title: Outcome of pediatric acute myeloid leukemia patients receiving intensive care in the United States.
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.
  
  
  METHODS
  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.
  
  
  METHODS
  Forty-three children's hospitals contributing data to the Pediatric Health Information System database.
  
  
  METHODS
  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.
  
  
  METHODS
  None.
  
  
  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.
authors.affiliation: 1Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA. 2Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 3Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA. 4Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 5Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA. 6Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA. 7Bristol-Myers Squibb, Hopewell, NJ. 8Division of Haematology/Oncology and Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada. 9Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 10Division of Pediatric Critical Care Medicine, Department of Pediatrics and Public Health Sciences, Penn State Hershey Milton S. Hershey Medical Center, Hershey, PA.
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Maude
authors.forename: Julie C
authors.initials: JC
authors.lastname: Fitzgerald
authors.forename: Brian T
authors.initials: BT
authors.lastname: Fisher
authors.forename: Yimei
authors.initials: Y
authors.lastname: Li
authors.forename: Yuan-Shung
authors.initials: YS
authors.lastname: Huang
authors.forename: Kari
authors.initials: K
authors.lastname: Torp
authors.forename: Alix E
authors.initials: AE
authors.lastname: Seif
authors.forename: Marko
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authors.lastname: Kavcic
authors.forename: Dana M
authors.initials: DM
authors.lastname: Walker
authors.forename: Kateri H
authors.initials: KH
authors.lastname: Leckerman
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Kilbaugh
authors.forename: Susan R
authors.initials: SR
authors.lastname: Rheingold
authors.forename: Lillian
authors.initials: L
authors.lastname: Sung
authors.forename: Theoklis E
authors.initials: TE
authors.lastname: Zaoutis
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
authors.forename: Neal J
authors.initials: NJ
authors.lastname: Thomas
authors.forename: Richard
authors.initials: R
authors.lastname: Aplenc
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000401:mortality*; D008297:Male; D012189:Retrospective Studies; D014481:United States