Risk factors for early mortality (within 6 weeks of diagnosis) in Chinese children with acute leukemia: a single-center retrospective cohort study

We aimed to summarize the clinical characteristics of children diagnosed with acute leukemia (AL) and analyze the risk factors associated with early mortality occurring within 6 weeks of diagnosis. This study aimed to identify high-risk patients and to guide early intervention strategies. Data collected from 242 children diagnosed with primary AL between November 1, 2020, and April 30, 2025, were analyzed. The prognostic value of indicators in predicting early mortality was evaluated. Among the 242 children diagnosed with AL, nine died during the initial induction chemotherapy (early mortality rate: 3.72%); six deaths (66.7%) occurred within 7 days of treatment initiation. The predominant cause of early mortality was intracranial hemorrhage (5/9, 55.56%), followed by sepsis-related fatalities (3/9, 33.33%), and cerebral infarction (1/9, 11.11%). Children with acute myeloid leukemia (non-acute promyelocytic leukemia) had a significantly higher early mortality rate (13.16% vs. 1.60%, P = 0.002) and a significantly higher incidence of deaths attributed to intracranial hemorrhage or cerebral infarction (10.53% vs. 1.06%, P = 0.008) than those with acute lymphoblastic leukemia. Several risk factors for early mortality in children with AL were identified (all P < 0.01): white blood cells (WBC), fibrinogen, serum potassium, international normalized ratio (INR), serum phosphorus, prothrombin time (PT), blood urea nitrogen (BUN), activated partial thromboplastin time (aPTT), d-dimer, lactate dehydrogenase (LDH), and α-hydroxybutyrate dehydrogenase (α-HBDH). The primary causes of early mortality in children with AL include intracranial hemorrhage and sepsis. Identified risk factors for early death encompass higher tumor burden (WBC, LDH,α-HBDH), internal environment disturbances (serum potassium, serum phosphorus, BUN), and coagulopathy (fibrinogen, INR, PT, aPTT, d-dimer).