CHARACTERISTICS AND OUTCOMES OF PEDIATRIC SEPTIC PATIENTS WITH CANCER: A RETROSPECTIVE COHORT STUDY

被引:5
作者
Abou Dagher, Gilbert [1 ]
Safa, Rawan [1 ]
Najjar, Karim [1 ]
El Khuri, Christopher [1 ]
Saleh, Aiman [1 ]
Mailhac, Aurelie [2 ]
Makki, Maha [1 ]
Berbari, Iskandar [1 ]
Chebl, Ralphe Bou [1 ]
机构
[1] Amer Univ Beirut, Med Ctr, Dept Emergency Med, Beirut, Lebanon
[2] Amer Univ Beirut, Clin Res Inst, Beirut, Lebanon
关键词
bone marrow transplant; emergency department; oncology; pediatric; sepsis; systemic inflammatory response syndrome; SEVERE SEPSIS; FEBRILE NEUTROPENIA; CHILDREN; EPIDEMIOLOGY; MALIGNANCY; BACTEREMIA; TRENDS; FEVER; SHOCK; RISK;
D O I
10.1016/j.jemermed.2019.04.018
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: Pediatric oncology patients may be at a higher risk of complications and mortality from sepsis compared with their nononcology counterpart. Objectives: The aim of this study is to compare characteristics, treatment, and sepsis-related mortality between oncology and nononcology patients presenting to the emergency department (ED). Methods: This is a retrospective single-center cohort study including patients <18 years old with a diagnosis of sepsis, severe sepsis, septic shock, or bacteremia presenting to an academic ED between January 2009 and January 2015. A total of 158 patients were included with 53.8% having an underlying malignancy. The primary outcome of the study was in-hospital mortality. Secondary outcomes included ED vital signs, resuscitation parameters, laboratory work, infection site, general practitioner unit, intensive care unit length of stay, and hospital length of stay. Results: Oncology patients had a higher in-hospital mortality (5.9% vs. 2.7%), however, it did not meet statistical significance (p = 0.45). On presentation, oncology patients had a lower respiratory rate (24.33 +/- 9.48 vs. 27.45 +/- 7.88; p = 0.04). There was a significant increase in the white blood count in oncology patients (4.011 +/- 4.965 vs. 17.092 +/- 12.806; p < 0.001) with this cohort receiving more intravenous fluids. In the first 6 hours (33.0 +/- 27.7 mL/kg vs. 24.9 +/- 16.1 mL/kg; p = 0.029) as well as having a higher percentage of vasopressor administration (15.3% vs. 1.4%; p = 0.002). Antibiotics were initiated at an earlier stage in the oncology cohort (1.25 +/- 1.95 vs. 3.33 +/- 1.97 hours; p < 0.0001). Cancer-free patients had a significantly higher rate of lung infections compared with cancer patients (68.5% vs. 32.9%; p < 0.0001). In terms of infection characteristics, cancer patients had a higher percentage of bacteremia (27.1% vs. 4.1%; p < 0.001). Conclusion: There was no statistical significance regarding mortality between the 2 cohorts. Pediatric cancer patients were found to have a higher incidence of bacteremia and received more aggressive treatment. (C) 2019 Elsevier Inc. All rights reserved.
引用
收藏
页码:216 / 225
页数:10
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