Does the nutritive status influence on the outcome of sepsis in children with cancer?
© BioMed Central Ltd. 2004
Published: 15 March 2004
Sepsis results in mortality in children receiving chemotherapy for malignancies. The influence of undernutrition on outcome in patients with neutropenia and sepsis is not clearly understood.
A 10-bed specialized ICU in the Belorussian Center for Paediatric Oncology.
To estimate the influence of nutritive status on the severity of septic complications and mortality in children with neutropenia.
We have followed prospectively 104 cases of sepsis (33 cases of sepsis, 36 cases of severe sepsis and 35 cases of septic shock, according to ACCP/SCCM criteria) among neutropenic children aged from 2 to 16 years, with myeloproliferative diseases and solid tumors. The mean PRISM II score at the time of ICU admission for patients with sepsis was 9.17 ± 5.9, for severe sepsis was 19.46 ± 5.92, and was 28 ± 7.29 for patients with septic shock. We compared the percent of weight loss during the period of chemotherapy before sepsis onset among survivors and nonsurvivors. The control group included 25 children with leukemia and lymphoma, matching by age, gender and duration of treatment, and without septic complications. For the statistical analysis a t test was used.
Weight loss (%)
6.96 ± 3.45
13.37 ± 6.1
8.36 ± 2.57
17.8 ± 5.47
5.58 ± 1.05
12.38 ± 6.1
In the control group weight loss was found in 37.1% patients, and the mean level of weight loss was 4.05 ± 1.48%, which was significantly (P < 0.05) lower than in patients with sepsis. There was no mortality in the control group. The mortality rate in patients with sepsis was 21.2%, in severe sepsis was 61%, and in septic shock was 85.7%.
Significant differences (P < 0.05) in weight loss between survivors and nonsurvivors were found in all groups of patients. Weight loss during chemotherapy for cancer is a risk factor associated with an increase of morbidity and mortality