Clinical characteristics and outcomes of pediatric cancer patients admitted to the intensive care unit during treatment: a retrospective analysis

Background Treatment of childhood cancer is associated with a substantial risk of life-threatening complications that may require admission to a pediatric intensive care unit (PICU). Data describing clinical characteristics, indications for intensive care, and outcomes in this population remain limited. Methods This retrospective, single-center study analyzed all pediatric oncology patients who required PICU admission because of acute clinical deterioration during cancer treatment between 2010 and 2022. Fifty-one children treated at the Department of Pediatric Oncology, Hematology, and Chemotherapy of the Upper Silesian Child Health Centre (Medical University of Silesia, Katowice, Poland) were included. Demographic data, underlying malignancies, reasons for PICU admission, laboratory findings, therapeutic interventions, and outcomes were analyzed. Results A total of 61 PICU hospitalizations occurred, including repeated admissions in nine patients with leukemia. Most children were diagnosed with hematological malignancies, followed by brain tumors and extracranial solid tumors. The leading indications for PICU admission were septic shock, respiratory failure, and cardiopulmonary failure, accounting for 75.4% of cases. Cardiovascular support with catecholamines was required in 52.5% of patients, and renal replacement therapy was initiated in 18.0%. Both catecholamine use and renal replacement therapy were independently associated with a significantly increased risk of mortality. Life-threatening complications requiring intensive care occurred most frequently during leukemia treatment. Conclusion Severe treatment-related complications requiring intensive care are common in pediatric oncology, particularly among children with hematological malignancies. Septic shock during neutropenia remains the predominant cause of PICU admission. Early identification of clinical deterioration and clearly defined criteria for timely PICU referral—especially in cases of septic shock—may improve survival outcomes in this vulnerable population.