Prognostic factors of sepsis in children with acute leukemia admitted to the pediatric intensive care unit

Li Wu; Ming Jin; Ruiqing Wang; Lihua Yang; Xiaorong Lai; Lihua Yu; Danna Lin; Lulu Huang; Yajie Zhang; Jingxin Zhang; Xu Liao; Juan Zi; Yuting Yuan; Yinghua Zeng; Ming Cheng; Shaohua Tao

doi:10.1002/pbc.30382

Prognostic factors of sepsis in children with acute leukemia admitted to the pediatric intensive care unit

Pediatr Blood Cancer. 2023 Jun 7:e30382. doi: 10.1002/pbc.30382. Online ahead of print.

Authors

Li Wu¹, Ming Jin², Ruiqing Wang¹, Lihua Yang¹, Xiaorong Lai¹, Lihua Yu¹, Danna Lin¹, Lulu Huang¹, Yajie Zhang¹, Jingxin Zhang¹, Xu Liao¹, Juan Zi¹, Yuting Yuan¹, Yinghua Zeng¹, Ming Cheng¹, Shaohua Tao²

Affiliations

¹ Department of Pediatric Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
² Department of Pediatric Intensive Care Unit, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.

PMID: 37283279
DOI: 10.1002/pbc.30382

Abstract

Objective: To analyze the prognostic factors of sepsis in children with acute leukemia admitted to the pediatric intensive care unit (PICU) and to compare the efficacy of different scoring systems for predicting the outcome of children.

Methods: Patients with an acute leukemia diagnosis admitted to a tertiary care university hospital PICU due to sepsis during chemotherapy between May 2015 and August 2022 were retrospectively analyzed through an electronic medical record system.

Results: During this period, 693 children with acute leukemia initially diagnosed were admitted to the center, and 155 (22.3%) of them were transferred to PICU due to deterioration of the disease during treatment. Total 109 (70.3%) patients were transferred to PICU due to sepsis. Here, 17 patients was excluded (prior treatment from another hospital; referring from other hospitals; discontinued treatment; incomplete medical record). Of the 92 patients studied, the mortality rate was 35.9%. Multivariate analysis revealed that remission status, lactate level, invasive mechanical ventilation (IMV), and inotropic support within 48 hours after PICU transfer were independent risk factors for PICU mortality. The pediatric sequential organ failure assessment (PSOFA) score had the greatest predictive validity for hospital mortality (area under the receiver operating characteristic curve [AUROC]: 0.83, 95% confidence intervals [CI]: 0.74-0.92), followed by the pediatric early warning score (PEWS) (0.82, 0.73-0.91) and pediatric critical illness score (PCIS) (0.79, 0.69-0.88).

Conclusion: The mortality rate among children with acute leukemia complicated with sepsis is high after being transferred to the PICU. Various scoring systems can be used to monitor the clinical status of patients, identify sepsis early, detect critical illness, and determine the optimal time for transfer to the PICU for supportive treatment, thereby improving the prognosis of these patients.

Keywords: PICU; acute leukemia; outcomes; pediatric sepsis; scoring systems.