Factors associated with mortality in pediatric pa- tients with acute lymphoblastic leukemia and neu- tropenic enterocolitis treated for in the Intensive Care Unit

• Main Authors: Mireya Muñoz-Ramírez, Horacio Márquez-Gon- zález, Patricia Zárate-Castañón
• Format: Article
• Language: Spanish
• Published: Instituto Nacional de Pediatría 2014-08-01
• Series: Acta Pediátrica de México
• Subjects: leucemia; enterocolitis neutropénica; factores de riesgo; mortalidad
• Online Access: http://ojs.actapediatrica.org.mx/index.php/APM/article/view/787
• ISSN: 0186-2391; 2395-8235

Background: Neutropenic enterocolitis is a complication manifested in cancer patients with neutropenia usually with absolute neutrophils counts of less than 500 cells/mm3. NEC clinically presents as acute abdomen and systemic inflammatory response syndrome. Up to 40 % of cases occur in patients with leukemia. There are few studied risk factors associated with mortality. Objective: To determine independent risk factors associated with mor- tality in patients with acute lymphoblastic leukemia and neutropenic enterocolitis. Methods: A nested case control study in a cohort of patients with neu- tropenic enterocolitis admitted to the pediatric intensive care unit of “Instituto Nacional de Pediatría” aged between one month and 17 years old. Cases were defined as subjects with acute lymphoblastic leukemia who were admitted to the pediatric intensive care unit and died from complications of neutropenic enterocolitis. Controls consisted in living patients with acute lymphoblastic leukemia who were admitted to the pediatric intensive care unit because of neutropenic enterocolitis and survived, two controls for sex and age were selected; 22 cases and 44 controls were obtained. Considered risk variables were: chemotherapy phase, type of chemotherapy, presence of organ failure, severity of sepsis and surgical management. Our statistical analysis consists in description of demographic variables, Fisher exact test for quantitative data and Mann-Whitney U test for qualitative data. Risk analysis identi- fied significant differences between the groups. Cox proportional risk analysis and Kaplan Meier graphs were done to express relative risk for mortality and survival differences respectively. Results: Most independent variables were: multiorgan dysfunction with relative risk of 57 (95% CI 6.6-75; p < 0.001); septic shock with relative risk of 15 (CI 95% 2-56; p = 0.008), etoposide use with relative risk of 2.6 (95% CI 1-6.6; p = 0.01) and gastrointestinal bleeding with relative risk of 2.1 (95% CI 1.1-5.5; p = 0.05). Conclusions: In a prospective cohort of patients with leukemia, who developed neutropenic enterocolitis, the variables most associated with mortality were multiorgan dysfunction and gastrointestinal bleeding.