Sepsis Can Affect Long Term Neurocognitive Dysfunction in Children With ALL
Prevention of infection, early recognition and management of sepsis, and preemptive neurocognitive interventions should be prioritized because these may prevent neurologic damage in children with ALL.
Sepsis associated with treatment for acute lymphoblastic leukemia (ALL) in pediatric patients can affect long-term neurocognitive function, according to results of a study published in JAMA Pediatrics.
Long-term survival in childhood ALL now exceeds 90%, but survivors are at risk for late effects including treatment-related neurocognitive dysfunction that can persist into adulthood. In this study, the researchers hypothesized that bacteremic sepsis occurring during treatment may contribute to long-term neurocognitive dysfunction. They conducted a prospective cohort study composed of 212 ALL survivors who had received risk-adapted chemotherapy from 2000 to 2010. None of the participants had undergone hematopoietic cell transplant or cranial irradiation, and all underwent neurocognitive testing at a median 7.7 years after their cancer diagnosis.
During their cancer treatment, 16 patients (7.5%) developed bacteremic sepsis, and 45 (21.2%) had bacteremia without sepsis. After adjusting for confounders that included age, sex, race, and leukemia risk category, those with a sepsis history performed worse
For patient who had a history of sepsis, analysis demonstrated worse performance in multiple neurocognitive domains, including executive function (spatial planning [difference.78; 95% CI,.57-1.00], visuospatial working memory [difference,.52; 95% CI,.26-.78], verbal fluency [difference,.38; 95% CI,.14-.62]), attention (response time variability [difference,.63; 95% CI,.30-.95] and vigilance [difference,.54; 95% CI,.24-.85]), compared to patients who had not become septic.
"Prevention of infection, early recognition and appropriate management of sepsis, and preemptive neurocognitive interventions should be prioritized, because these might prevent or ameliorate neurologic damage," the researchers concluded.
Cheung YT, Eskind A, Inaba H, Hudson MM, Pui CH, Krull KR, Wolf J. Association of bacteremic sepsis with long-term neurocognitive dysfunction in pediatric patients with acute lymphoblastic leukemia [published online September 24, 2018]. JAMA Pediatr. doi: 10.1001/jamapediatrics.2018.2500