Children with malignancies and septic shock - an attempt to understand the risk factors
J. pediatr. (Rio J.)
;
99(2): 127-132, Mar.-Apr. 2023. tab, graf
Article
in English
|
LILACS-Express
| LILACS
| ID: biblio-1430702
ABSTRACT
Abstract Objectives:
To explain the high mortality of septic shock in children with cancer.Methods:
A retrospective cohort from 2016 to 2020, of children aged 0 to 18 years, and septic shock.Results:
The authors included 139 patients. Acute lymphocytic leukemia was the most frequent diagnosis (16.5%), and Gram-negative bacteria were the most frequent blood culture isolates (22.3%). There were 57 deaths in ICU (41%), 10 in the first 24 hours of shock (early death). A LASSO model with variables neutropenia (coefficient 0.215), respiratory (0.81), hematological (1.41), and neurological (0.72) dysfunctions, age (-0.002) and solid tumor recurrence (0.34) generated AUC = 0.79 for the early death outcome. Survivors had significant differences in the PRISM-IV score (mean ± SD 10.9 ± 6.2 in the survivors, 14.1 ± 6.5 in the deceased, p = 0.004), and in the mean number of organ dysfunctions (3.2 ± 1.1 in the survivors, 3.8 ± 6.5 in the deceased, p < 0.001). A positive fluid balance in the first 24 hours of sepsis between 2% and 6% of body weight showed a reduction effect on the probability of death in ICU (hazard ratio 0.47, 95% CI 0.24-0.92, p = 0.027). The recurrence of any cancer was a predictor of in-hospital death, regardless of severity.Conclusions:
Recurrence of any cancer is an important risk of sepsis-related death. A positive fluid balance between 20 and 60 mL/kg or 2% and 6% of body weight in the first 24 hours after the onset of sepsis is related to lower mortality.
Full text:
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Index:
LILACS (Americas)
Type of study:
Etiology study
/
Prognostic study
/
Risk factors
Language:
English
Journal:
J. pediatr. (Rio J.)
Journal subject:
Pediatrics
Year:
2023
Type:
Article
Affiliation country:
Brazil
Institution/Affiliation country:
Universidade Federal de São Paulo (UNIFESP)/BR
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