Characteristics and outcomes of septic shock in onto-hematological malignancy children with granulocytopenia in the pediatric intensive care unit

Abstract

Objective To describe the characteristics and prognostic factors of septic shock in onco-hematological malignancy children with granulocytopenia,admitted to pediatric intensive care unit(PICU). Methods Retrospective cohort study was conducted among septic shock children with hematological cancer and granulocytopenia (n=40) admitted to PICU between January 2002 and May 2008. All the patients were in bone marrow inhibition phase with malignancy post-chemotherapy or had bone marrow hypoplasia. Results Eighteen out of 40 patients died (60%) and twelve survived,ten quitted. All patients were significantly fe-brile (>38.5 ℃) when they had septic shock; C-reaction protein (CRP) was significantly elevated. The main causes were pulmonary infections (35%) ,gastrointestinal tract infections (30%). Twenty patients had positive blood culture results, among whom 14 were Gram-negative bacilli infections (14/20,70%) and pseudomonas aemginosa was the main pathogen (8/14,57%). There were significant differences in serum glucose,serum albumin level,pH,standard base excess(SBE) ,serum lactic acid level and the Pediatric Risk Index Score for Mortality Ⅲ (PRISM Ⅲ) between the survival group and the death group (P<0.05). The mortality were 41% and 85% in patients with septic shock between primary remission or secondary remission group and relapse or non-remission group, and there was significantly difference (P<0.05). For the septic shock with dysfunction of 1,2,3 ,or more organs,mortality were 0,27% ,89%, 100% (excluded the quitted cases), and there was significantly difference (P<0.05). Conclusion For granulocytopenia children who were in bone marrow inhibition phase with malignancy post-chemotherapy or had bone marrow hypoplasia, there was an increase in mortality if complicated with septic shock. High fever was the main clinical manifes-tation; pulmonary and gastrointestinal tract are the main infection foci. Gram-negative bacteria (especially pseudomonas aeruginosa) was the main pathogen;so we suggested enhance the early empirically antibiotic therapy,especially preventive therapy for anti-gram-negative pathogens. The elevation of CRP was helpful in the early diagnosis of sepsis. Serum glucose, serum albumin level, pH, SBE, lactic acid level, and PRISM Ⅲ were significantly associated with the mortality of septic shock. Aggressively enhancing the primary diseases therapies,early recognition and proper treatment of septic shock would decrease the mortality of granulocyto-penia children complicated with septic shock, who were in bone marrow inhibition phase with malignancy post-chemotherapy or bone marrow hypoplasia. Key words: Septic shock; Granulocytopenia; Onco-hematological malignancy; Child; Pediatric inten-sive care unit