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Assessing the risk of mortality in paediatric cancer patients admitted to the paediatric intensive care unit: a novel risk score?

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Abstract

Intensive front-line protocols have improved survival in children with malignancies; however, intensive multimodal therapy of paediatric malignancies can be associated with a significant risk of serious adverse events. Common risk scores (PRISM, PRISM III, APACHE-II) fail to predict mortality in these patients. A retrospective chart analysis of 32 paediatric cancer patients admitted to the Paediatric Intensive Care Unit (PICU) at the University Hospital of Saarland between January 2001 and December 2003 for life-threatening complications was performed. The aim of this study was to assess risk factors for short-term outcome (survival vs. non-survival when leaving the PICU) and to develop a risk score to estimate outcome in these patients. Overall survival was good (25 of 32 patients). Mortality rate was significantly related to leukaemia/lymphoma ( P =0.029), to the number of organ failures ( P <0.0001), neutropenia ( P =0.001), septic shock ( P =0.025), mechanical ventilation ( P =0.01) and inotropic support ( P =0.01). Employing multiple logistic regression, the strongest predictor for poor outcome was the number of organ failures ( P <0.05). A risk score (cut-off value: >3 points for non-survival) which included the following risk factors (non-solid tumour, number of organ failures ( n >2), neutropenia, septic shock, mechanical ventilation, and inotropic medication) yielded a sensitivity of 7/7 (95% CI: 4.56–7.00), a specificity of 23/25 (95% CI: 18.49–24.75), a positive predictive value of 23/23 (95% CI: 19.80–23.00), and a negative predictive value of 7/9 (95% CI: 3.60–8.74) for the time of admission to the PICU. Conclusion:Although our risk of mortality score is of prognostic value in assessing short-term outcome in these patients, prospective validation in a larger study cohort is mandatory. Furthermore, it must be emphasised that this risk score must not be used for decision-making in an individual patient.

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Abbreviations

BMT :

bone marrow transplantation

GvHD :

graft versus host disease

O-PRISM :

oncological paediatric risk of mortality score

PICU :

paediatric intensive care unit

PRISM :

paediatric risk of mortality score

TISS :

therapeutic intervention scoring system

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Acknowledgements

We thank Karen Schneider for linguistic help with the manuscript.

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Authors and Affiliations

  1. Paediatric Intensive Care Unit, Department of Paediatrics, University Hospital of Saarland, Kirrbergerstrasse, 66421 , Homburg, Germany

    Sascha Meyer, Tamir Biran, Karim Ehlayil & Ludwig Gortner

  2. Department of Paediatric Haematology and Oncology, University Hospital of Saarland, Homburg, Germany

    Sven Gottschling & Norbert Graf

  3. Institute for Medical Biometrics, Epidemiology and Medical Informatics, University Hospital of Saarland, Homburg, Germany

    Thomas Georg

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  1. Sascha Meyer
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  2. Sven Gottschling
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  3. Tamir Biran
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  4. Thomas Georg
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  5. Karim Ehlayil
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  6. Norbert Graf
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  7. Ludwig Gortner
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Correspondence to Sascha Meyer.

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Meyer, S., Gottschling, S., Biran, T. et al. Assessing the risk of mortality in paediatric cancer patients admitted to the paediatric intensive care unit: a novel risk score?. Eur J Pediatr 164, 563–567 (2005). https://doi.org/10.1007/s00431-005-1695-y

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  • DOI: https://doi.org/10.1007/s00431-005-1695-y

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