Outcome of pediatric acute myeloid leukemia patients receiving intensive care in the United States

Shannon L. Maude, Julie C. Fitzgerald, Brian T. Fisher, Yimei Li, Yuan Shung Huang, Kari Torp, Alix E. Seif, Marko Kavcic, Dana M. Walker, Kateri H. Leckerman, Todd J. Kilbaugh, Susan R. Rheingold, Lillian Sung, Theoklis E. Zaoutis, Robert A. Berg, Vinay M. Nadkarni, Neal J. Thomas, Richard Aplenc

Research output: Contribution to journalArticle

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Abstract

Objective: Children with acute myeloid leukemia are at risk for sepsis and organ failure. Outcomes associated with intensive care support have not been studied in a large pediatric acute myeloid leukemia population. Our objective was to determine hospital mortality of pediatric acute myeloid leukemia patients requiring intensive care. Design: Retrospective cohort study of children hospitalized between 1999 and 2010. Use of intensive care was defined by utilization of specific procedures and resources. The primary endpoint was hospital mortality. Setting: Forty-three children's hospitals contributing data to the Pediatric Health Information System database. Patients: Patients who are newly diagnosed with acute myeloid leukemia and who are 28 days through 18 years old (n = 1,673) hospitalized any time from initial diagnosis through 9 months following diagnosis or until stem cell transplant. A reference cohort of all nononcology pediatric admissions using the same intensive care resources in the same time period (n = 242,192 admissions) was also studied. Interventions: None. Measurements and main results: One-third of pediatric patients with acute myeloid leukemia (553 of 1,673) required intensive care during a hospitalization within 9 months of diagnosis. Among intensive care admissions, mortality was higher in the acute myeloid leukemia cohort compared with the nononcology cohort (18.6% vs 6.5%; odds ratio, 3.23; 95% CI, 2.64-3.94). However, when sepsis was present, mortality was not significantly different between cohorts (21.9% vs 19.5%; odds ratio, 1.17; 95% CI, 0.89-1.53). Mortality was consistently higher for each type of organ failure in the acute myeloid leukemia cohort versus the nononcology cohort; however, mortality did not exceed 40% unless there were four or more organ failures in the admission. Mortality for admissions requiring intensive care decreased over time for both cohorts (23.7% in 1999-2003 vs 16.4% in 2004-2010 in the acute myeloid leukemia cohort, p = 0.0367; and 7.5% in 1999-2003 vs 6.5% in 2004-2010 in the nononcology cohort, p < 0.0001). Conclusions: Pediatric patients with acute myeloid leukemia frequently required intensive care resources, with mortality rates substantially lower than previously reported. Mortality also decreased over the time studied. Pediatric acute myeloid leukemia patients with sepsis who required intensive care had a mortality comparable to children without oncologic diagnoses; however, overall mortality and mortality for each category of organ failure studied was higher for the acute myeloid leukemia cohort compared with the nononcology cohort.

Original languageEnglish (US)
Pages (from-to)112-120
Number of pages9
JournalPediatric Critical Care Medicine
Volume15
Issue number2
DOIs
StatePublished - Feb 1 2014

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Critical Care
Acute Myeloid Leukemia
Pediatrics
Mortality
Sepsis
Hospital Mortality
Odds Ratio
Organs at Risk
Health Information Systems
Hospitalized Child
Hospitalization
Cohort Studies
Stem Cells
Retrospective Studies
Databases
Transplants

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Maude, S. L., Fitzgerald, J. C., Fisher, B. T., Li, Y., Huang, Y. S., Torp, K., ... Aplenc, R. (2014). Outcome of pediatric acute myeloid leukemia patients receiving intensive care in the United States. Pediatric Critical Care Medicine, 15(2), 112-120. https://doi.org/10.1097/PCC.0000000000000042
Maude, Shannon L. ; Fitzgerald, Julie C. ; Fisher, Brian T. ; Li, Yimei ; Huang, Yuan Shung ; Torp, Kari ; Seif, Alix E. ; Kavcic, Marko ; Walker, Dana M. ; Leckerman, Kateri H. ; Kilbaugh, Todd J. ; Rheingold, Susan R. ; Sung, Lillian ; Zaoutis, Theoklis E. ; Berg, Robert A. ; Nadkarni, Vinay M. ; Thomas, Neal J. ; Aplenc, Richard. / Outcome of pediatric acute myeloid leukemia patients receiving intensive care in the United States. In: Pediatric Critical Care Medicine. 2014 ; Vol. 15, No. 2. pp. 112-120.
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title = "Outcome of pediatric acute myeloid leukemia patients receiving intensive care in the United States",
abstract = "Objective: Children with acute myeloid leukemia are at risk for sepsis and organ failure. Outcomes associated with intensive care support have not been studied in a large pediatric acute myeloid leukemia population. Our objective was to determine hospital mortality of pediatric acute myeloid leukemia patients requiring intensive care. Design: Retrospective cohort study of children hospitalized between 1999 and 2010. Use of intensive care was defined by utilization of specific procedures and resources. The primary endpoint was hospital mortality. Setting: Forty-three children's hospitals contributing data to the Pediatric Health Information System database. Patients: Patients who are newly diagnosed with acute myeloid leukemia and who are 28 days through 18 years old (n = 1,673) hospitalized any time from initial diagnosis through 9 months following diagnosis or until stem cell transplant. A reference cohort of all nononcology pediatric admissions using the same intensive care resources in the same time period (n = 242,192 admissions) was also studied. Interventions: None. Measurements and main results: One-third of pediatric patients with acute myeloid leukemia (553 of 1,673) required intensive care during a hospitalization within 9 months of diagnosis. Among intensive care admissions, mortality was higher in the acute myeloid leukemia cohort compared with the nononcology cohort (18.6{\%} vs 6.5{\%}; odds ratio, 3.23; 95{\%} CI, 2.64-3.94). However, when sepsis was present, mortality was not significantly different between cohorts (21.9{\%} vs 19.5{\%}; odds ratio, 1.17; 95{\%} CI, 0.89-1.53). Mortality was consistently higher for each type of organ failure in the acute myeloid leukemia cohort versus the nononcology cohort; however, mortality did not exceed 40{\%} unless there were four or more organ failures in the admission. Mortality for admissions requiring intensive care decreased over time for both cohorts (23.7{\%} in 1999-2003 vs 16.4{\%} in 2004-2010 in the acute myeloid leukemia cohort, p = 0.0367; and 7.5{\%} in 1999-2003 vs 6.5{\%} in 2004-2010 in the nononcology cohort, p < 0.0001). Conclusions: Pediatric patients with acute myeloid leukemia frequently required intensive care resources, with mortality rates substantially lower than previously reported. Mortality also decreased over the time studied. Pediatric acute myeloid leukemia patients with sepsis who required intensive care had a mortality comparable to children without oncologic diagnoses; however, overall mortality and mortality for each category of organ failure studied was higher for the acute myeloid leukemia cohort compared with the nononcology cohort.",
author = "Maude, {Shannon L.} and Fitzgerald, {Julie C.} and Fisher, {Brian T.} and Yimei Li and Huang, {Yuan Shung} and Kari Torp and Seif, {Alix E.} and Marko Kavcic and Walker, {Dana M.} and Leckerman, {Kateri H.} and Kilbaugh, {Todd J.} and Rheingold, {Susan R.} and Lillian Sung and Zaoutis, {Theoklis E.} and Berg, {Robert A.} and Nadkarni, {Vinay M.} and Thomas, {Neal J.} and Richard Aplenc",
year = "2014",
month = "2",
day = "1",
doi = "10.1097/PCC.0000000000000042",
language = "English (US)",
volume = "15",
pages = "112--120",
journal = "Pediatric Critical Care Medicine",
issn = "1529-7535",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

Maude, SL, Fitzgerald, JC, Fisher, BT, Li, Y, Huang, YS, Torp, K, Seif, AE, Kavcic, M, Walker, DM, Leckerman, KH, Kilbaugh, TJ, Rheingold, SR, Sung, L, Zaoutis, TE, Berg, RA, Nadkarni, VM, Thomas, NJ & Aplenc, R 2014, 'Outcome of pediatric acute myeloid leukemia patients receiving intensive care in the United States', Pediatric Critical Care Medicine, vol. 15, no. 2, pp. 112-120. https://doi.org/10.1097/PCC.0000000000000042

Outcome of pediatric acute myeloid leukemia patients receiving intensive care in the United States. / Maude, Shannon L.; Fitzgerald, Julie C.; Fisher, Brian T.; Li, Yimei; Huang, Yuan Shung; Torp, Kari; Seif, Alix E.; Kavcic, Marko; Walker, Dana M.; Leckerman, Kateri H.; Kilbaugh, Todd J.; Rheingold, Susan R.; Sung, Lillian; Zaoutis, Theoklis E.; Berg, Robert A.; Nadkarni, Vinay M.; Thomas, Neal J.; Aplenc, Richard.

In: Pediatric Critical Care Medicine, Vol. 15, No. 2, 01.02.2014, p. 112-120.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Outcome of pediatric acute myeloid leukemia patients receiving intensive care in the United States

AU - Maude, Shannon L.

AU - Fitzgerald, Julie C.

AU - Fisher, Brian T.

AU - Li, Yimei

AU - Huang, Yuan Shung

AU - Torp, Kari

AU - Seif, Alix E.

AU - Kavcic, Marko

AU - Walker, Dana M.

AU - Leckerman, Kateri H.

AU - Kilbaugh, Todd J.

AU - Rheingold, Susan R.

AU - Sung, Lillian

AU - Zaoutis, Theoklis E.

AU - Berg, Robert A.

AU - Nadkarni, Vinay M.

AU - Thomas, Neal J.

AU - Aplenc, Richard

PY - 2014/2/1

Y1 - 2014/2/1

N2 - Objective: Children with acute myeloid leukemia are at risk for sepsis and organ failure. Outcomes associated with intensive care support have not been studied in a large pediatric acute myeloid leukemia population. Our objective was to determine hospital mortality of pediatric acute myeloid leukemia patients requiring intensive care. Design: Retrospective cohort study of children hospitalized between 1999 and 2010. Use of intensive care was defined by utilization of specific procedures and resources. The primary endpoint was hospital mortality. Setting: Forty-three children's hospitals contributing data to the Pediatric Health Information System database. Patients: Patients who are newly diagnosed with acute myeloid leukemia and who are 28 days through 18 years old (n = 1,673) hospitalized any time from initial diagnosis through 9 months following diagnosis or until stem cell transplant. A reference cohort of all nononcology pediatric admissions using the same intensive care resources in the same time period (n = 242,192 admissions) was also studied. Interventions: None. Measurements and main results: One-third of pediatric patients with acute myeloid leukemia (553 of 1,673) required intensive care during a hospitalization within 9 months of diagnosis. Among intensive care admissions, mortality was higher in the acute myeloid leukemia cohort compared with the nononcology cohort (18.6% vs 6.5%; odds ratio, 3.23; 95% CI, 2.64-3.94). However, when sepsis was present, mortality was not significantly different between cohorts (21.9% vs 19.5%; odds ratio, 1.17; 95% CI, 0.89-1.53). Mortality was consistently higher for each type of organ failure in the acute myeloid leukemia cohort versus the nononcology cohort; however, mortality did not exceed 40% unless there were four or more organ failures in the admission. Mortality for admissions requiring intensive care decreased over time for both cohorts (23.7% in 1999-2003 vs 16.4% in 2004-2010 in the acute myeloid leukemia cohort, p = 0.0367; and 7.5% in 1999-2003 vs 6.5% in 2004-2010 in the nononcology cohort, p < 0.0001). Conclusions: Pediatric patients with acute myeloid leukemia frequently required intensive care resources, with mortality rates substantially lower than previously reported. Mortality also decreased over the time studied. Pediatric acute myeloid leukemia patients with sepsis who required intensive care had a mortality comparable to children without oncologic diagnoses; however, overall mortality and mortality for each category of organ failure studied was higher for the acute myeloid leukemia cohort compared with the nononcology cohort.

AB - Objective: Children with acute myeloid leukemia are at risk for sepsis and organ failure. Outcomes associated with intensive care support have not been studied in a large pediatric acute myeloid leukemia population. Our objective was to determine hospital mortality of pediatric acute myeloid leukemia patients requiring intensive care. Design: Retrospective cohort study of children hospitalized between 1999 and 2010. Use of intensive care was defined by utilization of specific procedures and resources. The primary endpoint was hospital mortality. Setting: Forty-three children's hospitals contributing data to the Pediatric Health Information System database. Patients: Patients who are newly diagnosed with acute myeloid leukemia and who are 28 days through 18 years old (n = 1,673) hospitalized any time from initial diagnosis through 9 months following diagnosis or until stem cell transplant. A reference cohort of all nononcology pediatric admissions using the same intensive care resources in the same time period (n = 242,192 admissions) was also studied. Interventions: None. Measurements and main results: One-third of pediatric patients with acute myeloid leukemia (553 of 1,673) required intensive care during a hospitalization within 9 months of diagnosis. Among intensive care admissions, mortality was higher in the acute myeloid leukemia cohort compared with the nononcology cohort (18.6% vs 6.5%; odds ratio, 3.23; 95% CI, 2.64-3.94). However, when sepsis was present, mortality was not significantly different between cohorts (21.9% vs 19.5%; odds ratio, 1.17; 95% CI, 0.89-1.53). Mortality was consistently higher for each type of organ failure in the acute myeloid leukemia cohort versus the nononcology cohort; however, mortality did not exceed 40% unless there were four or more organ failures in the admission. Mortality for admissions requiring intensive care decreased over time for both cohorts (23.7% in 1999-2003 vs 16.4% in 2004-2010 in the acute myeloid leukemia cohort, p = 0.0367; and 7.5% in 1999-2003 vs 6.5% in 2004-2010 in the nononcology cohort, p < 0.0001). Conclusions: Pediatric patients with acute myeloid leukemia frequently required intensive care resources, with mortality rates substantially lower than previously reported. Mortality also decreased over the time studied. Pediatric acute myeloid leukemia patients with sepsis who required intensive care had a mortality comparable to children without oncologic diagnoses; however, overall mortality and mortality for each category of organ failure studied was higher for the acute myeloid leukemia cohort compared with the nononcology cohort.

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DO - 10.1097/PCC.0000000000000042

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JF - Pediatric Critical Care Medicine

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