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. 2023 Dec;12(23):21287-21292.
doi: 10.1002/cam4.6709. Epub 2023 Nov 27.

Prediction of attributable mortality in pediatric patients with cancer admitted to the intensive care unit for suspected infection: A comprehensive evaluation of risk scores

Zachary Rubnitz  1 , Yilun Sun  2 , Asya Agulnik  3 , Pamela Merritt  4 , Kim Allison  4 , Jose Ferrolino  4 , Ronald Dallas  4 , Li Tang  2 , Joshua Wolf  4   5
Affiliations

Prediction of attributable mortality in pediatric patients with cancer admitted to the intensive care unit for suspected infection: A comprehensive evaluation of risk scores

Zachary Rubnitz et al. Cancer Med. 2023 Dec.

Abstract

Objective: To evaluate the performance of existing sepsis scores for prediction of adverse outcomes in children with cancer admitted to the ICU with suspected sepsis.

Design: Retrospective chart review using data available at 1, 6, 12, and 24 h after ICU admission to calculate the Pediatric Risk of Mortality 3 (PRISM-3), Pediatric Sequential Organ Failure Assessment (pSOFA), Paediatric Logistic Organ Dysfunction 2 (PELOD-2), and Quick Pediatric Sequential Organ Failure Assessment (qSOFA) scores. Area under the receiver operator characteristic curve (AUROC) was used to evaluate performance for prediction of attributable mortality. Sensitivity analyses included recalculation of scores using worst preceding values for each variable, excluding hematologic parameters, and prediction of alternative outcomes.

Setting: St. Jude Children's Research Hospital, a pediatric comprehensive cancer center in the USA.

Patients: Pediatric patients (<25 years of age) receiving conventional therapy for cancer admitted to the ICU with suspected sepsis between 2013 and 2019.

Results: Of 207 included episodes of suspected sepsis, attributable mortality was 16 (7.7%) and all evaluated sepsis scores performed poorly (maximal AUROC of 0.73 for qSOFA at 1 and 24 h). Sensitivity analyses did not identify an alternative approach that significantly improved prediction.

Conclusions: Currently available sepsis scores perform poorly for prediction of attributable mortality in children with cancer who present to ICU with suspected sepsis. More research is needed to identify reliable predictors of adverse outcomes in this population.

Keywords: children; infection; neoplasm; prediction; sepsis.

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Conflict of interest statement

All authors have no conflicts of interest with regard to this study.

Figures

FIGURE 1
FIGURE 1
Performance of four pediatric sepsis risk prediction scores for prediction of attributable mortality in children with cancer.
See this image and copyright information in PMC

References

    1. Aljabari S, Balch A, Larsen GY, Fluchel M, Workman JK. Severe sepsis‐associated morbidity and mortality among critically ill children with cancer. J Pedia Intens Care. 2019;8:122‐129. - PMC - PubMed
    1. Christensen MS, Heyman M, Möttönen M, et al. Treatment‐related death in childhood acute lymphoblastic leukaemia in the Nordic countries: 1992–2001. Br J Haematol. 2005;131:50‐58. - PubMed
    1. Loeffen EAH, Knops RRG, Boerhof J, et al. Treatment‐related mortality in children with cancer: prevalence and risk factors. Eur J Cancer. 2019;121:113‐122. - PubMed
    1. O'Connor D, Bate J, Wade R, et al. Infection‐related mortality in children with acute lymphoblastic leukemia: an analysis of infectious deaths on UKALL2003. Blood. 2014;124:1056‐1061. - PubMed
    1. Oskarsson T, Söderhäll S, Arvidson J, et al. Treatment‐related mortality in relapsed childhood acute lymphoblastic leukemia. Pediatr Blood Cancer. 2018;65:65. - PubMed