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Children with malignancies and septic shock - an attempt to understand the risk factors
Azevedo, Rafael T.; Araujo, Orlei R.; Petrilli, Antonio S.; Silva, Dafne C.B..
Afiliação
  • Azevedo, Rafael T.; Universidade Federal de São Paulo (UNIFESP). Instituto de Oncologia Pediátrica (IOP). Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC). São Paulo. BR
  • Araujo, Orlei R.; Universidade Federal de São Paulo (UNIFESP). Instituto de Oncologia Pediátrica (IOP). Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC). São Paulo. BR
  • Petrilli, Antonio S.; Universidade Federal de São Paulo (UNIFESP). Instituto de Oncologia Pediátrica (IOP). Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC). São Paulo. BR
  • Silva, Dafne C.B.; Universidade Federal de São Paulo (UNIFESP). Instituto de Oncologia Pediátrica (IOP). Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC). São Paulo. BR
J. pediatr. (Rio J.) ; J. pediatr. (Rio J.);99(2): 127-132, Mar.-Apr. 2023. tab, graf
Article em En | LILACS-Express | LILACS | ID: biblio-1430702
Biblioteca responsável: BR1.1
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.
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Texto completo: 1 Coleções: 01-internacional Base de dados: LILACS Tipo de estudo: Etiology_studies / Prognostic_studies / Risk_factors_studies Idioma: En Revista: J. pediatr. (Rio J.) Assunto da revista: PEDIATRIA Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Brasil País de publicação: Brasil

Texto completo: 1 Coleções: 01-internacional Base de dados: LILACS Tipo de estudo: Etiology_studies / Prognostic_studies / Risk_factors_studies Idioma: En Revista: J. pediatr. (Rio J.) Assunto da revista: PEDIATRIA Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Brasil País de publicação: Brasil