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Background <p>To analyze risk factors for adverse outcomes in a nationally representative sample of pediatric cancer patients admitted to the PICU.</p> Methods <p>An observational study composed of a 2-year retrospective phase and a 2-year prospective phase was conducted before and during PICU admission in Italian PICUs.</p> Results <p>We included 518 patients, median age 7.2&#xa0;years (IQR 2.5–12.6). Main diagnosis: solid tumors (51%) and acute lymphoblastic leukemia (23%). Nineteen percent underwent stem cell transplantation (HSCT). Main causes of admission were respiratory failure (33%) and neurological impairment (24%). In-PICU mortality was 15%, higher in HSCT (41%) and non-solid cancer (25%). Pre-PICU mortality risk factors included HSCT (OR 3.48, 95%CI 1.5–8.11), higher Pediatric Overall Performance Category (POPC) (OR 1.72, 95%CI 1.23–2.42), and Pediatric Index of Mortality 3 (PIM-3) score (OR 1.03, 95%CI 1.01–1.06). In-PICU mortality risk factors included multiple organ failure (MOF) (OR 4.83, 95%CI 1.66–15.71), and cardiac arrest (OR 82.16, 95%CI 14.19–1594.61). The use of MV does not appear to be associated with increased mortality. Longer PICU LOS was associated with pre-admission acute respiratory distress syndrome (<i>p</i> &lt; 0.001), renal failure (<i>p</i> = 0.024), POPC (<i>p</i> = 0.007) and PIM 3 (<i>p</i> &lt; 0.001), and in-PICU use of total parenteral nutrition (<i>p</i> = 0.036), and duration of mechanical ventilation (MV) (<i>p</i> &lt; 0.001).</p> Conclusions <p>HSCT, non-solid tumor, higher PIM-3, and POPC on admission, MOF, and history of cardiac arrest were associated with poorer outcome. The use of MV does not appear to be associated with increased mortality.</p> Trial registration <p>ClinicalTrials.gov ID NCT04581655, October 7, 2020.</p>

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Exploring risk factors for pediatric cancer patients admitted to the Pediatric Intensive Care Unit: insight from a multicenter observational study revealing no association with mechanical ventilation

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  • 发表日期：

    2025年10月14日

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  • Angela Amigoni,
  • Sara Boscato,
  • Maria Cristina Mondardini,
  • Francesca Cavagnero,
  • Luca Marchetto,
  • Veronica Biassoni,
  • Carolina Birolo,
  • Gabriella Bottari,
  • Manuela Corno,
  • Stefania Ferrario,
  • Giorgia Maiolo,
  • Alessia Montaguti,
  • Emanuele Rossetti,
  • Immacolata Rulli,
  • Raffaella Sagredini,
  • Stefania Spaggiari,
  • Luisa Vatiero,
  • Gianluca Vigna,
  • Matteo Martinato,
  • Dario Gregori,
  • Marta Pillon,
  • Rosanna Irene Comoretto,
  • Luca Arcuri,
  • Elena Barisone,
  • Massimo Bellettato,
  • Paolo Biban,
  • Alessandra Biffi,
  • Arcangelo Prete,
  • Ezio Bonanomi,
  • Fabio Caramelli,
  • Corrado Cecchetti,
  • Alessandra Conio,
  • Emanuele Guacheri,
  • Alberto Giannini,
  • Andrea Moscatelli,
  • Sergio Picardo,
  • Zaccaria Ricci,
  • Elena Zoia

摘要

Background

To analyze risk factors for adverse outcomes in a nationally representative sample of pediatric cancer patients admitted to the PICU.

Methods

An observational study composed of a 2-year retrospective phase and a 2-year prospective phase was conducted before and during PICU admission in Italian PICUs.

Results

We included 518 patients, median age 7.2 years (IQR 2.5–12.6). Main diagnosis: solid tumors (51%) and acute lymphoblastic leukemia (23%). Nineteen percent underwent stem cell transplantation (HSCT). Main causes of admission were respiratory failure (33%) and neurological impairment (24%). In-PICU mortality was 15%, higher in HSCT (41%) and non-solid cancer (25%). Pre-PICU mortality risk factors included HSCT (OR 3.48, 95%CI 1.5–8.11), higher Pediatric Overall Performance Category (POPC) (OR 1.72, 95%CI 1.23–2.42), and Pediatric Index of Mortality 3 (PIM-3) score (OR 1.03, 95%CI 1.01–1.06). In-PICU mortality risk factors included multiple organ failure (MOF) (OR 4.83, 95%CI 1.66–15.71), and cardiac arrest (OR 82.16, 95%CI 14.19–1594.61). The use of MV does not appear to be associated with increased mortality. Longer PICU LOS was associated with pre-admission acute respiratory distress syndrome (p < 0.001), renal failure (p = 0.024), POPC (p = 0.007) and PIM 3 (p < 0.001), and in-PICU use of total parenteral nutrition (p = 0.036), and duration of mechanical ventilation (MV) (p < 0.001).

Conclusions

HSCT, non-solid tumor, higher PIM-3, and POPC on admission, MOF, and history of cardiac arrest were associated with poorer outcome. The use of MV does not appear to be associated with increased mortality.

Trial registration

ClinicalTrials.gov ID NCT04581655, October 7, 2020.