Characteristics and Risk Factors in Onco-Hematological Patients Without Prior Hematopoietic Stem Cell Transplantation Requiring Intensive Care: A Cross-Sectional Study

Background: Pediatric onco-hematological patients require intensive care due to the complexity of their conditions, aggressive disease progression, and the immunosuppressive effects of treatments like chemotherapy and immunotherapy, increasing their risk of life-threatening complications.
Objective: To detect the characteristics and investigate the different risk factors of mortality in onco-hematological patients without hematopoietic stem cell transplantation admitted to the PICU.
Patients and Methods: This Cross-sectional analytic study that  was conducted on 150 pediatric onco-hematological patients without history of hematopoietic stem cell transplantation admitted to the PICU between September 2021 and September 2023. Sociodemographic data, Diagnosis, treatment, and Causes of PICU admission were recorded. Correlations between diagnosis, treatment, and Causes of PICU admission to mortality were analyzed.
Results: The average age of patients was 7.2±4.5 years. 55.3% were males. 40.7% of cases had ALL and 20.7 had AML. Induction phase treatment before PICU admission was reported in 79.3% of cases. Analyzing the outcome, (43.3%) of patients improved. AML patients had the highest mortality rate (74.2%, p=0.027). Mortality was higher (61.1%, p=0.012) in patients who received treatment before PICU admission than those who didn’t. septic shock had the most striking association with mortality (100% of affected patients died, p<0.001), followed by respiratory failure (73.5% mortality, p<0.001) and metabolic disturbances (64.3% mortality, p=0.001).
Conclusion: This study highlights the high mortality risk in pediatric onco-hematological patients without prior HSCT in the PICU, primarily due to aggressive malignancies and treatment complications. Key mortality factors include AML, the induction phase of treatment, and critical conditions like respiratory failure, septic shock, and metabolic disturbances.