The Burden of Pediatric Critical Illness Among Pediatric Oncology Patients in Low- and Middle-income Countries: A Systematic Review and Meta-analysis

Background: Pediatric oncology patients have increased risk for critical illness; outcomes are well described in high-income countries (HICs); however, data is limited for low- and middle-income countries (LMICs). Methods: We systematically searched PubMed, EMBASE, Web of Science, CINAHL and Global Health databases for articles in 6 languages describing mortality in children with cancer admitted to intensive care units (ICUs) in LMICs. Two investigators independently assessed eligibility, data quality, and extracted data. We pooled ICU mortality estimates using random effect models. Results: Of 3641 studies identified, 22 studies were included, covering 4803 ICU admissions. Overall pooled mortality was 30.3 % [95 % Confidence-interval (CI) 21.7–40.6 %]. Mechanical ventilation [odds ratio (OR) 12.2, 95 %CI:6.2–24.0, p-value<0.001] and vasoactive infusions [OR 6.3 95 %CI:3.3–11.9, p-value<0.001] were associated with ICU mortality. Conclusions: ICU mortality among pediatric oncology patients in LMICs is similar to that in HICs, however, this review likely underestimates true mortality due to underrepresentation of studies from low-income countries.