Journal of Oncology Medicine & Practice

Cardiac Dysfunction in Pediatric Oncology Patients with Severe Sepsis and Septic Shock: Retrospective Single Center Study

Abstract

Omara A, Ali A, Almahr G, Al Masri K, Al Alawyat H*, Fathi A, Hegazi M, Korashi M, ElHaj M, Baioumy A, Shabaka A, Gewidah A, Omer H and Hajo A

Objectives: To determine the prevalence of sepsis-induced cardiac dysfunction (septic cardiomyopathy) in pediatric  oncology patients admitted to PICU, and to compare them to other oncology patients with sepsis/septic shock who have  no cardiac dysfunction regarding the risk of mortality, average length of stay, duration of inotropic/vasopressor support, ventilation free days, and the need for renal replacement therapy.
Design: a retrospective analysis of Sixty-six pediatric patients with underlying oncology disease who were admitted to the Pediatric critical care unit at King Fahad Specialist Hospital with the diagnosis of sepsis or septic shock between January 2014 and December 2015. Severe sepsis and septic shock were defined based on the definition of the Surviving Sepsis Campaign 2012. Sepsis-related cardiac systolic dysfunction (septic cardiomyopathy) was defined by High sensitive Troponin I, CK-MB and high BNP according to King Fahad Specialist Hospital-Dammam (KFSH-D) laboratory reference, Ejection fraction less than 50%, and shortening function less than 25% by transthoracic echocardiography, provided that transthoracic echocardiography is normal prior to PICU admission.
Results: The Prevalence of cardiac dysfunction in oncology patients having sepsis, severe sepsis or septic shock was 18.33%. (11 out of 60) (95% CI: 10.56, 29.92). The risk of mortality was higher in this group compared to those without cardiac dysfunction (54.5% versus 12.2%, p-value 0.005) regardless of the level of the cardiac enzymes (Troponin I, CK-MB and BNP). Oncology patients with cardiac dysfunction required more frequent mechanical ventilation, inotropic/ vasopressor support and renal replacement therapy (p-value is 0.037, 0.031, and 0.001 respectively) but no significant increase in the length of stay or the duration of mechanical ventilation and inotropes (p-value 0.483, 0.068 and 0.105 respectively).
Conclusion: Sepsis-induced cardiac dysfunction in pediatric oncology patients is more liable to have a higher risk of mortality; they required more frequent inotropic/vasopressor support, renal replacement therapy, and mechanical ventilation. Randomized controlled trials are necessary to determine the optimal timing for diagnosis and management strategy in septic patients having cardiac dysfunction.