Acute lymphoblastic leukemia in children hospitalized in the intensive care unit: A retrospective analysis
Keywords:
clinical deterioration, early signs, intensive care unit, acute lymphoblastic leukemia, childrenAbstract
Relevance: The most common pediatric malignancy is acute lymphoblastic leukemia (ALL), with a prevalence of 4.2 per 100,000 children. Some patients diagnosed with ALL will require hospitalization in intensive care units (ICU) at some point in their treatment.
The study aimed to identify significant clinical and laboratory parameters in prognosis to identify indicators of clinical deterioration in children with ALL and develop a scale for early detection of precursors of critical illness in children with ALL.
Methods: This retrospective study included inpatient medical records of all patients (0-18 years old) diagnosed with ALL and hospitalized in the intensive care unit (ICU) for oncohematological patients at the Scientific Center for Pediatrics and Pediatric Surgery (Almaty, Kazakhstan). The study period was three years – 2020 to 2022.
Results: The clinical and laboratory parameters of children with ALL were analyzed a day before admission to the ICU since those patients demonstrated worsening clinical status. This window of time was chosen to allow us to understand what were the precursors of early deterioration in children with ALL before hospitalization in the ICU. Study data were collected before hospitalization in the ICU during admission to the ICU, and there is data at transfer from the ICU depending on the outcome of the disease. During the study period, 188 patients with ALL were admitted to the ICU. Leukopenia and neutropenia were present in 60-80% of the patients, and elevated leukocyte count was observed in 30-40%, while normal leukocyte count was only 10%-20%. CRP and procalcitonin levels were elevated, showing the presence of inflammation.
Conclusion: Based on the retrospective analysis of the data, it can be said that the presented data are harbingers of critical conditions in children with ALL. Neurological, respiratory, cardiac, renal, and other parameters are important for patient treatment and management.
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