Background Sepsis is a common and serious complication in pediatric hematology oncology (PHO) patients. The Endothelial Activation and Stress Index (EASIX) score offers a potentially accessible tool for risk stratification in septic patients. Our objective was to evaluate the utility of the EASIX score in predicting adverse clinical outcomes among septic PHO patients. Methods Retrospective review of all PHO patients admitted to the intensive care unit (ICU) with sepsis from July 2022 till December 2024. Results 53 patients with 65 sepsis events were included in the analysis. The median age was 14.9 [IQR 9.9] y and the most common disease was hematologic malignancy (71%). In our cohort, 60% needed vasopressor support, 36% required IMV, and 22% underwent renal replacement therapy (RRT). Log2-EASIX >2.5 was associated with higher vasopressor requirements (87% versus 45% in the low log2-EASIX group, p=0.001), and increased need for RRT (39% versus 12%, p=0.024. PHO patients with log2-EASIX >2.5 were 6.9 more likely to require vasopressor support [(95% CI 1.7-27.8) p=0.007]. In addition, PHO patients with log2-EASIX >2.5 had longer ICU stay (7 d versus 2 d in the low log2-EASIX group, p=0.024), and extended overall hospitalization (33 d versus 25 d, p=0.029). Conclusion Higher EASIX score was associated with adverse outcomes in critically ill septic PHO patients. Our findings suggest that EASIX score can be used as a tool for identifying septic patients at increased risk of clinical deterioration and poor outcomes. Prospective studies in larger cohorts are warranted to validate and expand upon these findings.

Background: Sinusoidal obstruction syndrome (SOS), a serious complication after hematopoietic cell transplant (HCT), is associated with multi-organ dysfunction (MOD) and a high mortality rate. In severe cases, continuous kidney replacement therapy (CKRT) is initiated to manage fluid overload (FO) and acute kidney injury. Studies that evaluate the use of CKRT in this population are lacking. The aim of our study was to assess the outcome of critically ill children with severe SOS post HCT who received CKRT. We also sought to assess factors associated with survival and liberation post CKRT. Procedure: Retrospective review of all children admitted to the intensive care unit (ICU) with SOS post HCT who received CKRT from January 2010 to August 2022. Results: Among the 53 children who received CKRT post HCT, 13 had severe SOS. The median age was 6 years; 62% were males, and most (77%) received allogeneic HCT. In this cohort, 92% required respiratory support and 85% required vasopressor support. The ICU survival rate was 62%. Survivors experienced lower cumulative FO on the 2 days following CKRT initiation (-4.2% in survivors versus -0.5% in non-survivors, p=0.07). Higher urine output on D1 and D2 after discontinuation of CKRT was associated with successful liberation. Conclusions: In this study of post-HCT children with SOS and MOD who received CKRT, 62% survived until ICU discharge. This survival rate is encouraging as it approximates the survival rates of general pediatric cohorts treated with CKRT. Reducing FO after initiation of CKRT can improve survival in these children.