Alcamo Alicia M, Lindell Robert B, Sheetz Sydney A, Ham Steven D, Strayer Andrew, Weiss Scott L, Nishisaki Akira, Pinto Neethi P, Topjian Alexis A, Fitzgerald Julie C
Division of Critical Care Medicine, Department of Anesthesia and Critical Care, Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
Pediatric Sepsis Program, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
Front Oncol. 2025 Aug 27;15:1638516. doi: 10.3389/fonc.2025.1638516. eCollection 2025.
Sepsis is a leading cause of morbidity and mortality in children worldwide, yet the development of new morbidity after sepsis has not been clearly defined in high-risk subgroups such as children with cancer. Using the TOPICC (Trichotomous Outcome Prediction in Critical Care) multicenter cohort study dataset, we evaluated whether children with cancer have a higher risk of the composite outcome of death or new morbidity at hospital discharge compared to children without cancer. Among 854 children with sepsis, 88 patients (10.3%) had an underlying cancer diagnosis. Children with cancer were older (median 8.1 vs 3.7 years) and more frequently developed sepsis while in the hospital. The pattern of organ failure differed between groups, with less frequent invasive mechanical ventilation (26.1% vs 49.9%, <0.001) but more frequent vasoactive infusions (47.7% vs 35.8%, =0.03) in children with cancer compared to non-oncology patients. Children with cancer had an increased rate of death or new morbidity (22.7% vs 12.1%, 0.006) compared to non-oncology patients. New morbidity (defined by ΔFSS score >2 points) occurred in 13.9% of cancer vs 6.9% of non-cancer survivors (=0.03), and PICU mortality was similar between groups (10.2% vs 5.6%, =0.09). Cancer diagnosis was independently associated with higher odds of death or new disability at discharge (adjusted odds ratio 3.71, <0.001) in multivariable logistic regression, after adjusting for baseline FSS, baseline developmental delay, clinical concern for neurologic injury on PICU admission, and PICU supportive measures. These results suggest that children with cancer who develop sepsis are more likely to experience adverse outcomes at hospital discharge, even after accounting for baseline health and critical illness severity.
脓毒症是全球儿童发病和死亡的主要原因，然而，在癌症患儿等高风险亚组中，脓毒症后新发病的情况尚未明确界定。利用TOPICC（重症监护中的三分结果预测）多中心队列研究数据集，我们评估了癌症患儿与非癌症患儿相比，在出院时死亡或出现新发病这一复合结局的风险是否更高。在854例脓毒症患儿中，88例（10.3%）有潜在癌症诊断。癌症患儿年龄较大（中位数8.1岁对3.7岁），且在住院期间更频繁地发生脓毒症。两组间器官衰竭模式不同，与非肿瘤患者相比，癌症患儿侵袭性机械通气频率较低（26.1%对49.9%，<0.001），但血管活性药物输注频率较高（47.7%对35.8%，=0.03）。与非肿瘤患者相比，癌症患儿死亡或新发病的发生率更高（22.7%对12.1%，0.006）。新发病（定义为ΔFSS评分>2分）在癌症幸存者中占13.9%，在非癌症幸存者中占6.9%（=0.03），两组间儿科重症监护病房（PICU）死亡率相似（10.2%对5.6%，=0.09）。在多变量逻辑回归中，在调整了基线FSS、基线发育迟缓、PICU入院时对神经损伤的临床关注以及PICU支持措施后，癌症诊断与出院时死亡或新残疾的较高几率独立相关（调整后的优势比为3.71，<0.001）。这些结果表明，发生脓毒症的癌症患儿即使在考虑了基线健康状况和危重病严重程度后，在出院时更有可能经历不良结局。
