title: Pediatric cancer type predicts infection rate, need for critical care intervention, and mortality in the pediatric intensive care unit.
abstract: OBJECTIVE
  Up to 38 % of children with cancer require pediatric intensive care unit (PICU) admission within 3 years of diagnosis, with reported PICU mortality of 13-27 % far exceeding that of the general PICU population. PICU outcomes data for individual cancer types are lacking and may help identify patients at risk for poor clinical outcomes.
  
  
  METHODS
  We performed a retrospective multicenter analysis of 10,365 PICU admissions of cancer patients no greater than 21 years old among 112 PICUs between 1 January 2009 and 30 June 2012. We evaluated the effect of cancer type, age, gender, genetic syndrome, stem cell transplantation, PRISM3 score, infections, and critical care interventions on PICU mortality.
  
  
  RESULTS
  After excluding scheduled perioperative admissions, cancer patients represented 4.2 % of all PICU admissions (10,365/246,346), had overall mortality of 6.8 % (708/10,365) vs. 2.4 % (5,485/230,548) in the general PICU population (RR = 2.9, 95 % CI 2.7-3.1, p < 0.001), and accounted for 11.4 % of all PICU deaths (708/6,215). Hematologic cancer patients had greater median PRISM3 score (8 vs 2, p < 0.001), rates of sepsis (27 vs 9 %, RR = 2.9, 95 % CI 2.6-3.1, p < 0.001), and mortality (9.6 vs 4.5 %, RR = 2.1, 95 % CI 1.8-2.5, p < 0.001) compared to solid cancer patients. Among hematologic cancer patients, stem cell transplantation, diagnosis of acute myeloid leukemia, PRISM3 score, and infection were all independently associated with PICU mortality.
  
  
  CONCLUSIONS
  Children with cancer account for 4.2 % of PICU admissions and 11.4 % of PICU deaths. Hematologic cancer patients have significantly higher admission illness severity, rates of infections, and PICU mortality than solid cancer patients. These data may be useful in risk stratification for closer monitoring and patient counseling.
authors.affiliation: Division of Critical Care Medicine, Department of Pediatrics, University of California, San Francisco-School of Medicine, 505 Parnassus Ave, M680, San Francisco, 94143-0106, CA, USA, zinterm@peds.ucsf.edu.
authors.forename: Matt S
authors.initials: MS
authors.lastname: Zinter
authors.forename: Steven G
authors.initials: SG
authors.lastname: DuBois
authors.forename: Aaron
authors.initials: A
authors.lastname: Spicer
authors.forename: Katherine
authors.initials: K
authors.lastname: Matthay
authors.forename: Anil
authors.initials: A
authors.lastname: Sapru
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007239:Infections / Q000453:epidemiology / Q000401:mortality*; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008297:Male; D015337:Multicenter Studies as Topic; D009369:Neoplasms / Q000145:classification* / Q000453:epidemiology / Q000401:mortality*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult