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Risk Factors for Death in Children and Adolescents With Cancer and Sepsis/Septic Shock

da Silva, Elenice Domingos MD*; Koch Nogueira, Paulo Cesar MD, PhD; Russo Zamataro, Tânia Maria MD*; de Carvalho, Werther Brunow MD, PhD; Petrilli, Antonio Sérgio MD, PhD§

Journal of Pediatric Hematology/Oncology: July 2008 - Volume 30 - Issue 7 - p 513-518
doi: 10.1097/MPH.0b013e31815acae0
Original Articles

Objective To assess risk factors for mortality in children and adolescents with cancer and sepsis/septic shock, admitted to intensive care unit.

Patients and Methods Retrospective study of a cohort of cancer and sepsis/septic shock patients (n=155) admitted to Oncological Pediatric Intensive Care Unit, between October 1998 and October 2001, with assessment of 12 potential risk factors for mortality by univariate analysis, followed by multivariable analysis.

Results Forty-seven out of 155 patients died (30.3%). In the present sample, after multivariable analysis, 3/12 variables proved to be statistically significant: respiratory infection [hazard ratio (HR)=2.3 and 95% confidence interval (CI)=1.3-4.2], duration of granulocytopenia (HR=2.4 and 95% CI=1.2-4.9), and number of organ dysfunction (HR=7.4 and 95% CI=2.6-21.3).

Conclusions Our data suggest that mortality in Oncological Pediatric Intensive Care Unit is high and the main factors involved in prognosis are number of dysfunctional organs, respiratory infections, and duration of granulocytopenia; the mortality rises 7.4 times for each dysfunctional organ. We believe that prospective and multicenter studies are necessary to better characterize risk factors that are specific for cancer patients to produce a particular score to predict severity of complications and mortality of children with cancer.

*Oncologic Pediatric Intensive Care Unit, Instituto de Oncologia Pediátrica (IOP)/Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC)

Department of Pediatric

Pediatric Intensive Care Unit

§Instituto de Oncologia Pediátrica (IOP)/Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), Universidade Federal de São Paulo (UNIFESP), Sao Paulo, Brazil

Reprints: Elenice Domingos da Silva, MD, Instituto de Oncologia Pediátrica-GRAACC/UNIFESP, rua: Botucatu, no 743, Vila Clementino, cep:04023-062, São Paulo-SP, Brazil (e-mail:

Received for publication July 16, 2007; accepted September 8, 2007

© 2008 Lippincott Williams & Wilkins, Inc.