The Application of Scoring Systems in Pediatric Intensive Care Unit for Onco-Hematological Patients Who Have Not Undergone Stem Cell Transplantation: A Cross-Sectional Study

Abstract Pediatric onco-hematological patients require intensive care due to the complexity of their conditions, aggressive disease progression, and the immunosuppressive effects of treatments like chemotherapy and immunotherapy, increasing their risk of life-threatening complications. This study aimed to assess and compare the performance of PRISM III (Paediatric Risk of Mortality 3), PRISM IV (Paediatric Risk of Mortality 4), PIM3 (Pediatric Index of Mortality 3), TISS (Therapeutic Intervention Scoring System), and pSOFA (Pediatric Sequential Organ Failure Assessment) in onco-hematological patients after admission to the pediatric intensive care unit (PICU) without a history of hematopoietic stem cell transplantation and to evaluate risk factors of mortality. We included 150 onco-hematological patients without prior stem cell transplantation admitted to PICU. Sociodemographic data, diagnosis, treatment, and causes of PICU admission were recorded. The average age was 7.2 ± 4.5 years, and 55.3% were male. Overall, 43.3% of patients survived. Nonsurvivors showed significantly higher PIM3, PRISM III, PRISM IV, pSOFA, and TISS ≥ 4 scores (p < 0.001). The pSOFA score demonstrated the highest sensitivity (87.1%), specificity (86.2%), and diagnostic accuracy (area under the curve [AUC]: 0.946) for mortality prediction, followed by PIM3 (AUC: 0.862). Mortality was 56.7%, with pSOFA and PIM3 emerging as the most accurate predictors of outcomes.