TY - JOUR
T1 - PICU mortality of children with cancer admitted to pediatric intensive care unit a systematic review and meta-analysis
AU - Wösten-van Asperen, Roelie M
AU - van Gestel, Josephus P J
AU - van Grotel, Martine
AU - Tschiedel, Eva
AU - Dohna-Schwake, Christian
AU - Valla, Frédéric V
AU - Willems, Jef
AU - Angaard Nielsen, Jeppe S
AU - Krause, Martin F
AU - Potratz, Jenny
AU - van den Heuvel-Eibrink, Marry M
AU - Brierley, Joe
N1 - Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Background: Outcomes for children diagnosed with cancer have improved dramatically over the past 20 years. However, although 40% of pediatric cancer patients require at least one intensive care admission throughout their disease course, PICU outcomes and resource utilization by this population have not been rigorously studied in this specific group. Methods: Using a systematic strategy, we searched Medline, Embase, and CINAHL databases for articles describing PICU mortality of pediatric cancer patients admitted to PICU. Two investigators independently applied eligibility criteria, assessed data quality, and extracted data. We pooled PICU mortality estimates using random-effects models and examined mortality trends over time using meta-regression models. Results: Out of 1218 identified manuscripts, 31 studies were included covering 16,853 PICU admissions with the majority being retrospective in nature. Overall pooled weighted mortality was 27.8% (95% confidence interval (CI), 23.7–31.9%). Mortality decreased slightly over time when post-operative patients were excluded. The use of mechanical ventilation (odds ratio (OR): 18.49 [95% CI 13.79–24.78], p < 0.001), inotropic support (OR: 14.05 [95% CI 9.16–21.57], p < 0.001), or continuous renal replacement therapy (OR: 3.24 [95% CI 1.31–8.04], p = 0.01) was significantly associated with PICU mortality. Conclusions: PICU mortality rates of pediatric cancer patients are far higher when compared to current mortality rates of the general PICU population. PICU mortality has remained relatively unchanged over the past decades, a slight decrease was only seen when post-operative patients were excluded. This compared infavorably with the improved mortality seen in adults with cancer admitted to ICU, where research-led improvements have led to the paradigm of unlimited, aggressive ICU management without any limitations on resuscitations status, for a time-limited trial.
AB - Background: Outcomes for children diagnosed with cancer have improved dramatically over the past 20 years. However, although 40% of pediatric cancer patients require at least one intensive care admission throughout their disease course, PICU outcomes and resource utilization by this population have not been rigorously studied in this specific group. Methods: Using a systematic strategy, we searched Medline, Embase, and CINAHL databases for articles describing PICU mortality of pediatric cancer patients admitted to PICU. Two investigators independently applied eligibility criteria, assessed data quality, and extracted data. We pooled PICU mortality estimates using random-effects models and examined mortality trends over time using meta-regression models. Results: Out of 1218 identified manuscripts, 31 studies were included covering 16,853 PICU admissions with the majority being retrospective in nature. Overall pooled weighted mortality was 27.8% (95% confidence interval (CI), 23.7–31.9%). Mortality decreased slightly over time when post-operative patients were excluded. The use of mechanical ventilation (odds ratio (OR): 18.49 [95% CI 13.79–24.78], p < 0.001), inotropic support (OR: 14.05 [95% CI 9.16–21.57], p < 0.001), or continuous renal replacement therapy (OR: 3.24 [95% CI 1.31–8.04], p = 0.01) was significantly associated with PICU mortality. Conclusions: PICU mortality rates of pediatric cancer patients are far higher when compared to current mortality rates of the general PICU population. PICU mortality has remained relatively unchanged over the past decades, a slight decrease was only seen when post-operative patients were excluded. This compared infavorably with the improved mortality seen in adults with cancer admitted to ICU, where research-led improvements have led to the paradigm of unlimited, aggressive ICU management without any limitations on resuscitations status, for a time-limited trial.
KW - Cancer
KW - Mortality
KW - Pediatric intensive care units
KW - Hospital Mortality
KW - Humans
KW - Child, Preschool
KW - Infant
KW - Intensive Care Units, Pediatric
KW - Male
KW - Hospitalization
KW - Neoplasms/mortality
KW - Adolescent
KW - Female
KW - Retrospective Studies
KW - Child
UR - http://www.scopus.com/inward/record.url?scp=85070267011&partnerID=8YFLogxK
U2 - 10.1016/j.critrevonc.2019.07.014
DO - 10.1016/j.critrevonc.2019.07.014
M3 - Review article
C2 - 31404827
SN - 1040-8428
VL - 142
SP - 153
EP - 163
JO - Critical Reviews in Oncology/Hematology
JF - Critical Reviews in Oncology/Hematology
ER -