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Critical Illness and Cardiac Dysfunction in Anthracycline-Exposed Pediatric Oncology Patients*

Wolfe, Katie K. MD; Reichek, Jennifer MSW, MD; Marsillio, Lauren E. MD, MSCI

Pediatric Critical Care Medicine: July 2019 - Volume 20 - Issue 7 - p 595-602
doi: 10.1097/PCC.0000000000001915
Feature Article

Objectives: To determine if the presence of cardiac dysfunction in anthracycline-exposed pediatric oncology patients is associated with an increased frequency of PICU admission or mortality.

Design: Retrospective parallel cohort study.

Setting: PICU at an academic freestanding children’s hospital.

Subjects: Children with oncologic diagnoses who received anthracyclines between January 2006 and December 2014 and were admitted to the hospital within 1 year of completion of therapy.

Interventions: None.

Measurements and Main Results: Charts of 734 patients were reviewed and 545 were included in analysis. Anthracycline-exposed pediatric oncology patients with cardiac dysfunction were more likely to be admitted to the PICU than those without cardiac dysfunction (87% vs 37% rate of PICU admission). PICU admission was also associated with identified infection and higher cumulative anthracycline dose. Once admitted to the PICU, those anthracycline-exposed patients with cardiac dysfunction had significantly higher mortality (26% vs 6%) and longer length of stay (7 vs 2 d) than children without cardiac dysfunction. Patients with cardiac dysfunction were more likely to require mechanical ventilation (59% vs 18%), required more vasoactive medications for longer, and were more likely to develop fluid overload. Death within 1 year of ICU admission was associated with higher cumulative anthracycline dose.

Conclusions: Children with cancer who received anthracyclines, especially at higher doses, and who develop cardiac dysfunction are at higher risk of critical illness, have higher rates of multiple organ dysfunction and higher rates of mortality than anthracycline-exposed patients without cardiac dysfunction.

All authors: Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL.

*See also p. 672.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Research reported in this publication was supported, in part, by the National Institutes of Health’s National Center for Advancing Translational Sciences, Grant Number UL1TR001422.

Dr. Wolfe’s institution received funding from the National Institutes of Health National Center for Advancing Translational Sciences. Dr. Marsillio’s institution received funding from Northwestern University Clinical and Translational Sciences Institute. Dr. Reichek has disclosed that she does not have any potential conflicts of interest.

Address requests for reprints to: Katie K. Wolfe, MD, Division of Critical Care Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave, Box 73, Chicago, IL 60611. E-mail:

Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies