ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 25 of 61
JMBS 2019, 4(5): 165–172
Clinical Medicine

Diagnostic Prediction Scale of Patient Acuity in Children with Acute Leukemia

Odinets Y. V., Kondratiuk T. O.

Leukemia is the most common oncologic neoplastic disease in children. National Cancer Registry of Ukraine states that the frequency of acute leukemia in children is 4.5:100000, and the death rate caused by acute leukemia is 1.1:100000. Leukemia and its treatment may cause the development of specific life-threatening complications. The purpose of the study was to develop a diagnostic prediction scale that would measure the degree of patient acuity in children with acute leukemia. Material and methods. 57 patients diagnosed with acute leukemia were observed. All the patients were receiving their treatment in Kharkiv Clinical Children's Hospital № 16 from 2016 to 2018. With the help of “Pediatric scale of hematologic patient acuity”, the level of patient acuity was assessed when the patient was admitted to intensive care unit and when the complications after chemotherapy were developing. The “Pediatric scale of hematologic patient acuity” was developed on the basis of the following scales: MOSF, PELOD, Score of Stone and Elebute, SAPS, PSI, APACHE II, PRISM III. In addition, the following indicators, that were not present in diagnostic scales mentioned above, were added to our scale: estimation of the level of stab leukocytes, presence/absence of renal failure, presence/absence of injuries of gastrointestinal tract or other organ systems. Results and discussion. The highest summary scores were observed in patients during chemotherapy-induced complications compared to the scores patients received at the onset of leukemia. For both groups, seven lethal outcomes were predicted. According to the scale that we developed, patients with lethal outcomes in both groups had significantly higher summary scores. According to the ROC analysis, when the level of acuity is higher than 9, the probability of the lethal outcome is highly significant (p<0.001); the area under the ROC curve is 0.78. The Pediatric scale of hematologic patient acuity shows the correlation between the level of patient acuity and summary scores. Moreover, it gives an opportunity to predict adverse outcome in children with acute leukemia at the onset of the disease as well as during chemotherapy-induced complications. The area under the ROC curve (0.78-0.79) and with the degree of patient acuity at the score of 9 and higher shows that there is probability of the adverse outcome of the treatment. Conclusion. Combination of existing diagnostic scales with the introduction of the proposed additions getting a score assessment of the severity of the child, taking into account the presence or absence of infectious processes, the state of hemopoiesis, which is important to be taken into account in children with acute leukemia. The proposed scale does not contain estimates of rare biochemical markers and can be used in hospitals that do not have a well-developed laboratory service. For further research it is good to improve diagnosis and treatment of purulent-septic and other complications in children with acute leukemia. It is planned to accumulate the experience of using the diagnostic scale on a larger number of patients. Studies will be conducted on the ratio of scores on a scale with other laboratory parameters (immunogram of blood and other) in children with acute leukemia.

Keywords: acute leukemia, children, score of acuteness, lethal outcome from leukemia

Full text: PDF (Ukr) 252K

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