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Pediatric Critical Care Medicine:
doi: 10.1097/PCC.0000000000000042
Feature Articles

Outcome of Pediatric Acute Myeloid Leukemia Patients Receiving Intensive Care in the United States

Maude, Shannon L. MD, PhD1,2; Fitzgerald, Julie C. MD, PhD3,4; Fisher, Brian T. DO, MSCE2,4,5,6; Li, Yimei PhD1,4; Huang, Yuan-Shung MS6; Torp, Kari BA1; Seif, Alix E. MD, MPH1,2; Kavcic, Marko MD1; Walker, Dana M. MD, MSCE7; Leckerman, Kateri H. MS5; Kilbaugh, Todd J. MD2,3,4; Rheingold, Susan R. MD1,2; Sung, Lillian MD, PhD8; Zaoutis, Theoklis E. MD, MS2,4,5,6,9; Berg, Robert A. MD, FCCM2,3; Nadkarni, Vinay M. MD, MS, FCCM2,3; Thomas, Neal J. MD, MS, FCCM10; Aplenc, Richard MD, PhD1,2,4,6,9

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Abstract

Objective: Children with acute myeloid leukemia are at risk for sepsis and organ failure. Outcomes associated with intensive care support have not been studied in a large pediatric acute myeloid leukemia population. Our objective was to determine hospital mortality of pediatric acute myeloid leukemia patients requiring intensive care.

Design: Retrospective cohort study of children hospitalized between 1999 and 2010. Use of intensive care was defined by utilization of specific procedures and resources. The primary endpoint was hospital mortality.

Setting: Forty-three children’s hospitals contributing data to the Pediatric Health Information System database.

Patients: Patients who are newly diagnosed with acute myeloid leukemia and who are 28 days through 18 years old (n = 1,673) hospitalized any time from initial diagnosis through 9 months following diagnosis or until stem cell transplant. A reference cohort of all nononcology pediatric admissions using the same intensive care resources in the same time period (n = 242,192 admissions) was also studied.

Interventions: None.

Measurements and Main Results: One-third of pediatric patients with acute myeloid leukemia (553 of 1,673) required intensive care during a hospitalization within 9 months of diagnosis. Among intensive care admissions, mortality was higher in the acute myeloid leukemia cohort compared with the nononcology cohort (18.6% vs 6.5%; odds ratio, 3.23; 95% CI, 2.64–3.94). However, when sepsis was present, mortality was not significantly different between cohorts (21.9% vs 19.5%; odds ratio, 1.17; 95% CI, 0.89–1.53). Mortality was consistently higher for each type of organ failure in the acute myeloid leukemia cohort versus the nononcology cohort; however, mortality did not exceed 40% unless there were four or more organ failures in the admission. Mortality for admissions requiring intensive care decreased over time for both cohorts (23.7% in 1999–2003 vs 16.4% in 2004–2010 in the acute myeloid leukemia cohort, p = 0.0367; and 7.5% in 1999–2003 vs 6.5% in 2004–2010 in the nononcology cohort, p < 0.0001).

Conclusions: Pediatric patients with acute myeloid leukemia frequently required intensive care resources, with mortality rates substantially lower than previously reported. Mortality also decreased over the time studied. Pediatric acute myeloid leukemia patients with sepsis who required intensive care had a mortality comparable to children without oncologic diagnoses; however, overall mortality and mortality for each category of organ failure studied was higher for the acute myeloid leukemia cohort compared with the nononcology cohort.

©2014The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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