ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Critical Care
This article is part of the Research TopicEditor Challenge in Pediatric Critical Care: Innovative Sepsis Management and Post-Discharge Care in Low-Resource SettingsView all articles
Predictors of Mortality of Pediatric Cancer Patients Admitted to the Intensive Care Unit (ICU) in a Low-Middle-Income Country (LMIC)
Provisionally accepted
- 1Pediatric Oncology Department, Children's Cancer Hospital Egypt 57357, Cairo, Egypt
- 2National Cancer Institute Cairo University, Cairo, Egypt
- 3Research and Biostatistics Department, Children's Cancer Hospital Egypt 57357, Cairo, Egypt
- 4Intensive Care Unit, Children's Cancer Hospital Egypt 57357, Cairo, Egypt
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BACKGROUND: Advancements in cancer therapies have markedly increased survival rates among patients. However, this progress has also led to a growing number of pediatric cancer patients requiring admission to intensive care units due to the severity of their disease and complications arising from treatment. It is essential to identify the predictors of mortality within this population to enhance clinical outcomes effectively. METHODS: A retrospective study included patients younger than or aged 18 years old at diagnosis of malignancy who were admitted to the medical ICU in The Children Cancer Hospital, Egypt, from January 1, 2019, to August 1, 2021. The primary objectives were to determine the mortality rate, identify the common causes of ICU admissions, and analyze the predictors of mortality among the pediatric cancer patients admitted to the ICU. RESULTS: A total of 1,501 ICU admissions were included. The most common causes of admission were sepsis (39%) and respiratory failure (31%). The mortality rate for the whole cohort was 32%. The most common causes of death were sepsis (46%) and disease progression/relapse (28.6%). Multivariable analysis identified higher mortality for patients admitted with septic shock (OR= 6.01, 95%CI 3.97-9.23, P<0.001) and respiratory failure (OR= 6.35, 95%CI 4.13-9.97, P<0.001), patients with progressive disease (OR= 1.86, 95%CI 1.38-2.50, P<0.001), those transferred from inpatient wards (OR= 1.63, 95%CI 1.20-2.22, P= 0.002) and patients with longer ICU stay (OR= 1.04, 95%CI 1.04-1.06, P<0.001). CONCLUSION: Pediatric cancer patients admitted to the ICU in LMICs have a high mortality rate, which confirms the need for targeted strategies to improve outcomes in this vulnerable population. Key approaches suggested by our research include early cancer diagnosis, optimized identification of early warning signs of critical illness, and decreasing sepsis-related mortalities by strict infection control, early diagnosis, and antimicrobial stewardship programs.
Keywords: pediatric oncology, ICU admissions, Mortality predictors, respiratory failure, septic shock, LMICs, hematological malignancies, Acute Lymphoblastic Leukemia
Received: 08 Oct 2025; Accepted: 30 Jan 2026.
Copyright: © 2026 Helmy, Khedr, Madney, Kamal, Kieran, Mostafa and Elhaddad. 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: Rana Helmy
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