Unraveling mortality risks in pediatric oncology: Exploring bloodstream coinfections and inflammatory biomarkers in COVID-19

Background Pediatric oncology patients face heightened mortality rates, primarily due to bacteremia exacerbated by the ongoing COVID-19 pandemic. Given hyperinflammation's role in coronavirus pathogenesis and the importance of inflammatory biomarkers in adults, we aim to explore 60-day mortality predictors in children with cancer, where research remains limited. This study aimed to investigate predictors of mortality in pediatric oncology patients with COVID-19, focusing on bacteremia and inflammatory biomarkers. Methods Sixty pediatric cancer patients with COVID-19 and 60 with bacteremia (no COVID-19) were included. Bloodstream coinfections were identified, and causative species with antimicrobial sensitivities were characterized. Various inflammatory indices were calculated. Survival analyses identified risk factors for COVID-19 patients' mortality. Mortality factors in bacteremia patients were examined. Results The 60-day OS rate of COVID-19 pediatrics was 81.7 %. Worse outcomes were associated with solid tumors, ICU admission, moderate/severe COVID-19, lymphopenia, high NLR, high CLR, and Gram-negative bacteremia (p-values = 0.002, 0.025, 0.042, 0.013, 0.047, 0.052, and 0.025). Multivariate analysis identified solid tumors, high NLR, and high CLR as independent factors for lower OS (p-values = 0.003, 0.046, and 0.046). Bacteremia was revealed in 24 COVID-19 patients (40 %). In patients with bacteremia (n = 84), non-survivors exhibited higher rates of ICU admission, fever, Gram-negative bacteria (GNB), and elevated CRP (p-values = 0.007, 0.038, <0.001, and 0.006), with multivariate analysis identifying GNB and ICU as independent mortality risk factors (p-values = 0.002 and 0.031). Conclusions: NLR and CLR predict mortality in pediatric oncology patients with COVID-19, with solid tumors heightening risk. Infection severity, GNB, and patient condition significantly influence outcomes of bacteremia cancer patients.