use of ICU intervention on wards, abnormal lactate, platelets, or C-reactive protein, reason for deterioration, and number of organs with dysfunction); hospital factors were not significant predictors of mortality.
Hospitalized pediatric hematology-oncology patients with CDE have high mortality with significant variability across centers. Mortality, however, is largely driven by modifiable event-level factors, demonstrating the need for targeted interventions to improve survival.
住院的儿科血液肿瘤患者频繁发生临床恶化事件（CDEs），需要重症监护病房（ICU）进行干预，且死亡率很高，在资源有限的环境中尤其如此。本研究确定了拉丁美洲和西班牙提供儿童癌症护理的医院中CDE死亡率的独立危险因素。
各中心实施了一项前瞻性CDE登记，定义为无计划地转至更高护理级别、在病房使用ICU级别的干预措施或在病房非姑息性死亡。作者分析了2017年4月至2022年12月的登记数据。主要结局是CDE死亡率，定义为在ICU住院期间、ICU出院后<24小时或病房内ICU干预结束时发生的死亡。多水平模型确定了CDE死亡率的事件、患者和医院层面的独立危险因素。
在18个国家的69家参与医院中，3319名儿科血液肿瘤患者报告了4134起CDEs，事件死亡率为26.8%（1108起事件）。在所有CDEs中，33.7%在病房使用了ICU干预措施，87.5%被转至更高护理级别。在多水平模型中，恶化开始时存在的事件死亡率的显著独立危险因素包括患者（疾病复发）和事件（例如，入院原因、在病房使用ICU干预措施、乳酸、血小板或C反应蛋白异常、恶化原因以及功能障碍器官的数量）；医院因素不是死亡率的显著预测因素。
患有CDE的住院儿科血液肿瘤患者死亡率很高，各中心之间存在显著差异。然而，死亡率在很大程度上是由可改变的事件层面因素驱动的，这表明需要有针对性的干预措施来提高生存率。
