Table_1_Prognostic factors for multi-organ dysfunction in pediatric oncology patients admitted to the pediatric intensive care unit.docx

BackgroundPediatric oncology patients who require admission to the pediatric intensive care unit (PICU) have worse outcomes compared to their non-cancer peers. Although multi-organ dysfunction (MOD) plays a pivotal role in PICU mortality and morbidity, risk factors for MOD have not yet been identified. We aimed to identify risk factors at PICU admission for new or progressive MOD (NPMOD) during the first week of PICU stay.
MethodsThis retrospective cohort study included all pediatric oncology patients aged 0 to 18 years admitted to the PICU between June 2018 and June 2021. We used the recently published PODIUM criteria for defining multi-organ dysfunction and estimated the association between covariates at PICU baseline and the outcome NPMOD using a multivariable logistic regression model, with PICU admission as unit of study. To study the predictive performance, the model was internally validated by using bootstrap.
ResultsA total of 761 PICU admissions of 571 patients were included. NPMOD was present in 154 PICU admissions (20%). Patients with NPMOD had a high mortality compared to patients without NPMOD, 14% and 1.0% respectively. Hemato-oncological diagnosis, number of failing organs and unplanned admission were independent risk factors for NPMOD. The prognostic model had an overall good discrimination and calibration.
ConclusionThe risk factors at PICU admission for NPMOD may help to identify patients who may benefit from closer monitoring and early interventions. When applying the PODIUM criteria, we found some opportunities for fine-tuning these criteria for pediatric oncology patients, that need to be validated in future studies.

背景：需要入住儿科重症监护病房（Pediatric Intensive Care Unit, PICU）的儿科肿瘤患者，相较于非肿瘤同龄患者，预后更差。尽管多器官功能障碍（multi-organ dysfunction, MOD）是儿科重症监护病房患者病死率与致残率的关键影响因素，但目前尚未明确其危险因素。本研究旨在明确儿科重症监护病房入住时的相关危险因素，以预测患儿在入住儿科重症监护病房首周内新发或进展性多器官功能障碍（new or progressive MOD, NPMOD）的发生风险。
方法：本研究为回顾性队列研究，纳入了2018年6月至2021年6月期间入住儿科重症监护病房的所有0~18岁儿科肿瘤患者。本研究采用最新发布的PODIUM标准定义多器官功能障碍，并以儿科重症监护病房入住事件为研究单位，通过多变量logistic回归模型分析儿科重症监护病房基线特征与结局指标新发或进展性多器官功能障碍之间的关联。为评估模型的预测性能，本研究采用Bootstrap法对模型进行内部验证。
结果：本研究共纳入571例患者的761次儿科重症监护病房入住事件。其中154次入住事件（占比20%）发生了新发或进展性多器官功能障碍。新发或进展性多器官功能障碍患者的病死率显著高于未发生该病症的患者，分别为14%与1.0%。血液肿瘤诊断、衰竭器官数量以及非计划性入住，均为新发或进展性多器官功能障碍的独立危险因素。本预后模型整体区分度与校准度均表现良好。
结论：儿科重症监护病房入住时的新发或进展性多器官功能障碍危险因素，有助于识别可从强化监测与早期干预中获益的患者。在应用PODIUM标准时，本研究发现可针对儿科肿瘤患者对该标准进行优化调整，该优化方案需在未来研究中进一步验证。