The morbidity and mortality of pediatric oncology patients presenting to the intensive care unit with septic shock

Abstract

Background: Children with an underlying diagnosis of malignancy are at high risk for developing serious infections. Previous studies, although very limited in number, suggest a particularly poor outcome for these patients if admitted to an intensive care unit with septic shock.

Procedure: A review of all oncology patients admitted to the pediatric intensive care unit (PICU) at a tertiary care Children's Hospital over an 11-year period with a diagnosis of septic shock was performed. Patients were age and gender-matched with non-oncology patients also admitted to the PICU with septic shock during the same time period. Mortality and morbidity rates were compared, and risk factors for poor outcome were examined.

Results: The charts of 69 oncology patients and 69 control patients were reviewed. Mortality rate at PICU discharge was not significantly different between the two groups (15.9% in the oncology group, versus 11.6% in the control group, P = 0.607). Organ dysfunction was higher in the oncology group (P = 0.005), although length of PICU stay was shorter (P = 0.036). There was no difference in ventilator days or vasopressor use.

Conclusion: This review found that the survival of oncology patients admitted to the PICU with septic shock was not significantly different from control patients, and was significantly higher than previous reports. Aggressive management of these children is warranted as their long term prognosis may be much more favorable than originally thought.