Multi-organ failure predicts short-term mortality in children with malignancies

NEW YORK (Reuters Health) – The results of a recent study suggest that multi-organ failure is the greatest direct cause of mortality in children with malignancies.

In a retrospective analysis, Dr. Gideon Paret, of Chaim Sheba Medical Center, Tel Hashomer, Israel, and colleagues reviewed the records of 94 children with malignancies admitted to the PICU between 1989 and 1999. The team used stepwise logistic regression to examine predictors of 30-day mortality rates.

The children had a mean age of 7.3 years. Forty-five children (48%) had hematologic malignancies, 21 (22%) had extracranial solid tumors, and 28 (30%) had intracranial tumors.

The researchers observed an overall 30-day survival rate of 66%. Children who were admitted for respiratory failure had the highest mortality rate, at 40%. Those with circulatory collapse and neurologic deterioration also had high mortality rates, at 33.3% and 31%, respectively.

"The admitting pediatric risk of mortality score (PRISM) among the survivors was 6.6, compared with 15.2 among nonsurvivors (p < 0.01)," the authors explain in the January issue of the Journal of Pediatric Hematology/Oncology. "The number of organ system failures was higher among the nonsurvivors on admission (p < 0.001)." Children who required ventilatory (p < 0.001) or inotropic (p < 0.01) support had worse outcomes.

Thirty-six patients (38%) developed sepsis while in the PICU. The mortality rate among septic children was 50%, compared with 24% among nonseptic children (p < 0.01). Seventeen children (18%) had sepsis presenting on admission to the PICU. This was significantly associated with the development of organ system failure (p < 0.01).

"Further refinement of reliable clinical predictors of survival will enable better triage of these children to the PICU for possible prevention of systemic complications and reduction of mortality rates," Dr. Paret and colleagues conclude.

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