BRIEF RESEARCH REPORT article
Front. Oncol.
Sec. Pediatric Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1638516
This article is part of the Research TopicCritical Complications In Pediatric Oncology and Hematopoietic Cell Transplant - Volume IIIView all 10 articles
New sepsis-associated morbidity and mortality in pediatric oncology patients: a secondary analysis of the TOPICC dataset
Provisionally accepted
Alicia M Alcamo1
Robert B Lindell1
Sydney A Sheetz1Steven D Ham1
Andrew Strayer2Scott L Weiss3
Akira Nishisaki1
Neethi P Pinto1Alexis A Topjian1
Julie C Fitzgerald1*- 1Children's Hospital of Philadelphia, Philadelphia, United States
- 2Haverford College, Haverford, United States
- 3Nemours Children's Health, Wilmington, United States
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Sepsis is a leading cause of morbidity and mortality in children worldwide, yet the development of new morbidity after sepsis has not been clearly defined in high-risk subgroups such as children with cancer. Using the TOPICC (Trichotomous Outcome Prediction in Critical Care) multi-center cohort study dataset, we evaluated whether children with cancer have a higher risk of death or new morbidity at hospital discharge compared to children without cancer. Among 854 children with sepsis, 88 patients (10.3%) had an underlying cancer diagnosis. Children with cancer were older (median 8.1 vs 3.7 years) and more frequently developed sepsis while in the hospital. The pattern of organ failure differed between groups, with less frequent invasive mechanical ventilation (26.1% vs 49.9%, p<0.001) but more frequent vasoactive infusions (47.7% vs 35.8%, p=0.03) in children with cancer compared to those without cancer. Children with cancer had an increased rate of death or new morbidity (22.7% vs 12.1%, p=0.006) compared to non-cancer patients. New morbidity (ΔFSS score >2 points) occurred in 13.9% of cancer vs 6.9% of non-cancer survivors (p=0.03), and PICU mortality was similar between groups (10.2% vs 5.6%, p=0.09). Cancer diagnosis was independently associated with higher odds of death or new morbidity at discharge (OR 3.71, p<0.001), after adjusting for baseline FSS, developmental delay, concern for neurologic injury on PICU admission, and critical illness severity. These results suggest that children with cancer who develop sepsis are more likely to experience adverse outcomes at discharge, after accounting for baseline health and critical illness severity.
Keywords: Pediatrics, Sepsis, oncology, Critical Care, Morbidity, functional status scale Brief Research Report
Received: 30 May 2025; Accepted: 29 Jul 2025.
Copyright: © 2025 Alcamo, Lindell, Sheetz, Ham, Strayer, Weiss, Nishisaki, Pinto, Topjian and Fitzgerald. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Julie C Fitzgerald, Children's Hospital of Philadelphia, Philadelphia, United States
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