Intracranial haemorrhage a strong mortality risk factor for kids with acute leukaemia

Despite being uncommon, intracranial haemorrhages (ICH) are typically fatal among children with acute leukaemia, a recent study has found.

Reviewing a hospital database, researchers accessed the data of 494 children with acute leukaemia (median age at diagnosis, 4.9 years; 58.7 percent male). Of these, 12 developed ICH over a median follow-up of 2.1 years, resulting in an incidence density rate of 6.2 per 1,000 person-years.

Most of the children who developed ICH suffered from multiple bleeding sites, and eight ICH patients had severe cerebral oedema, leading to rapid brain herniation. The haemorrhage also tended to develop during the induction period of chemotherapy. Three patients had deep grey nuclei bleeding. ICH developed within a median of 18 days after leukaemia diagnosis.

ICH emerged as a significant mortality risk factor. Median survival time was 24 days in those who developed the condition, as opposed to 4.0 years in those who did not. The resulting likelihood of death was more than three times higher (hazard ratio, 3.17, 95 percent CI, 1.63–6.19; p<0.01).

Multiple logistic regression analysis found that age (adjusted odds ratio [OR], 1.19, 95 percent CI, 1.02–1.40; p=0.02), white blood cell counts (adjusted OR, 1.0049, 1.002–1.0077; p=0.001) and lactate dehydrogenase concentration (adjusted OR, 1.0077, 1.0021–1.0133; p=0.01) were all significant risk factors for the development of ICH.

“We found that the incidence of ICH in our patients was much higher than that in the general paediatric population,” said researchers. “The mortality rate … was high, and most patients … died within a short period.”