Pediatric sequential organ failure assessment score predicts prognosis in children with acute lymphoblastic leukemia and sepsis: association with early multiple organ dysfunction.

[OBJECTIVE] To systematically analyze the clinical characteristics and prognostic factors of children with acute lymphoblastic leukemia (ALL) complicated by sepsis, and to compare the predictive efficacy of different scoring systems, with the expectation of providing a basis for early clinical identification of high-risk patients.

[METHODS] A retrospective analysis was conducted on the clinical data of 260 children with ALL who were admitted to the hospital due to sepsis during chemotherapy. Based on their outcomes after admission to the PICU, they were divided into survival (n=184) and death (n=76) groups. General information, disease status at PICU admission, laboratory indicators, and treatment were collected. Univariate logistic regression analysis was used to identify associated factors of mortality, and the predictive efficacy of different scoring systems for prognosis was compared.

[RESULTS] Bloodstream infection (29.23%), pulmonary infection (27.69%), and multiple site infection (23.46%) were the main infection sites, with bacterial infection being the predominant pathogen (48.85%). Clinical risk classification was predominantly high-risk (45.77%) and intermediate-risk (41.54%), with an overall PICU mortality rate of 29.23%. Univariate logistic regression analysis showed that leukemia remission status (PR/NR), inflammatory markers (CRP, PCT, IL-6), and organ function-related indicators (ALT, AST, TBiL, Scr, BUN, cTnI, CK-MB, BNP) within 48 hours of PICU admission were statistically correlated with mortality (all P<0.05). Furthermore, 24-hour lactate clearance and PaO/FiO were negatively correlated with mortality (OR<1, P<0.05). ROC curve analysis showed the AUCs for predicting mortality were 0.751, 0.788, and 0.885, respectively, based on the Pediatric Critical Illness Score, Pediatric Early Warning Score, and Pediatric Sequential Organ Failure Assessment Score (PSOFA), with PSOFA showing the highest predictive efficacy.

[CONCLUSION] Children with ALL complicated by sepsis, characterized by bloodstream infection, pulmonary infection, multiple site infection, and intermediate-to-high-risk subtypes, have a higher risk of death upon admission to the PICU. Leukemia remission status, 24-hour lactate clearance, inflammatory response, organ function, and respiratory function indicators within 48 hours of PICU admission are closely related to prognosis. Multidimensional indicators combined with a clinical scoring system can help identify high-risk children early and optimize the timing of PICU intervention, thereby improving prognosis.